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LETTER TO EDITOR
Year : 2014  |  Volume : 3  |  Issue : 2  |  Page : 141-142

Giant cell tumor of right index finger: Fine needle aspiration cytology finding


Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh, India

Date of Web Publication19-May-2014

Correspondence Address:
S Srikanth
Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar 505 415, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.132711

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How to cite this article:
Srikanth S. Giant cell tumor of right index finger: Fine needle aspiration cytology finding. Int J Health Allied Sci 2014;3:141-2

How to cite this URL:
Srikanth S. Giant cell tumor of right index finger: Fine needle aspiration cytology finding. Int J Health Allied Sci [serial online] 2014 [cited 2019 Sep 21];3:141-2. Available from: http://www.ijhas.in/text.asp?2014/3/2/141/132711

Sir,

Giant cell tumor of tendon sheath (GCT-TS) is a benign solitary tumor arising from the tendon sheath of the limbs. They occur more in the upper limb than the lower limb. The presentation is rare with only very few cases reported in the literature so far. It typically presents as a localized tumor arising from the complex of the tendon sheath of small joints of the hand and feet. GCT-TS of soft tissue is considered to be the counterpart of GCT of bone. They are benign soft-tissue tumors of the limbs which arise from the complex of tendon sheath and periarticular soft tissues of small joints. It has been reported to occur most commonly in the hand (77%) and less so in the ankle and foot (3%). Here we present a case of GCT of tendon sheath involving right index finger with a recurrence history which was diagnosed on FNAC.

A 35-year-old female came to othopedics department with complaints of painless nodular swelling over the right hand index finger since 1 year. Three years back the patient had similar complaints and it was diagnosed as GCT-TS outside. She took local treatment outside and now she had similar complaints. Provisional diagnosis of GCT-TS of the right index finger was made. MRI was done and diagnosed it as GCT of tendon sheath [Figure 1]. On examination multiple, firm, non-tender, nodular swellings were present on the right index finger. They were free from the skin but fixed to the flexor tendon sheath. Sensations and movements of the finger were normal. Find need aspiration cytology (FNAC) was done using 10-ml syringe with 23-G needle and aspirated hemorraghic material. FNAC show many multinucleated giant cells with occasional binucleate cells and few scattered cells with pleomorphic and hyperchromatic nuclei with prominent nucleoli [Figure 2]. On FNAC we diagnosed it as GCT-TS of right hand index finger. On the basis of radiology and FNAC we diagnosed it as GCT-TS.
Figure 1: MRI showing GCT-TS involving volar and medial aspect of right index finger causing mass defect in the form of thinning and fracture of distal end of middle phalanx

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Figure 2: FNAC smears showing many multinucleated giant cells with binucleate cells and scattered single cells with prominent nucleoli. (a, H and E, x10; b, H and E, x40)

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Giant cell tumors of soft tissues are slow-growing tumors and are of two types, diffuse type (rare) and localized type (common). The diffuse type is rare and usually affects the lower limbs especially around the knee, followed by ankle, foot and occasionally affects the hand. The diffuse form is often locally aggressive with recurrence after excision. This case report focuses on the common localized form of the giant cell tumor of the tendon sheath that is often found in hand and feet. Despite the undetermined etiology, the clinical presentation, diagnosis, and surgical treatment of GCT-TS are described. The tumor is most commonly diagnosed in the fourth and fifth decades of life (range 4-82 years), [1],[2] with women affected more commonly than men (64.3% women). [3],[4],[5]

Recurrence is a major concern in GCT-TS, with rates of up to 44% being reported. [6] In the case of recurrence, marginal excision of the tumor should be repeated. Functionality of the involved digit should be considered and may result in the decision to amputate for large tumors that interfere with function. In our case also history of recurrence is noticed.

We present this case to highlight the role of FNAC in diagnosing certain rare tumors like GCT-TS and the recurrence of the tumor if it is not properly treated.

 
  References Top

1.Ushijima M, Hashimoto H, Tsuneyoshi M, Enjoji M. Giant cell tumor of the tendon sheath (nodular tenosynovitis). A study of 207 cases to compare the large joint group with the common digit group. Cancer 1986;57:875-84.  Back to cited text no. 1
[PUBMED]    
2.Beekman F. Giant-cell tumors of the tendon sheaths. Ann Surg 1915;62:738-45.  Back to cited text no. 2
[PUBMED]    
3.Jones FE, Soule EH, Coventry MB. Fibrous xanthoma of synovium (giant-cell tumor of tendon sheath, pigmented nodular synovitis). A study of one hundred and eighteen cases. J Bone Joint Surg Am 1969;51:76-86.  Back to cited text no. 3
[PUBMED]    
4.Walsh EF, Mechrefe A, Akelman E, Schiller AL. Giant cell tumor of tendon sheath. Am J Orthop (Belle Mead NJ) 2005;34:116-21.  Back to cited text no. 4
    
5.Glowacki KA. Giant cell tumors of tendon sheath. J Hand Surg Am 2003;3:100-7.  Back to cited text no. 5
    
6.Middleton WD, Patel V, Teefey SA, Boyer MI. Giant cell tumors of the tendon sheath: Analysis of sonographic findings. AJR Am J Roentgenol 2004;183:337-9.  Back to cited text no. 6
    


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