ਟੈਂਡਨ ਸ਼ੀਥ ਦਾ ਜਾਇੰਟ ਸੈੱਲ ਟਿਊਮਰ (ਉਂਗਲੀ ਜਾਂ ਅੰਗੂਠੇ 'ਤੇ ਗੁੱਠੀ)

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

• Giant cell tumors of the tendon sheaths in the hand are benign lesions [2, 3].
• Recurrence is the primary risk associated with giant cell tumors of the tendon sheaths in the hand [2, 3].
• Recurrence of giant cell tumors of the tendon sheaths in the hand typically occurs within 36 months of excision [2].
• Complete surgical resection remains the treatment of choice for most patients with tenosynovial giant cell tumors [6].
• Diffuse disease in tenosynovial giant cell tumors presents challenges due to high recurrence rates [6].
• In cases of infiltrative giant cell tumor of the tendon sheath, radiation therapy may provide local tumor control with preservation of hand function [1].
• Total surgical excision ensuring removal of the attachment site (flexor sheath/palmar fascia) resulted in no local recurrences at a mean follow-up of 3.2 years for fibroma of the tendon sheath [7].
• Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence of giant cell tumor of the tendon sheath in the hand [8].

Anatomy & Pathophysiology¶

• Radiation therapy may provide local tumor control with preservation of hand function in cases of infiltrative Giant Cell Tumor of the Tendon Sheath (GCTTS) [1].
• Surgical treatment for Pigmented Villonodular Synovitis (PVNS) led to good functional results with an average Enneking score of 92% of normal limb function [10].
• Patients with diffuse Pigmented Villonodular Synovitis reported good functional outcomes without evidence of recurrence in a 19-patient cohort with an average follow-up of almost 7 years [22].
• Satisfactory functional results in diffuse Pigmented Villonodular Synovitis mirror the status of the underlying joint [42].

Classification¶

• Giant cell tumors of the synovial sheaths in the hand are benign lesions [3].
• Tenosynovial giant cell tumors include pigmented villonovular synovitis [6].
• Fibroma of the tendon sheath is a distinct entity from giant cell tumor of the tendon sheath [7].
• Epiphyseal chondromatous giant cell tumors represent a distinct clinical entity of essentially benign giant cell tumors [9].
• Giant cell tumors of bone in the hand are a rare condition [4].
• Giant cell tumors of the distal radius are classified into Grades 1, 2, and 3 [14].
• Tumors with extension limited to a single site of palmar cortical perforation are classified as grade 3(p) [35].
• Campanacci grade III giant cell tumours of the distal radius are a specific classification subset [40].
• Direct involvement of the extensor tendons, flexor tendons, or joint capsule places patients in a high-risk category with respect to recurrence [25].
• Grade III lesions, particularly with extensive soft tissue involvement, represent a subset of patients at higher risk of recurrence [18, 12].

Clinical Presentation¶

• Giant cell tumors of the tendon sheaths in the hand are benign synovial neoplasms [21].
• Giant cell tumors of the tendon sheaths in the hand have the potential for local recurrence [21].
• Recurrence is the primary risk for giant cell tumors of the tendon sheaths in the hand [2, 3].
• Direct involvement of the extensor tendons, flexor tendons, or joint capsule puts patients in a high-risk category with respect to recurrence [25].

