Tenosynovial Giant Cell Tumor, Localized Type

Warning: This page is under construction and has not undergone final review.

Definition

• Benign circumscribed tumor containing variable numbers of multinucleolated giant cells

Alternate/Historical Names

• Giant cell tumor of tendon sheath
• Nodular tenosynovitis

Diagnostic Criteria

• Circumscribed
  • Usually under 4 cm
  • May erode bone
  • Rare in skin
• Mixed cell population
  • Uniform round to oblong mononuclear cells
    • Cytologically bland
    • Mitotic figures rare to frequent
      • High mitotic rate may predict recurrence
  • Multinucleated giant cells
    • Same nuclear features as mononuclear cells
    • Variable numbers, absent in rare cases
  • Xanthoma cells and hemosiderin laden macrophages
• Nearly all in hands and feet
• Metaplastic bone and cartilage may be seen
• Vascular invasion infrequent but of no significance

Robert B West MD PhD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: pending

Supplemental studies

Immunohistology

• Mononuclear and giant cells CD68 and LCA positive in most cases
• Desmin stains dendritic cells in half of cases

Genetic analysis

Differential Diagnosis

• Diffuse type tenosynovial giant cell tumor
• Fibroma of tendon sheath
• Foreign body granuloma
• xxxxoma
• xxx tumor

Fibroma of Tendon Sheath	Localized Type Tenosynovial Giant Cell Tumor
Paucicellular	Cellular
Giant cells rare	Giant cells in nearly all cases

Rare cellular fibromas of tendon sheath may be indistinguishable from giant cell poor tenosynovial giant cell tumors, but have the same behavior

Foreign Body Granuloma	Localized Tenosynovial Giant Cell Tumor
Associated acute and chronic inflammation	No associated inflammation

Clinical

• Common tumor
• Nearly all on hands and feet
  • 85% on fingers
  • Occasionally on knee
  • Very rare near hip
• 30% recur
  • No metastases

Grading / Staging / Report

• Grading and staging not applicable
• Mangerial category
  • Ib (Recurrences do occur but are not destructive; never metastasizes)

Lists

soft tissue tumors with prominent giant cells

should read ../../ above

Bibliography

• Kempson RL, Fletcher CDM, Evans HL, Henrickson MR, Sibley RS. Tumors of the Soft Tissues, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 30, 2001
• Fletcher CDM, Unni KK, Mertens F. Pathology and Genetics of Tumours of Soft Tissue and Bone, World Health Organization Classification of Tumours 2002
• Weiss SW, Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors, 4th edition, 2001