Giant Cell Tumor ng Tendon Sheath (Buto sa Daliri o Hinlalaki) Impormasyon

Ano ang nararamdaman mo

Maaaring mapansin mo ang isang maliit, matigas na buntong sa iyong daliri o hinlalaki. Ito ay isang benignong paglago, na nangangahulugan na hindi ito kanser. Nakaupo ito sa tendon sheath, ang madulas na takip na tumutulong sa iyong mga tendon na gumalaw nang maayos. Karamihan sa mga tao ay nakakakita na ang buntong ito ay walang sakit sa simula. Maaaring pakiramdam lang nito ay isang kakaibang buntong sa ilalim ng balat.

Habang lumalaki ang buntong, maaari itong pindutin ang mga malalapit na nerbiyos o tisyu. Maaaring makaramdam ka ng mapait na sakit o matulis na sakit sa partikular na lugar na iyon. Karaniwang lumalala ang sakit kapag gumagamit ng iyong kamay. Ang mga gawain na nangangailangan ng hawak o pagpipit, tulad ng pagbubukas ng bote o paghawak ng telepono, ay maaaring maging hindi komportable. Maaari ring mapansin mo ang pagkakasikip ng kasukasuan sa kasukasuan malapit sa buntong.

May ilang tao ang nakakakita ng sakit sa gabi. Maaari itong magpahina sa pagtulog o pagmanat sa pagtulog. Ang paghiga sa kamay na iyon ay maaaring magdagdag ng presyon sa buntong, na nagdudulot ng pulso o tingling. Maaari kang gumising na may mahigpit na daliri na tumatagal ng ilang minuto bago lumuwag.

Ang mga araw-araw na gawain ay maaaring maging mahirap. Ang mga simpleng galaw tulad ng pag-button ng damit o pagtatakip ng iyong itaas na bahagi ay maaaring maging kakaiba. Ang pag-abot sa likod ng iyong likod upang i-fasten ang bra o ayusin ang iyong damit ay maaaring maging masakit. Maaari kang makakita na iwasan ang paggamit ng kamay na iyon para sa mabigat na pag-angat o paulit-ulit na mga gawain.

Mahalagang malaman na maaaring bumalik ang buntong pagkatapos ng pag-alis. Ang lokal na pagbabalik ay nakikita sa hanggang 20% ng mga kaso. Karamihan sa mga pagbabalik ay nangyayari sa loob ng unang dalawang taon pagkatapos ng operasyon. Gayunpaman, may ilang pasyente na nananatiling nasa panganib sa loob ng mas matagal, na may mga pagbabalik na nangyayari sa labindalawa hanggang tatlumpung taon pagkatapos ng paunang paggamot. Ito ang dahilan kung bakit susubaybayan ng iyong doktor ang lugar nang mahigpit sa loob ng panahon.

Kung mayroon kang namaga sa loob ng mahabang panahon, o kung nagsimula ang pamamaga pagkatapos ng isang pinsala, kinakailangan ang tamang pag-imaging. Tinitiyak nito ang pagwawakas ng ibang kondisyon. Bagama't bihira, ang mga tumor ng malambot na tisyu ay maaaring magmukhang karaniwang pinsala. Ang pagiging mabuti ay susi upang matiyak na makakuha ka ng tamang diagnosis at paggamot. Ang iyong doktor ay gabayin ka sa mga susunod na hakbang upang pamahalaan ang iyong mga sintomas at maiwasan ang mga komplikasyon.

Ano ang nangyayari talaga

Ang giant cell tumour of the tendon sheath ay isang karaniwang, hindi kanserosong buto na bumubuo sa iyong kamay. Karaniwan itong lumalabas sa isdaliri o hinlalaki. Maaaring matakot ang pangalan, ngunit ang paglago na ito ay benign. Ibig sabihin nito, hindi ito kumakalat sa ibang bahagi ng iyong katawan.

