Giant cell tumour of tendon sheath

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Giant cell tumour of tendon sheath
Diagnosis in short

GCT of tendon sheath. H&E stain.

LM foam cells, multinucleated giant cells (may be scarce), +/-tendon, +/-hemosiderin-laden macrophages
LM DDx giant cell lesions
Gross circumscribed mass - yellow-brown to tan
Site hand - classic site

Prognosis good (benign), can be malignant (rare)

Giant cell tumour of tendon sheath is a relatively common tumour of small joints. It is grouped with the chondro-osseous tumours. It is abbreviated GCT of tendon sheath.

Fibroma of tendon sheath (abbreviated FTS) redirect to this article.

General

Gross

Features:[2]

  • Circumscribed mass - yellow-brown to tan.

Note:

  • May be associated with bony erosions in larger lesions.[2]

Image:

Microscopic

Features:[1]

  • Foam cells.
    • Cells with moderate to abundant foamy-appearing cytoplasm.
  • Multinucleated giant cells - may be scarce.
  • +/-Tendon.
    • Dense connective tissue.
  • +/-Hemosiderin-laden macrophages.

Note:

  • Features of malignancy: nuclear pleomorphism,[4] abnormal mitoses, >10 mitoses/HPF, tumour necrosis lack of maturation to superficial part (nuclei shrink, cytoplasm lipid-ified).[1]

DDx:

  • Giant cell lesions.
  • Plexiform fibrohistiocytoma.[citation needed]
  • Fibroma of tendon sheath (FTS) - if one believes it is a separate entity.[6]
    • IHC suggests FTS and GCT of tendon sheath are one entity.[7]

Images

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Submitted as "Giant Cell Tumour Right Long Finger", Excision:
- Giant cell tumour of tendon sheath.

Block letters

LESION, RIGHT INDEX FINGER, EXCISION:
- GIANT CELL TUMOUR OF THE TENDON SHEATH.

Micro

The sections show histiocytes and rare multinucleated giant cells on a background of dense connective tissue compatible with tendon. No nuclear atypia is apparent. Rare mitotic activity is identified. No atypical mitoses are apparent.

Alternate

The sections show histiocyte-like cells and rare multinucleated giant cells on a background of dense connective tissue compatible with tendon. Hemosiderin-laden macrophages are present. No nuclear atypia is apparent. No mitotic activity is apparent.

See also

References

  1. 1.0 1.1 1.2 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 341-2. ISBN 978-0470519035.
  2. 2.0 2.1 2.2 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 612. ISBN 978-0781765275.
  3. Pan, YW.; Huang, XY.; You, JF.; Tian, GL.; Li, C. (Nov 2008). "[Malignant giant cell tumor of the tendon sheaths in the hand].". Zhonghua Wai Ke Za Zhi 46 (21): 1645-8. PMID 19094761.
  4. 4.0 4.1 Shinjo, K.; Miyake, N.; Takahashi, Y. (Oct 1993). "Malignant giant cell tumor of the tendon sheath: an autopsy report and review of the literature.". Jpn J Clin Oncol 23 (5): 317-24. PMID 8230758.
  5. Suresh, SS.; Zaki, H. (Dec 2010). "Giant cell tumor of tendon sheath: case series and review of literature.". J Hand Microsurg 2 (2): 67-71. doi:10.1007/s12593-010-0020-9. PMID 22282671.
  6. Heckert, R.; Bear, J.; Summers, T.; Frew, M.; Gwinn, D.; McKay, P. (Dec 2012). "Fibroma of the tendon sheath - a rare hand tumor.". Pol Przegl Chir 84 (12): 651-6. doi:10.2478/v10035-012-0107-z. PMID 23399633.
  7. Maluf, HM.; DeYoung, BR.; Swanson, PE.; Wick, MR. (Feb 1995). "Fibroma and giant cell tumor of tendon sheath: a comparative histological and immunohistological study.". Mod Pathol 8 (2): 155-9. PMID 7777476.