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Click a tab below to learn about diagnosing diffuse or localized TGCT.

DIFFUSE TGCT
(PVNS)
LOCALIZED TGCT
(GCT-TS)
Differential diagnoses

Diffuse TGCT tumors, like other soft tissue tumors, can be misdiagnosed.4 Therefore, physicians should be aware of differential diagnoses of diffuse TGCT that can include:

  • Meniscal tear or sports injuries5,6
  • Synovial proliferative disorders such as rheumatoid arthritis and
    synovial chondromatosis5,7,8
  • Fibroma9
  • Xanthoma9
  • Soft tissue sarcoma10

Diagnosis of TGCT can be confirmed by magnetic resonance imaging (MRI), determined preoperatively by biopsy,
or discovered during surgery.2,11

Diffused TGCT MRI

Diagnosis of TGCT can be confirmed by magnetic resonance imaging (MRI), determined preoperatively by biopsy,
or discovered during surgery.2,11

MRI of diffuse TGCT of a knee showing the negative signal of tumor (dark; marked with ✩), which is associated with iron deposition.

Adapted and reproduced with permission from
Palmerini E et al.12

How you can help patients receive proper care

As a healthcare professional, by understanding the disease course of TGCT, you can help patients receive proper care in a timely manner. Click your area of specialty below to learn how you may play a role in the journey to diagnosis and treatment of TGCT.*

This information is not intended to serve as guidelines or a tool for diagnosis and treatment. Rather, it is meant to raise awareness of TGCT in disciplines that may be involved in caring for patients who have it.

Orthopedic surgeons

Orthopedic surgeons should be aware that patients with TGCT may seek or be referred to their care because they have specialized training in managing joint problems.13-15 TGCT is a group of rare tumors usually arising from the synovium of joints, bursae, and tendon sheaths.1,15 The diffuse form typically affects larger joints, with the majority of tumors occurring in the knee.1,14-17

Pathologists

Pathologists should be aware that pathological examination can aid in eliminating differential diagnoses and identifying malignant conditions.16,18 A few cases of malignant TGCT have been reported, although TGCT is rarely malignant.16,18,19
MRI is the best approach to diagnosing TGCT and planning for follow-up care18,20-22; nonetheless, histopathological and cytological examination may be suggestive of TGCT and aid in reaching a correct diagnosis.8,18,20

Physical therapists and rehabilitation specialists

Physical therapists and rehabilitation specialists should be aware that the clinical presentation of TGCT can mimic common pathologies often associated with sports injuries or arthritis, which frequently results in patients being misdiagnosed.5,14,23-25 Symptoms tend to be nonspecific (eg, pain, swelling, limited range of motion),5 and patients may consult physical therapists or rehabilitation specialists to address their needs.26,27

Primary care physicians

Primary care physicians (PCPs) may be the first healthcare provider patients consult after they develop initial or progressive symptoms, including pain, swelling, or limited mobility.1,28,29 PCPs may provide physical assessments, review patient
history, and order routine biological tests to rule out differential diagnoses. They also may refer patients to
appropriate specialists.28-30

Radiologists

Radiologists should be aware that imaging techniques are important tools for diagnosing TGCT lesions preoperatively,
and the findings can help guide treatment.18,20,21,31 MRI is the best approach to diagnosing TGCT and planning for
follow-up care.18,20-22

Rheumatologists

Rheumatologists should be aware that symptoms of TGCT often are similar to those of phlogistic pathology, including arthritis or rheumatic arthrosynovitis, which contributes to patients initially being misdiagnosed.5,23,24 TGCT should be included among differential diagnoses of swelling, as it resembles osteoarthritis in the joints.29

Sports medicine specialists

Sports medicine specialists should be aware that the clinical presentation of TGCT can mimic common pathologies often associated with sports injuries, including pulled muscles or meniscal tears. TGCT should be included among differential diagnoses of pain, swelling, and limited range of motion, as it resembles sports-related complications.5,14,25,32