Ang buto ay bumubuo sa malambot na tissue na sumasakop sa iyong mga tendon. Ang mga tendon ay matibay, hibla na parang lubid na nag-uugnay sa iyong mga kalamnan sa iyong mga buto. Pinapayagan nito kang yumuko at tuwid ang iyong mga daliri. Ang tumour ay dahan-dahang lumalago sa loob ng tendon sheath, na ang protektibong manggas na nakapalibot sa mga hiblang ito.

Habang lumalaki ang masa, ito ay tumutulak sa mga kalapit na istraktura. Ang presyur na ito ang nagdudulot ng mga sintomas na maaaring mararamdaman mo. Maaaring mapansin mo ang matigas, walang sakit na butil sa ilalim ng balat. Sa ilang kaso, ang paglago ay maaaring mag-irita sa joint o limitahan ang galaw.

Kahit na ang mga tumour na ito ay benign, maaari silang maging agresibo sa bihirang mga kaso. Mayroon silang kagustuhang bumalik pagkatapos ng pag-alis. Ito ang dahilan kung bakit mahalaga ang maingat na paggamot. Ang iyong surgeon ay layuning alisin ang buong buto upang bawasan ang risk na bumalik ito.

Mahalagang paghiwalayin ang kondisyong ito sa ibang mga buto sa kamay. Minsan, ang mga imaging tests tulad ng X-rays o MRIs ay hindi malinaw na makakapaghihiwalay sa pagitan ng giant cell tumour at iba pang uri ng mga paglago. Ito ang dahilan kung bakit mahalaga ang tumpak na diagnosis bago desisyunin ang paggamot.

Habang ang mga tumour na ito ay pinakakaraniwan sa mga matatanda, bihirang ito sa mga bata. Kung mayroon kang buto sa iyong kamay, ang iyong surgeon ay masusing e-evaluate ito. Itutukoy nila kung ang partikular na uri ng paglago na ito ay naroroon at magplaplano ng pinakamainam na paraan para sa iyo.

Mga ginagawa namin para rito

Sa Mater Private Hospital Rockhampton, pinapamamaraan ni Dr. Kieran Hirpara ang kondisyong ito sa pamamagitan ng pagkumpirma muna kung ano eksakto ang bulto. Tumutulong ang imaging upang matukoy namin kung ang giant cell tumour of the tendon sheath ba ito kumpara sa ibang sanhi, bagama’t minsan ay maaari itong magmukhang katulad ng iba pang isyu sa malambot na tisyu. Sinisimulan namin ang malinaw na diagnosis bago pumili ng landas.

Para sa maraming pasyente, nagsisimula kami sa konservatibong paggamot. Kasama rito ang pagbabago sa aktibidad upang bawasan ang stress sa daliri o hinlalaki, at hand therapy upang panatilihing makinis ang galaw ng kasukasuan. Kung mayroong sakit o pamamaga, maaari naming inirerekomenda ang mga anti-inflammatory na gamot o isang cortisone injection upang paitiin ang lugar. Layunin ng mga hakbang na ito na pamahalaan ang mga sintomas at mapabuti ang pagganap nang walang operasyon. Karaniwan naming binibigyan ng patas na pagsubok ang paraang ito upang makita kung nagbibigay ito ng sapat na ginhawa.

Isinasalang-aling ang operasyon kapag hindi nagbibigay ng sapat na pagpapabuti ang konservatibong paggamot, o kung lumalaki ang bulto o nakakaapekto ito sa pagganap ng iyong kamay. Ang mga giant cell tumour of the tendon sheath ay benign (hindi kanseroso) ngunit maaaring mag-recur (bumalik) pagkatapos ng pag-alis. Ang aming layunin ay ang masusing ngunit konservatibong pag-alis upang matanggal ang bulto habang pinapanatili ang pagganap ng iyong kasukasuan at tendon. Sa ilang kaso, kung ang lesion ay nakakaapekto sa buto, maaari naming gamitin ang isang teknika na tinatawag na curettage, kung saan aming kakaliskisin ang apektadong lugar, minsan ay punan ang espasyo ng bone cement upang suportahan ang istruktura.