Investigations¶

• Radiation therapy may provide local tumor control with preservation of hand function in cases of infiltrative giant cell tumor of the tendon sheath [1].
• Giant cell tumors of the tendon sheaths in the hand are benign lesions where recurrence is the primary risk, typically occurring within 36 months of excision [2].
• Giant cell tumors of the synovial sheaths in the hand are benign lesions in which recurrence is the primary risk [3].
• Complete surgical resection remains the treatment of choice for most patients with tenosynovial giant cell tumors, though diffuse disease presents challenges due to high recurrence rates [6].
• Total surgical excision ensuring removal of the attachment site (flexor sheath/palmar fascia) resulted in no local recurrences at a mean follow-up of 3.2 years for fibroma of tendon sheath of the hand [7].
• Pigmented villonoid synovitis and giant-cell tumor of tendon sheath are benign synovial neoplasms with the potential for local recurrence [21].
• Although MRI findings and location might help in the diagnosis of a tenosynovial giant cell tumor, careful assessment is mandatory, especially in unusual locations [33].
• Pigmented villonodular synovitis of the shoulder is extremely rare, with clinical and radiological findings generally being nonspecific and often mimicking a malignancy [38].

Treatment¶

• Both curettage and resection/amputation are acceptable treatment options for giant cell tumour of bone in the hand, with treatment decisions needing to be individualized based on the site and extent of disease to minimize morbidity while maximizing disease control [4].
• Intralesional excision remains a viable, and likely the standard, mode of treatment for most giant cell tumors of the distal radius unless there is extensive bone loss [5].
• Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence in giant cell tumor of tendon sheath in the hand [8].
• Conservative treatments yielded good results without amputation for epiphyseal chondromatous giant cell tumors of the upper end of the humerus [9].
• Centralization of the ulna is a simple and effective modality of reconstruction following resection of Campanacci Grade 3 giant cell tumor of the distal radius [11].
• En bloc resection and matched nonvascularized toe phalangeal transfer for Campanacci Grade 2 or 3 giant cell tumor of the phalanges resulted in a functional tumor-free digit with a low complication rate and no recurrences [13].
• Intralesional excision appears to be more appropriate for the treatment of local lesions (Grades 1 and 2) than Grade 3 giant cell tumors of the distal radius [14].
• The use of a massive biocompatible bipolar unconstrained prosthesis is a viable treatment option for distal radius reconstruction after en-bloc resection of a giant cell tumour, offering rapid functional improvement without donor-site morbidity [17].
• Selective use of curettage and cementing is recommended in Grade III giant cell tumor lesions, particularly with extensive soft tissue involvement [18].
• Intralesional excision with cautery and methylmethacrylate provides a reliable method of treatment of giant cell tumors with good long-term functional results [19].
• Intralesional excision with local adjuvant therapy is recommended for the treatment of giant cell tumor of bone because it results in a good functional outcome compared to extralesional excision [27].
• Repeated curettage with adjuvants eventually resulted in the cure for all patients and is therefore a reasonable treatment for both primary and recurrent giant cell tumor of the small bones of the hands and feet [28].
• Reconstruction after wide excision by nonvascularized fibular graft is a viable alternative for giant cell tumors of the lower end of radius, though it is a challenging procedure that may be accompanied by major complications [29].
• Non-surgical treatment has a similar risk of complications to intralesional nerve-sparing surgery and has better functional outcomes than intralesional nerve-sparing surgery for giant cell tumor of the sacrum, but patients must remain on therapy over time [32].

Complications¶

• Well-designed studies combining recurrence rates from several hand surgery centers are needed to better demonstrate associated risk factors for recurrence [8].
• Subsets of patients with giant cell tumor of bone are at higher risk of recurrence and should be clinically followed more closely [12].
• Metachronous multicentric giant cell tumor can present with long disease-free intervals, such as 24 years between initial presentation and multicentric recurrence [15].

Recovery¶

• Recurrence is the primary risk for giant cell tumors of the tendon sheaths in the hand, typically occurring within 36 months of excision [2].
• Recurrence is the primary risk for giant cell tumors of the synovial sheaths in the hand [3].
• Surgical treatment of pigmented villonous synovitis led to good functional results with an average Enneking score of 92% of normal limb function [10].
• A patient with metachronous multicentric giant cell tumor had a disease-free interval of 24 years between the initial presentation and the multicentric recurrence [15].
• The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome [20].
• Patients with pigmented villonous synovitis of the hip managed with arthroscopic synovectomy reported good functional outcomes without evidence of recurrence in a cohort with an average follow-up of almost 7 years [22].
• Tumor resection with negative margins is supported for giant cell tumors in the radius [26].