Differential diagnoses

Localized TGCT tumors, like other soft tissue tumors, can be misdiagnosed.4 Therefore, physicians should be aware of differential diagnoses of localized TGCT that can include:

  • Localized trauma/joint degeneration4
  • Ganglion cyst31
  • Xanthoma33
  • Hemangioma33
  • Giant cell tumor of the bone34

Diagnosis of TGCT can be confirmed by magnetic resonance imaging (MRI), determined preoperatively by biopsy, or discovered during surgery.2,11

Localized TGCT MRI

Diagnosis of TGCT can be confirmed by magnetic resonance imaging (MRI), determined preoperatively by biopsy, or discovered during surgery.2,11

Image of right ankle, produced by sagittal T1-weighted spin-echo MRI, showing a well-delineated localized giant cell tumor (marked with ✩) anterior to the ankle.

Adapted and reproduced with permission from Illian C et al.4

How you can help patients receive proper care

As a healthcare professional, by understanding the disease course of TGCT, you can help patients receive proper care in a timely manner. Click your area of specialty below to learn how you may play a role in the journey to diagnosis and treatment of TGCT.*

This information is not intended to serve as guidelines or a tool for diagnosis and treatment. Rather, it is meant to raise awareness of TGCT in disciplines that may be involved in caring for patients who have it.

Hand surgeons

Hand surgeons should be aware that localized TGCT occurs predominantly in the hand. Patients with small, localized tumors in the hand may be referred to hand surgeons because of their specialized knowledge and skill set.1,16,29,35-37

Orthopedic surgeons

Orthopedic surgeons should be aware that patients with TGCT may seek or be referred to their care because they have specialized training in managing joint problems.13-15 TGCT is a group of rare tumors usually arising from the synovium of joints, bursae, and tendon sheaths.1,15 The localized form is commonly seen in smaller joints, with the majority of tumors occurring in the digits.1,15,38

Pathologists

Pathologists should be aware that pathological examination can aid in eliminating differential diagnoses.16,18 MRI is the best approach to diagnosing TGCT and planning for follow-up care18,20-22; nonetheless, histopathological and cytological examination may be suggestive of TGCT and aid in reaching a correct diagnosis.8,18,20

Physical therapists and rehabilitation specialists

Physical therapists and rehabilitation specialists should be aware that the clinical presentation of TGCT can mimic common pathologies often associated with sports injuries or arthritis, which frequently results in patients being misdiagnosed.5,14,23-25 Symptoms tend to be nonspecific (eg, pain, swelling, limited range of motion),5 and patients may consult physical therapists or rehabilitation specialists to address their needs.26,27

Primary care physicians

Primary care physicians (PCPs) may be the first healthcare provider patients consult after they develop initial or progressive symptoms, including pain, swelling, or limited mobility.28,29,39,40 PCPs may provide physical assessments, review patient
history, and order routine biological tests to rule out differential diagnoses. They also may refer patients to
appropriate specialists.28-30

Radiologists

Radiologists should be aware that imaging techniques are important tools for diagnosing TGCT lesions preoperatively,
and the findings can help guide treatment.18,20,21,31 MRI is the best approach to diagnosing TGCT and planning for
follow-up care.18,20-22

Rheumatologists

Rheumatologists should be aware that symptoms of TGCT often are similar to those of phlogistic pathology, including arthritis or rheumatic arthrosynovitis, which contributes to patients initially being misdiagnosed.5,23,24 TGCT should be included among differential diagnoses of swelling, as it resembles osteoarthritis in the joints.29

Sports medicine specialists

Sports medicine specialists should be aware that the clinical presentation of TGCT can mimic common pathologies often associated with sports injuries, including pulled muscles or meniscal tears. TGCT should be included among differential diagnoses of pain, swelling, and limited range of motion, as it resembles sports-related complications.5,14,25,32

