Giant cell tumour of tendon sheath with bone invasion in extremities: analysis of clinical and imaging findings

The purpose of this study was to review the clinical and imaging characteristics of giant cell tumour of tendon sheath (GCTTS) with bone invasion.

Radiography (n = 9), magnetic resonance imaging (MRI) (n = 7), computed tomography (CT) (n = 4) and clinical findings of nine patients with surgically and pathologically confirmed GCTTS with bone invasion were retrospectively reviewed. Specific imaging findings including tumour site, maximum tumour size, shape, margin, density or signal intensity, bone invasion, periosteal reaction, calcification, and cystic areas were documented.

There were five males and four females, with median age of 34 years. Presenting symptoms were painless mass in five patients, painful mass in two, intermittent pain and swelling in one and pain without mass in one. Five tumours were in the ankle–foot region, two in the hand, one in the cubital fossa and one in the patellofemoral joint. The total symptom duration ranged from 5 months to 6 years (median 12 months). The maximum tumour size ranged from 1.0 to 6.8 cm (median 3.0 cm). Radiographically, all tumours appeared as cortical destruction with well-defined margins. Four patients underwent CT scanning that clearly showed an iso-attenuated mass with intraosseous soft tissue. MR scanning was performed in seven patients who demonstrated a round, oval, spindle-shaped or multilobular soft tissue mass near or inside the joint with cortical destruction and intraosseous soft tissue. Five lesions were homogeneous moderate signal on T1WI. Moderate (n = 1), slightly high or high (n = 2) and low (n = 2) signal intensities were evident on T2WI. Two lesions showed heterogeneous low-to-moderate signal intensities on T1WI and mixed low signal intensities on T2WI.

GCTTS is a benign soft tissue mass that may present as an intraosseous lesion near extremity joints and frequently occurring in foot and hand on radiological examinations. GCTTS with bone invasion should be considered when MRI shows solid mass with characteristic low signal on T2-weighted images.