Ang recurrence ay isang kilalang panganib. Karamihan sa mga recurrence ay nangyayari sa loob ng unang dalawang taon, ngunit ang ilang mga pasyente ay nananatiling nasa panganib sa loob ng mas matagal, na may mga recurrence na nangyayari hanggang sa tatlongampung taon pagkatapos ng paunang paggamot. Mahigpit naming pinagmamasdan ka pagkatapos ng operasyon upang maagang makita ang anumang pagbabago. Kung mangyari ang recurrence, epektibo pa rin ang karagdagang operasyon. Hindi tila binabawasan ang epektibidad ng paggamot sa recurrence gamit ang simpleng pagkakaliskis o mas malawak na pag-alis ng mga naunang paggamot tulad ng paglalagay ng cement.

Sa bihirang mga kaso kung saan ang tumour ay malawak o mahirang alisin sa pamamagitan ng operasyon, maaaring maging opsyon ang radiation therapy. Ipinaliliwanag ng mga pag-aaral na ang radiation ay epektibong nakokontrol ang tumour, na may walong-pu’t limang porsyentong rate ng kawalan ng pag-unlad sa loob ng sampung taon. Ito ay isang ligtas at epektibong alternatibo kapag hindi feasible ang operasyon.

Tinitingnan namin ang paggamot bilang isang shared decision. Usapin namin sa iyo ang mga panganib, benepisyo, at posibilidad ng recurrence. Ang aming layunin ay kontrolin ang lesion sa lokal na antas habang pinapanatili ang pagganap ng iyong kamay sa pangmatagalan. Sa pamamagitan ng therapy, gamot, o operasyon, iniaangkop namin ang plano sa iyong partikular na pangangailangan at sakop ng sakit.

Ano ang inaasahan

Ang giant cell tumour of tendon sheath ay isang karaniwang, hindi kanserosong buntong sa iyong daliri o hinlalaki. Kahit benign ito, maaari itong muling lumitaw pagkatapos ng pag-alis. Karamihan sa mga pagkabalik ay nangyayari sa loob ng unang dalawang taon. Gayunpaman, may ilang pasyente na nananatiling nasa panganib sa loob ng mas matagal, na may mga pagkabalik na nangyayari labindalawa hanggang tatlongampung taon pagkatapos ng paunang paggamot.

Kung iiwanan mo ang buntong, maaari itong manatili o dahan-dahang lumaki. Bihirang maglaan sa sarili nito. Dahil maaaring lokal na agresibo ang mga tumour na ito, malamang na irekomenda ng iyong doktor ang pag-alis upang pigilan ang karagdagang paglago at protektahan ang pag-andar ng iyong kasukasuan.

Pagkatapos ng operasyon, kailangan ng iyong kamay ng oras upang gumaling. Inaasahan ang ilang pamamaga at katigasan habang binabawi ang galaw. Karamihan sa mga tao ay bumabalik sa karaniwang mga gawain sa loob ng ilang linggo, bagaman maaaring tumagal ng mas matagal ang buong lakas. Sinusubaybayan namin nang mahigpit ang iyong progreso upang matiyak na nananatiling matatag at functional ang kasukasuan.

Sa bihirang mga kaso, maaaring maiwan ang mga selula ng tumour sa surgical scar, na nagdudulot ng pagkabalik sa malambot na tisyu. Ito ang dahilan kung bakit binibigyan namin ng masusing pansin ang detalye ng operasyon. Kung muling lumitaw ang tumour, madalas itong maipagagamot muli gamit ang maingat na pagkaskas o mas malawak na pag-alis. Epektibo ang mga ulit na prosedura na ito at hindi binabawasan ang iyong pagkakataon para sa pangmatagalang kontrol.