Key Evidence¶

• [L4] In cases of infiltrative GCTTS, radiation therapy may provide local tumor control with preservation of hand function. [1] (10.1016/j.jhsa.2012.01.011)
• [L4] Giant cell tumors of the tendon sheaths in the hand are benign lesions where recurrence is the primary risk, typically occurring within 36 months of excision. [2] (10.1016/j.otsr.2013.03.008)
• [L4] Giant cell tumors of the synovial sheaths in the hand are benign lesions in which recurrence is the primary risk. [3] (10.1016/j.jhsa.2013.08.051)
• [L4] Both curettage and resection/amputation are acceptable treatment options for the rare condition of giant cell tumour of bone in the hand, with a need to individualize treatment decisions based on the site and extent of disease to minimize treatment morbidity while maximizing disease control. [4] (10.1177/17531934211007820)
• [L3] Intralesional excision remains a viable, and likely the standard, mode of treatment for most giant cell tumors of the distal radius unless there is extensive bone loss. [5] (10.1007/s11999-014-4054-3)
• [L5] Complete surgical resection remains the treatment of choice for most patients with tenosynovial giant cell tumors, though diffuse disease presents challenges due to high recurrence rates. [6] (10.5435/jaaos-d-24-01255)
• [L4] Total surgical excision ensuring removal of the attachment site (flexor sheath/palmar fascia) resulted in no local recurrences at a mean follow-up of 3.2 years. [7] (10.1177/1753193412469146)
• [L3] Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence. [8] (10.1186/s12891-019-2866-8)
• [L4] The author concludes that these tumors represent a distinct clinical entity of essentially benign giant cell tumors that should be recognized in the literature, noting that conservative treatments yielded good results without amputation. [9] (10.1097/01.blo.0000229309.90265.df)
• [L4] Surgical treatment led to good functional results with an average Enneking score of 92% of normal limb function. [10] (10.1097/01.blo.0000224051.01873.fb)
• [L4] This is a simple and effective modality of reconstruction after resection of distal radial tumors. [11] (10.1016/j.jhsa.2022.05.011)
• [L4] Our observations suggest there are subsets of patients with giant cell tumor of bone who are at higher risk of recurrence and should be clinically followed more closely. [12] (10.1007/s11999-011-2172-8)
• [L4] En bloc resection and matched nonvascularized toe phalangeal transfer resulted in a functional tumor-free digit with a low complication rate and no recurrences. [13] (10.1016/j.jhsa.2024.06.013)
• [L3] Based on data obtained from the number of studies available, intralesional excision appears to be more appropriate for the treatment of local lesions (eg, Grades 1 and 2) than Grade 3 GCTs of the distal radius. [14] (10.1007/s11999-012-2464-7)
• [L4] This patient has the longest disease-free interval of a metachronous multicentric giant cell tumor reported to date, with 24 years passing between the initial presentation and the multicentric recurrence. [15] (10.1097/01.blo.0000068770.86536.e1)
• [Case_report] The use of a massive biocompatible bipolar unconstrained prosthesis is a viable treatment option for distal radius reconstruction after en-bloc resection of a giant cell tumour, offering rapid functional improvement without donor-site morbidity. [17] (10.1016/j.otsr.2013.04.001)
• [L4] We recommend selective use of this procedure in Grade III lesions, particularly with extensive soft tissue involvement. [18] (10.4103/0019-5413.77138)
• [L4] Intralesional excision with cautery and methylmethacrylate provides a reliable method of treatment of giant cell tumors with good long-term functional results. [19] (10.1097/01.blo.0000128280.59965.e3)
• [L3] The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome. [20] (10.1177/1558944717743598)
• [L4] Pigmented villonoid synovitis and giant-cell tumor of tendon sheath are benign synovial neoplasms with the potential for local recurrence. [21] (10.2106/00004623-198466010-00012)
• [L4] Patients reported good functional outcomes without evidence of recurrence in a 19 patient cohort with an average follow-up of almost 7 years. [22] (10.1177/2325967119s00413)
• [L3] Direct involvement of the extensor tendons, flexor tendons, or joint capsule puts patients in a high-risk category with respect to recurrence. [25] (10.1016/j.jhsa.2009.12.004)
• [L4] Findings support tumor resection with negative margins in the radius. [26] (10.1016/j.jhsa.2017.06.079)
• [L3] Intralesional excision with local adjuvant therapy is recommended for the treatment of giant cell tumor of bone because it results in a good functional outcome compared to extralesional excision. [27] (10.1007/s004020100317)
• [L3] Repeated curettage with adjuvants eventually resulted in the cure for all patients and is therefore a reasonable treatment for both primary and recurrent GCT of the small bones of the hands and feet. [28] (10.1302/0301-620x.95b6.30876)
• [L4] Reconstruction after wide excision by nonvascularized fibular graft is a viable alternative for giant cell tumors of the lower end of radius though it is a challenging procedure and may be accompanied by major complications. [29] (10.1007/s00402-010-1059-6)
• [L3] Non-surgical treatment has a similar risk of complications to intralesional nerve-sparing surgery and has better functional outcomes than intralesional nerve-sparing surgery, but patients must remain on therapy over time. [32] (10.1186/s12891-021-04907-0)
• [L4] Although MRI findings and location might help in the diagnosis of a T-GCT, careful assessment is mandatory, especially in unusual locations. [33] (10.1186/s12891-016-1050-7)
• [L4] Tumors with extension limited to a single site of palmar cortical perforation are classified as grade 3(p) and can be treated with intralesional treatment alone. [35] (10.1016/j.jhsa.2010.07.010)
• [Case_report] PVNS of the shoulder is extremely rare, with clinical and radiological findings generally being nonspecific and often mimicking a malignancy. [38] (10.1007/s001670050158)
• [L4] En bloc resection of Campanacci grade III giant cell tumours of the distal radius may reduce the local recurrence rate, and a prosthesis reconstruction is still an alternative option. [40] (10.1186/s12891-025-08851-1)
• [L4] The satisfactory functional results mirror the status of the underlying joint. [42] (10.1097/01.blo.0000229345.57092.a2)

