Microsurgical resection of tenosynovial giant cell tumor in the digits microsurgery for digital GCT.

Abstract

Background: Tenosynovial giant cell tumor (TGCT) is a benign tumor arising from the synovial tissue and frequently occur in the digits. The treatment is surgical excision, but a high local recurrence rate is reported. The utilization of the surgical microscope during resection of digital TGCTs appears to be beneficial for more detailed visualization. We presented the outcomes of microsurgical resection of TGCT and discussed how to prevent recurrence of TGCT.

Methods: We reviewed 34 consecutive patients with TGCT cases operated by the single operator. The age at surgery ranged from 9 to 77 years, with an average of 48. The most common affected digit was the thumb (n = 13). In all cases, an operating microscope was utilized. The postoperative follow-up period was an average of 27.6 months.

Results: Intraoperative findings with the use of a microscope revealed an unexpectedly large number of cases with continuity to the adjacent joints. In cases of joint invasion, the capsule was opened to directly visualize the inside of the joint, and intra-articular tumor was resected enbloc together with extra-articular components. The classification of the disease was mixed type in 17 digits, localized type in 17. Postoperative recurrence was found in only one case (2.9 %).

Conclusion: Microsurgery may be a beneficial tool for TGCT resection, but there have been only few reports. Invasive TGCT into the volar plate or infiltrating into the bone near the tendon attachment are well visualized and could be more certainly resected. The recurrence rate after microscopic TGCT resection was only 2.9 %, which is probably the lowest rate in the previously reported literature. Microsurgery allows sufficient visualization of the TGCT invasion and is useful for dissection of digital nerves and arteries.