Para sa karamihan sa mga pasyente, ang outlook ay positibo. Inaasahan na mapanatili ang buong paggamit ng iyong kamay. Layunin namin ang matibay, kasukasuan-pang-iing na pag-andar. Kahit mahalaga ang pagbabantay, hindi mo kailangang mag-alala nang sobra. Ang regular na mga check-up ay tumutulong sa amin na makakita ng anumang pagbabago nang maaga. Sa tamang pag-aalaga, maaari mong mapanatiling malusog at aktibo ang iyong kamay sa mga susunod na taon.

Kailan makipag-ugnayan sa doktor

Kumonsulta sa iyong doktor kung napansin mo ang isang patuloy na buntis sa iyong daliri o hinlalaki na hindi nawawala. Humingi ng pagsusuri ng espesyalista kung mayroon kang sakit na hindi gumagaling sa pamamagitan ng pahinga, o kung ang buntis ay nagdudulot ng kahinaan, pagkakasara, o kawalan ng katatagan sa iyong kamay. Humingi ng agad na pag-aalaga kung biglaang lumala ang mga sintomas o nakakaapekto sa iyong pagtulog o trabaho. Ang matagal na pamamaga, kahit pagkatapos ng isang pinsala, ay maaaring magpahiwatig ng seryosong kondisyon na nangangailangan ng tamang pag-imaging bago ang operasyon. Ang maagang pagsusuri ay tumutulong upang maiwasan ang mga komplikasyon at tinitiyak ang pinakamahusay na resulta para sa iyong pag-andar ng kamay.

Evidence & references

Overview

Giant cell tumour of tendon sheath is a common benign tumour of the hand [2].
Reports of giant cell tumour of tendon sheath in the paediatric population are rare [2].
Giant cell tumour of tendon sheath can be locally recurrent after excision [2].
Imaging studies can be of little utility in distinguishing glomus tumors from other lesions like giant cell tumor of the tendon sheath [5].
Vigilance for malignancy is encouraged for lesions such as giant cell tumors, as aggressive treatment such as wide excision or amputation may be necessary to prevent recurrence [1].
Orthopaedic surgeons should be familiar with the spectrum of hand and wrist tumors, the work-up necessary to arrive at a precise diagnosis, and the treatment that will achieve the most favorable outcome [6].

Anatomy & Pathophysiology

Giant cell tumors are classified as benign bony and soft tissue tumors of the hand [1].
Giant cell tumors can exhibit aggressive behavior requiring wide excision or amputation to prevent recurrence [1].
Giant cell tumors can recur at the third lumbar vertebra [22].
If the vertebral body and posterior arch are affected in giant cell tumors, curettage is insufficient to prevent recurrence [22].
Giant cell tumors can occur in the proximal phalanx [23].
Giant cell tumors can recur in the second metacarpal [42].
Primary parosteal osteosarcoma of the finger is a rare tumor with characteristic radiographic and microscopic appearance [36].
Fibroma of tendon sheath (FTS) is an extremely rare condition in the hand of a 3-year-old child [39].
Florid reactive periostitis presents as soft tissue swelling adjacent to hand bones with pseudomalignant or pseudoinflammatory features [45].

Classification

Giant cell tumour of tendon sheath is a common benign tumour of the hand [2].
Giant cell tumour of tendon sheath can be locally recurrent after excision [2].
Reports of giant cell tumour of tendon sheath in the paediatric population are rare [2].
Imaging studies can be of little utility in distinguishing glomus tumors from other lesions like giant cell tumor of the tendon sheath [5].

