Tumor de células gigantes tenosinovial variante nodularestudio de su comportamiento según sus diferentes localizaciones

Abstract

Tenosynovial giant cell tumor is an uncommon, benign but locally aggressive tumor consisting of 2 subtypes: nodular (TGCT-N) and diffuse (TGCT-D). TGCT-N has been poorly studied, and there are currently no clinical guidelines for its management. Material and methods: 54 patients underwent surgery at San Juan de Alicante University Hospital, between January 2013 and June 2021. In 41 cases the lesion was in the hand, in 5 in the knee and 8 in the foot. Epidemiological, clinical and diagnostic-therapeutic data were collected retrospectively. Scores at the end of follow-up were prospectively collected on several general (MSTS, VAS) and specific (QuickDASH in the hand, IKS and Lysholm in the knee and AOFAS in the foot) clinical-functional scales.Data were analyzed comparing between the three locations and between Hand-Not Hand groups. Recurrence-free survival was studied as well. Results: After a mean follow-up of 78 months, we have observed differences in the clinical presentation depending on where the tumor is located, with a palpable mass in the hand and foot and swelling in the knee being more frequent. Intra-articular localization is much more frequent in the No Hand group (knee and foot). Cases in the knee and foot required MRI and biopsy to reach the diagnosis. Satellite lesions and fragmented tumor were more frequent in the knee and foot. En bloc exeresis was more frequent in the hand. The size of the maximum diameter was larger in the lesions of the No Hand group. Recurrence was more frequent in hand patients and tumor persistence, in patients in the No Hand group. Marginal excision achieved improvement in all clinical-functional scales, both general and specific. Recurrence occurred only in patients with TGCT-N located in the hand (10%) and tumor persistence, although asymptomatic and stable, was more frequent in the No Hand group. All recurrences occurred during the first 2 years after surgery. Conclusions: We have observed differences in the behavior of TGCT-N according to its location, especially if it originates in the hand or outside the hand, which determines the diagnostic-therapeutic management and prognosis. In our series, all recurrences occurred during the first 2 years after surgery.