Nerve-adherent giant cell tumors of tendon sheath: A new presentation

• Published in: World neurosurgery Vol. 92; pp. 583.e19 - 583.e24
• Main Authors: Elsherif, Mohamed A., MBBCh, Wenger, Doris E., MD, Vaubel, Rachael A., MD, PhD, Spinner, Robert J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Adherent; Adult; Antigens, CD - metabolism; Antigens, Differentiation, Myelomonocytic - metabolism; Extrasynovial; Female; Gadolinium - pharmacokinetics; Giant cell tumor of tendon sheath; Giant Cell Tumor of Tendon Sheath - diagnostic imaging; Giant Cell Tumor of Tendon Sheath - surgery; Humans; Implantation; Magnetic Resonance Imaging; Male; Nerve compression; Neurosurgery; Neurosurgical Procedures; Peripheral nerves; Positron-Emission Tomography; Tenosynovial giant cell tumors; Adherent; Tenosynovial giant cell tumors; Peripheral nerves; Giant cell tumor of tendon sheath; Implantation; Extrasynovial; Nerve compression; MRI; PET; GCTTS; TSGCT
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.05.062

Abstract Background Tenosynovial giant cell tumors (TSGCT) are a group of slowly growing benign neoplasms of synovial membrane of joints, tendons and bursae. The localized type or giant cell tumor of tendon sheath (GCTTS) is the extra-articular form of tenosynovial giant cell tumors. We describe two patients with GCTTS confirmed histologically at the time of surgical resection which were adherent to peripheral nerves. Rare GCTTS can cause extrinsic compression of major nerves. Case descriptions Case one: A 36-year-old man presented with a left wrist mass associated with pain and paresthesia in the radial three digits. On Ultrasound and MRI, the mass appeared arising from the left median nerve with a picture suggestive of an atypical neurogenic tumor, however the possibility of GCTTS could not be excluded. Intraoperatively, the tumor was adherent to the median nerve without connections to nearby intercarpal joints. Case two A 25-year-old woman with a history of malignant melanoma presented with an incidentally discovered mass on routine follow up. Magnetic resonance imaging (MRI) of the pelvis showed an ovoid mass related to the right sciatic nerve. The MRI picture was suggestive of a GCTTS, though a benign neurogenic tumor was favored given the anatomic relation to the sciatic nerve. Intraoperatively, the tumor appeared as a nodule implanted on the nerve and was easily peeled off it. Conclusion We present a new, rare presentation of GCTTS adherent to peripheral nerves with extrinsic compression. We suggest either an implantation mechanism or an unrecognized extra-synovial origin for such tumors.