Clinical Presentation

Giant cell tumour of tendon sheath is a common benign tumour of the hand [2].
Reports of giant cell tumour of tendon sheath in the paediatric population are rare [2].
Giant cell tumour of tendon sheath can be locally recurrent after excision [2].
Imaging studies can be of little utility in distinguishing glomus tumors from other lesions like giant cell tumor of the tendon sheath [5].
Prolonged and atypical swelling of soft tissue, even with a previous traumatic lesion, may indicate underlying malignancy, necessitating proper imaging before surgery [13].
Primary bone and soft-tissue tumors that mimic common sports injuries are relatively rare but can be easily missed, leading to limb- and life-threatening consequences [20].
Vigilance for malignancy is encouraged for lesions like giant cell tumors to prevent recurrence [1].
Orthopaedic surgeons should be familiar with the spectrum of hand and wrist tumors, the work-up necessary to arrive at a precise diagnosis, and the treatment that will achieve the most favorable outcome [6].
Soft tissue sarcomas of the hand may have better survival than those at other sites, but prognosis must be interpreted with caution due to the rarity of the condition [9].
An unusual pathway for spread of squamous cell carcinoma from the thumb to the small finger is via the flexor tendon sheaths, which should be considered in the evaluation of patients with hand tumors [15].
Local recurrence is seen in ≤20% of cases of giant cell tumor of bone [29].
A second local intralesional procedure is typically sufficient in cases of giant cell tumor of bone detected early [29].
Most recurrences of giant-cell tumor of bone can be expected within the first two years [12].
Some patients with giant-cell tumor of bone remain at risk for recurrence for a much longer period, with recurrences occurring nineteen to thirty years after initial treatment [12].
Two cases of soft-tissue recurrence of giant-cell tumor within a surgical scar indicate that tumor cells may be implanted in a surgical wound [3].
There are subsets of patients with giant cell tumor of bone who are at higher risk of recurrence and should be clinically followed more closely [7].
Malignant transformation of a giant cell tumor of bone while receiving denosumab treatment is a rare but important possibility [16].

Investigations

Imaging studies have limited utility in distinguishing glomus tumors from other lesions such as giant cell tumor of the tendon sheath [5].
Prolonged and atypical soft tissue swelling, even in the presence of a previous traumatic lesion, may indicate underlying malignancy and necessitates proper imaging before surgery [13].
The use of CT and whole body bone scans may be beneficial when indicated, particularly after the occurrence of a second tumor focus [38].

Treatment

Vigilance for malignancy is encouraged, and aggressive treatment such as wide excision or amputation may be necessary for certain lesions like giant cell tumors to prevent recurrence [1].
Giant cell tumour of tendon sheath is a common benign tumour of the hand that can be locally recurrent after excision [2].
Two cases of soft-tissue recurrence of giant-cell tumor within a surgical scar are reported, indicating that tumor cells may be implanted in a surgical wound [3].
Despite its benign histology, giant cell tumor of bone is an aggressive tumor that demands meticulous attention to surgical detail and close postoperative surveillance for successful local tumor control and durable, joint-preserving function [4].
Both curettage and resection/amputation are acceptable treatment options for the rare condition of giant cell tumour of bone in the hand, with a need to individualize treatment decisions based on the site and extent of disease to minimize treatment morbidity while maximizing disease control [8].
The transplantation of a toe phalanx for a recurrent giant-cell tumor in a skeletally immature patient resulted in a satisfactory outcome with full hand function and no tumor recurrence forty-one years later [10].
Intralesional excision remains a viable, and likely the standard, mode of treatment for most giant cell tumors of the distal radius unless there is extensive bone loss [11].
Although most recurrences of giant-cell tumor of bone can be expected within the first two years, some patients remain at risk for a much longer period, with recurrences occurring nineteen to thirty years after initial treatment [12].
Wide excision should be considered in the presence of extensive soft tissue involvement, and early treatment yields good results [14].
The available studies suffer from selection bias and are inadequate to answer questions regarding the appropriate use, duration, and efficacy of denosumab in giant cell tumors of bone definitively [17].
The effectiveness of treatment of a recurrence with either an intralesional or a wide excisional procedure does not appear to be diminished by initial curettage and cementing [18].
Treatment is directed at controlling the lesion locally, with curettage and adjuvant therapy being the primary goal for most lesions to preserve the articular surface [19].
Giant-cell tumor of bone was effectively treated with megavoltage radiation in patients in whom operative resection would have been difficult or was not feasible, with a ten-year lack of progression rate of 85 percent [21].
Radiation therapy is a safe and effective treatment option for benign giant cell tumors of bone [27].
Reconstruction after wide excision by nonvascularized fibular graft is a viable alternative for giant cell tumors of the lower end of radius though it is a challenging procedure and may be accompanied by major complications [31].
This tumor should be treated with conservative but thorough excision [32].
The authors recommend intralesional surgery with polymethylmethacrylate for the majority of primary GCTs [33].