References

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  1. So-called fibrohistiocytic tumours. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, eds. WHO Classification of Tumours of Soft Tissue and Bone. 4th ed. International Agency for Research on Cancer; 2013:99-108. Bosman FT, Jaffe ES, Lakhani SR, Ohgaki H, eds. World Health Organization Classification of Tumours; vol 5.
  2. Akinci O, Akalin Y, İncesu M, Eren A. Long-term results of surgical treatment of pigmented villonodular synovitis of the knee. Acta Orthop Traumatol Turc. 2011;45(3):149-155. doi:10.3944/AOTT.2011.2442
  3. Bisbinas I, De Silva U, Grimer RJ. Pigmented villonodular synovitis of the foot and ankle: a 12-year experience from a tertiary orthopedic oncology unit. J Foot Ankle Surg. 2004;43(6):407-411. doi:10.1053/j.jfas.2004.09.002
  4. Illian C, Kortmann HR, Künstler HO, Poll LW, Schofer M. Tenosynovial giant cell tumors as accidental findings after episodes of distortion of the ankle: two case reports. J Med Case Rep. Published online December 15, 2009. 2009;3:9331. doi:10.1186/1752-1947-3-9331
  5. Hegedus EJ, Theresa K. Postoperative management of pigmented villonodular synovitis in a single subject. J Orthop Sports Phys Ther. 2008;38(12):790-797. doi:10.2519/jospt.2008.2934
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  7. Abdullah A, Abdullah S, Haflah NHM, Ibrahim S. Giant cell tumor of the tendon sheath in the knee of an 11-year-old girl. J Chin Med Assoc. 2010;73(1):47-51.
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  14. Lucas DR. Tenosynovial giant cell tumor: case report and review. Arch Pathol Lab Med. 2012;136(8):901-906. doi:10.5858/arpa.2012-0165-CR
  15. Mastboom MJL, Verspoor FGM, Verschoor AJ, et al; TGCT study group. Higher incidence rates than previously known in tenosynovial giant cell tumors: a nationwide study in The Netherlands. Acta Orthop. 2017;88(6):688-694. doi:10.1080/17453674.2017.1361126
  16. Ravi V, Wang W-L, Lewis VO. Treatment of tenosynovial giant cell tumor and pigmented villonodular synovitis. Curr Opin Oncol. 2011;23(4):361-366. doi:10.1097/CCO.0b013e328347e1e3
  17. Ottaviani S, Ayral X, Dougados M, Gossec L. Pigmented villonodular synovitis: a retrospective single-center study of 122 cases and review of the literature. Semin Arthritis Rheum. 2011;40(6):539-546. doi:10.1016/j.semarthrit.2010.07.005
  18. Brahmi M, Vinceneux A, Cassier PA. Current systemic treatment options for tenosynovial giant cell tumor/pigmented villonodular synovitis: targeting the CSF1/CSF1R axis. Curr Treat Options Oncol. Published online January 28, 2016. 2016;17(2):10. doi:10.1007/s11864-015-0385-x
  19. Asano N, Yoshida A, Kobayashi E, Yamaguchi T, Kawai A. Multiple metastases from histologically benign intraarticular diffuse-type tenosynovial giant cell tumor: a case report. Hum Pathol. 2014;45(11):2355-2358. http://dx.doi.org/10.1016/j.humpath.2014.06.025
  20. Camillieri G, Di Sanzo V, Ferretti M, Calderaro C, Calvisi V. Intra-articular tenosynovial giant cell tumor arising from the posterior cruciate ligament. Orthopedics. Published online July 1, 2012. 2012;35(7):e1116-e11168. doi:10.3928/01477447-20120621-34
