Giant cell tumor of tendon sheath of distal phalanx of thumb.
Dr. Puja Chaurasia, MS General Surgery
E-mail ID:
daffodilpuja@gmail.com
Key clinical message: Giant cell tumor of the phalanges is a rare
entity; therefore delayed or missed diagnosis of giant cell tumor
especially of the thumb distal phalanx can be extremely debilitating.
Abstract
We report a rare case of giant cell tumor tendon sheath in 26 year old
man as a benign soft tissue tumor of thumb; managed by complete
excision. Histopathological examination revealed spindle shaped cells
with numerous multi-nucleated giant cells.
Keywords: soft tissue tumor, tendon sheath, distal phalanx, thumb
Introduction
Giant cell tumor of tendon sheath
(GCTTS) is a rare, benign, slow growing, locally aggressive soft tissue
tumor of the hand region with an overall incidence of 1 in 50,000
individuals [1]. Etiology of the entity includes trauma,
inflammation, metabolic disease and neoplasia [2,3]. It occurs at
any age with female predominance in third to fifth decade of life
[4]. Histopathological examination of the tumor with clinical
examination and various radiological armamentariums aid in the
diagnosis[5]. Complete surgical excision is the therapeutic goal
though the risk of recurrence is 30-45% [6]. Long-term follow-up is
advised in order to detect early recurrence [7].
Case presentation
A 26 year old male presented with complaints of painless lump in the
distal phalanx of his right thumb. The lump was gradually progressive in
size since he first noticed it 3 months back. He denied any history of
trauma or prior occurrence of the lesion, fever, bruising, numbness,
tingling and purulent discharge. Clinical examination revealed a 3x2 cm
firm, mobile, solitary mass attached to a tendon on the volar bulb of
right thumb. The lump didn’t extend into the subungual region and
adjacent skin was normal. There were no signs of inflammation or
discharge. The full range of motion of the distal interphalangeal joint
could be obtained. There were no signs of neurosensory indifference. We
thereafter made a differential diagnosis of either giant cell tumor or
ganglionic cyst.
Investigation
A plain radiograph was obtained which showed a soft tissue swelling with
normal bones; no fracture, dislocation, or destructive lesion (Figure 1)