Complications

Giant cell tumour of tendon sheath is a common benign tumour of the hand that can be locally recurrent after excision [2].
Reports of giant cell tumour of tendon sheath in the paediatric population are rare [2].
Soft-tissue recurrence of giant-cell tumor within a surgical scar indicates that tumor cells may be implanted in a surgical wound [3].
Giant cell tumor of bone is an aggressive tumor that demands meticulous attention to surgical detail and close postoperative surveillance for successful local tumor control and durable, joint-preserving function [4].
There are subsets of patients with giant cell tumor of bone who are at higher risk of recurrence and should be clinically followed more closely [7].
Both curettage and resection/amputation are acceptable treatment options for giant cell tumour of bone in the hand, with treatment decisions needing to be individualized based on the site and extent of disease to minimize treatment morbidity while maximizing disease control [8].
The transplantation of a toe phalanx for a recurrent giant-cell tumor in a skeletally immature patient resulted in a satisfactory outcome with full hand function and no tumor recurrence forty-one years later [10].
Although most recurrences of giant-cell tumor of bone can be expected within the first two years, some patients remain at risk for a much longer period, with recurrences occurring nineteen to thirty years after initial treatment [12].
Prolonged and atypical swelling of soft tissue, even with a previous traumatic lesion, may indicate underlying malignancy, necessitating proper imaging before surgery [13].
The available studies regarding treatment with denosumab suffer from selection bias and are inadequate to answer questions regarding the appropriate use, duration, and efficacy of denosumab in giant cell tumors of bone definitively [17].

Recovery

Giant cell tumour of tendon sheath is a common benign tumour of the hand that can be locally recurrent after excision [2].
Reports of giant cell tumour of tendon sheath in the paediatric population are rare [2].
Two cases of soft-tissue recurrence of giant-cell tumor within a surgical scar indicate that tumor cells may be implanted in a surgical wound [3].
Despite its benign histology, giant cell tumor of bone is an aggressive tumor that demands meticulous attention to surgical detail and close postoperative surveillance for successful local tumor control and durable, joint-preserving function [4].
There are subsets of patients with giant cell tumor of bone who are at higher risk of recurrence and should be clinically followed more closely [7].
Although most recurrences of giant-cell tumor of bone can be expected within the first two years, some patients remain at risk for a much longer period, with recurrences occurring nineteen to thirty years after initial treatment [12].
The transplantation of a toe phalanx for a recurrent giant-cell tumor in a skeletally immature patient resulted in a satisfactory outcome with full hand function and no tumor recurrence forty-one years later [10].
The effectiveness of treatment of a recurrence with either an intralesional or a wide excisional procedure does not appear to be diminished by initial curettage and cementing [18].