  21. Bedir R, Balik MS, Sehitoglu I, Güçer H, Yurdakul C. Giant cell tumour of the tendon sheath: analysis of 35 cases and their Ki-67 proliferation indexes. J Clin Diagn Res. 2014;8(12):FC12-FC15. doi:10.7860/JCDR/2014/10553.5311
  22. Mastboom MJL, Verspoor FGM, Hanff DF, et al. Severity classification of tenosynovial giant cell tumours on MR imaging. Surg Oncol. 2018;27(3):544-550. doi:10.1016/j.suronc.2018.07.002
  23. Ehrenstein V, Andersen SL, Qazi I, et al. Tenosynovial giant cell tumor: incidence, prevalence, patient characteristics, and recurrence. A registry-based cohort study in Denmark. J Rheumatol. 2017;44(10):1476-1483. doi:10.3899/jrheum.160816
  24. Verspoor FGM, Hannink G, Scholte A, Van Der Geest ICM, Schreuder HWB. Arthroplasty for tenosynovial giant cell tumors: 17 patients followed for 0.2 to 15 years. Acta Orthop. Published online June 30, 2016. 2016;87(5):497-503. doi:10.1080/17453674.2016.1205168
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  26. Skou ST, Roos EM. Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice. Clin Exp Rheumatol. 2019;37(suppl 120)(5):S112-S117.
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  29. Al-Jarallah K, Waheeb SA, Attia Y, Abraham M. Giant cell tumor of tendon sheath mimicking nodal osteoarthritis. J Arthritis. Published online. 2012;1(1):1000103. doi:10.4172/2167-7921.1000103
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  31. Zhang Y, Huang J, Ma X, Wang X, Zhang C, Chen L. Giant cell tumor of the tendon sheath in the foot and ankle: case series and review of the literature. J Foot Ankle Surg. 2013;52(1):24-27. doi:10.1053/j.fas.2012.09.008
  32. Mayo Clinic Staff. Muscle strains. Mayo Clinic. Published September 1, 2020. Accessed September 3, 2020. https://www.mayoclinic.org/diseases-conditions/muscle-strains/symptoms-causes/syc-20450507
  33. Adams EL, Yoder EM, Kasdan ML. Giant cell tumor of the tendon sheath: experience with 65 cases. Eplasty. Published November 12, 2012. 2012;12:e50.
  34. Cho JM, Chang JH, Kim SH, Lee KS. Pediatric giant cell tumor of the tendon sheath of the craniocervical junction involving the occipital condyle. Childs Nerv Syst. 2016;32(1):175-179. doi:10.1007/s00381-015-2820-5
  35. Monaghan H, Salter DM, Al-Nafussi A. Giant cell tumour of tendon sheath (localized nodular tenosynovitis): clinicopathological features of 71 cases. J Clin Pathol. 2001;54(5):404-407. doi:10.1136/jcp.54.5.404
  36. Gibbons CLMH, Khwaja HA, Cole AS, Cooke PH, Athanasou NA. Giant-cell tumour of the tendon sheath in the foot and ankle. J Bone Joint Surg Br. 2002;84(7):1000-1003. doi:10.1302/0301-620x.84b7.13115
  37. Wang C, Song RR, Kuang PD, Wang LH, Zhang MM. Giant cell tumor of the tendon sheath: magnetic resonance imaging findings in 38 patients. Oncol Lett. Published online April 7, 2017. 2017;13(6):4459-4462. doi:10.3892/ol.2017.6011
  38. Hu Y, Kuang B, Chen Y, Shu J. Imaging features for diffuse-type tenosynovial giant cell tumor of the temporomandibular joint: a case report. Medicine. 2017;96(26):e7383. doi:10.1097/MD.0000000000007383
  39. Gouin F, Noailles T. Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis). Orthop Traumatol Surg Res. 2017;103(1S):S91-S97. http://dx.doi.org/10.1016/j.otsr.2016.11.002
  40. Hsu CS, Hentz VR, Yao J. Tumours of the hand. Lancet Oncol. 2007;8(2):157-166. doi:10.1016/S1470-2045(07)70035-9