Giant Cell Tumor of Tendon Sheath

Giant Cell Tumor of Tendon Sheath

David R. Lucas, MD

Giant cell tumor of tendon sheath presents as a painless, slow-growing mass that arises from a tendon sheath, most often on the volar aspect of a finger image. Secondary skin involvement is rare.

GCTTS has a mixture of mononuclear stromal cells, multinucleated giant cells image, and macrophages, including xanthoma cells image. Stromal fibrosis image and hemosiderin deposits image are very common.



  • Giant cell tumor of tendon sheath (GCTTS)


  • Localized tenosynovial giant cell tumor, localized pigmented villonodular synovitis (PVNS), nodular tenosynovitis


  • Benign soft tissue tumor of synovial origin

    • Polymorphous population of neoplastic stromal cells, macrophages, and osteoclast-like giant cells

    • Well circumscribed, noninvasive



  • Neoplastic growth

    • Balanced translocation involving 1p13 (CSF1 gene) in many tumors

      • CSF1 overexpression by neoplastic stromal cells

      • Recruitment and activation of intratumoral macrophages by CSF1R activation



  • Incidence

    • 2nd most common tumor of hand

  • Age

    • Any age; peak 3rd-4th decade

  • Gender

    • Women outnumber men 2:1


  • Digits (85%)

    • Especially fingers (75%)

    • Tendon sheath (usually volar) or interphalangeal joint

  • Large joints (10%)

    • Ankle, knee, wrist, elbow

    • Bursa

    • Intraarticular tumors called localized PVNS

  • Skin secondarily involved in < 5% of cases


  • Painless mass

  • Slow growing

  • Uncommon findings: Triggering, carpal and ulnar tunnel syndromes


  • Surgical approaches

    • Complete local excision


  • Benign, but recurs locally (around 20%)

  • Risk factors for recurrence: Degenerative joint disease, distal phalanx, interphalangeal joint of thumb, osseous erosion

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Giant Cell Tumor of Tendon Sheath

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