References¶

[1] Radiation Therapy for Infiltrative Giant Cell Tumor of the Tendon Sheath. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.01.011

[2] Giant cell tumors of the tendon sheaths in the hand: Review of 96 patients with an average follow-up of 12 years. Orthopaedics & Traumatology: Surgery & Research. 2013. DOI: 10.1016/j.otsr.2013.03.008

[3] Giant Cell Tumors of the Tendon Sheaths in the Hand: Review of 96 Patients With an Average Follow-Up of 12 Years. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.051

[4] Giant cell tumour of hand bones: outcomes of treatment. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211007820

[5] Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?. Clinical Orthopaedics & Related Research. 2015. DOI: 10.1007/s11999-014-4054-3

[6] Tenosynovial Giant Cell Tumor and Pigmented Villonodular Synovitis. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01255

[7] Fibroma of tendon sheath of the hand: a series of 20 patients with 23 tumours. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412469146

[8] Giant cell tumor of tendon sheath in the hand: analysis of risk factors for recurrence in 50 cases. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2866-8

[9] THE CLASSIC: Epiphyseal Chondromatous Giant Cell Tumors of the Upper End of the Humerus. Clinical Orthopaedics and Related Research. 2006. DOI: 10.1097/01.blo.0000229309.90265.df

[10] What Affects the Recurrence and Clinical Outcome of Pigmented Villonodular Synovitis?. Clinical Orthopaedics and Related Research. 2006. DOI: 10.1097/01.blo.0000224051.01873.fb

