Giant cell tumors of tendon sheath are rare in children. The most common site is the hand and the second frequent site is the ankle-foot complex. No study has previously looked at giant cell tumors of tendon sheath in children. The goal of this study was to assess their behavior including recurrence rates after surgical excision. The study was performed at a tertiary pediatric orthopaedic oncology center.
The authors assessed all giant cell tumors of tendon sheath since 1989. Diagnosis was based on confirmed histopathologic determination. A minimum follow-up of one-year was an inclusion criterion. Surgical technique involved meticulous dissection, intraoperative incisional biopsy with frozen section, and magnifying loupes. Thirty-four patients were identified but five patients were excluded because of inadequate information. This left a total of 29 patients with 16 boys and 13 girls. Fifteen tumors were noted in the upper extremity and 14 in the lower extremity. The tumors in the upper extremity primarily involved the fingers in 13 and were noted about the various joints. Presentation was a mass that was either firm or solid, non-fluctuant, or palpable. All patients underwent surgical excision of the tumor. Histology was typical for giant cell tumor of tendon sheath. Twenty-eight patients healed uneventfully and one patient developed a superficial wound infection that resolved after a course of oral antibiotics. The mean follow-up period was approximately six years. No recurrence was noted at final follow-up in any of the cases. One patient had two previous recurrences prior to surgery at this tertiary institution.
This article lends support that giant cell tumors of tendon sheath in children may be less likely to recur compared to adult cases (a recurrence rate of 10-15% has been reported in adults). The authors used meticulous technique without any adjuvant therapy. The typical presentation was a gradually enlarging mass and histological analysis was considered the goal standard for accurate diagnosis. The authors now believe that children with giant cell tumors of the tendon sheath have a better outcome after surgery than adults. Complete surgical excision is often curative without recurrence.
Giant, Cell, Tumor, Tendon, Sheath, Recurrence, Pediatric