[11] Functional Outcomes of Centralization of the Ulna as a Method of Reconstruction Following Resection of Campanacci Grade 3 Giant Cell Tumor of the Distal Radius. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.05.011

[12] Giant Cell Tumor of Bone: Are We Stratifying Results Appropriately?. Clinical Orthopaedics & Related Research. 2012. DOI: 10.1007/s11999-011-2172-8

[13] Campanacci Grade 2 or 3 Giant Cell Tumor of the Phalanges: En Bloc Resection and Matched Nonvascularized Toe Phalangeal Transfer. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.06.013

[14] Which Treatment is the Best for Giant Cell Tumors of the Distal Radius? A Meta-analysis. Clinical Orthopaedics & Related Research. 2012. DOI: 10.1007/s11999-012-2464-7

[15] Metachronous Multicentric Giant Cell Tumor: A Case Report and Literature Review. Clinical Orthopaedics & Related Research. 2003. DOI: 10.1097/01.blo.0000068770.86536.e1

[17] Massive wrist prosthesis for giant cell tumour of the distal radius: A case report with a 3-year follow-up. Orthopaedics & Traumatology: Surgery & Research. 2013. DOI: 10.1016/j.otsr.2013.04.001

[18] Local recurrences after curettage and cementing in long bone giant cell tumor. Indian Journal of Orthopaedics. 2011. DOI: 10.4103/0019-5413.77138

[19] Results of Giant Cell Tumor of Bone Treated With Intralesional Excision. Clinical Orthopaedics & Related Research. 2004. DOI: 10.1097/01.blo.0000128280.59965.e3

[20] Extensor Carpi Ulnaris Tenodesis Versus No Stabilization After Wide Resection of Distal Ulna Giant Cell Tumors. HAND. 2017. DOI: 10.1177/1558944717743598

[21] Pigmented villonodular synovitis (giant-cell tumor of the tendon sheath and synovial membrane). A review of eighty-one cases.. The Journal of Bone & Joint Surgery. 1984. DOI: 10.2106/00004623-198466010-00012

[22] Pigmented Villonodular Synovitis of the Hip Managed with Arthroscopic Synovectomy: An Analysis of 19 Cases with up to 10-year Follow-up. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00413

[25] Recurrence of Giant Cell Tumors in the Hand: A Prospective Study. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.12.004

[26] Factors Associated with Recurrent Giant Cell Tumors of the Upper Extremity. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.079

[27] Oncologic and functional results after treatment of giant cell tumors of bone. Archives of Orthopaedic and Trauma Surgery. 2001. DOI: 10.1007/s004020100317

[28] Giant cell tumours of the small bones of the hands and feet. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b6.30876

[29] Autogenous non-vascularized fibula for treatment of giant cell tumor of distal end radius. Archives of Orthopaedic and Trauma Surgery. 2010. DOI: 10.1007/s00402-010-1059-6

[32] Intralesional nerve-sparing surgery versus non-surgical treatment for giant cell tumor of the sacrum. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04907-0

[33] Tenosynovial giant cell tumors in unusual locations detected by positron emission tomography imaging confused with malignant tumors: report of two cases. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1050-7

[35] Features of Grade 3 Giant Cell Tumors of the Distal Radius Associated With Successful Intralesional Treatment. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.07.010

[38] Pigmented villonodular synovitis of the shoulder: review and case report. Knee Surgery, Sports Traumatology, Arthroscopy. 1999. DOI: 10.1007/s001670050158

[40] En bloc excision and customized prosthesis replacement for Campanacci III giant cell tumours of the distal radius: five cases report and a review of the literature. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08851-1

[42] Diffuse Pigmented Villonodular Synovitis. Clinical Orthopaedics and Related Research. 2007. DOI: 10.1097/01.blo.0000229345.57092.a2