Key Evidence

[L5] Vigilance for malignancy is encouraged, and aggressive treatment such as wide excision or amputation may be necessary for certain lesions like giant cell tumors to prevent recurrence. [1] (10.1016/j.jhsa.2010.08.015)
[L4] Giant cell tumour of tendon sheath is a common benign tumour of the hand that can be locally recurrent after excision, and reports in the paediatric population are rare, with this case believed to be the youngest reported. [2] (10.1177/1753193412455792)
[L4] Two cases of soft-tissue recurrence of giant-cell tumor within a surgical scar are reported, indicating that tumor cells may be implanted in a surgical wound. [3] (10.2106/00004623-196749020-00016)
[L3] Despite its benign histology, giant cell tumor of bone is an aggressive tumor that demands meticulous attention to surgical detail and close postoperative surveillance for successful local tumor control and durable, joint-preserving function. [4] (10.1097/01.blo.0000180055.76969.08)
[Case_report] Imaging studies can be of little utility in distinguishing glomus tumors from other lesions like giant cell tumor of the tendon sheath. [5] (10.1016/j.jhsa.2012.02.035)
[L5] Orthopaedic surgeons should be familiar with the spectrum of these tumors, the work-up necessary to arrive at a precise diagnosis, and the treatment that will achieve the most favorable outcome. [6] (10.5435/00124635-200611000-00013)
[L4] Our observations suggest there are subsets of patients with giant cell tumor of bone who are at higher risk of recurrence and should be clinically followed more closely. [7] (10.1007/s11999-011-2172-8)
[L4] Both curettage and resection/amputation are acceptable treatment options for the rare condition of giant cell tumour of bone in the hand, with a need to individualize treatment decisions based on the site and extent of disease to minimize treatment morbidity while maximizing disease control. [8] (10.1177/17531934211007820)
[L5] It notes that while soft tissue sarcomas of the hand may have better survival than those at other sites, prognosis must be interpreted with caution due to the rarity of the condition. [9] (10.1016/j.jhsa.2010.08.014)
[Case_report] The transplantation of a toe phalanx for a recurrent giant-cell tumor in a skeletally immature patient resulted in a satisfactory outcome with full hand function and no tumor recurrence forty-one years later. [10] (10.2106/00004623-199412000-00015)
[L3] Intralesional excision remains a viable, and likely the standard, mode of treatment for most giant cell tumors of the distal radius unless there is extensive bone loss. [11] (10.1007/s11999-014-4054-3)
[L4] Although most recurrences of giant-cell tumor of bone can be expected within the first two years, some patients remain at risk for a much longer period, with recurrences occurring nineteen to thirty years after initial treatment. [12] (10.2106/00004623-199408000-00013)
[L5] Prolonged and atypical swelling of soft tissue, even with a previous traumatic lesion, may indicate underlying malignancy, necessitating proper imaging before surgery. [13] (10.1016/j.csm.2013.03.008)
[Case_report] Wide excision should be considered in the presence of extensive soft tissue involvement, and early treatment yields good results. [14] (10.1016/j.jhsa.2014.01.004)
[L5] This unusual pathway should be considered in the evaluation of patients with hand tumors. [15] (10.1016/j.jhsa.2009.06.012)
[L4] Malignant transformation of a giant cell tumor of bone while receiving denosumab treatment is a rare but important possibility that physicians should be aware of, as denosumab is increasingly used for this condition. [16] (10.1007/s11999-015-4249-2)
[L5] The available studies suffer from selection bias and are inadequate to answer questions regarding the appropriate use, duration, and efficacy of denosumab in giant cell tumors of bone definitively. [17] (10.1097/corr.0000000000001217)
[L3] Furthermore, the effectiveness of treatment of a recurrence with either an intralesional or a wide excisional procedure does not appear to be diminished by initial curettage and cementing. [18] (10.2106/00004623-199412000-00009)
[L4] Treatment is directed at controlling the lesion locally, with curettage and adjuvant therapy being the primary goal for most lesions to preserve the articular surface. [19] (10.1016/j.hcl.2004.03.016)
[L5] Primary bone and soft-tissue tumors that mimic common sports injuries are relatively rare but can be easily missed, leading to limb- and life-threatening consequences. [20] (10.5435/jaaos-22-04-223)
[L4] Giant-cell tumor of bone was effectively treated with megavoltage radiation in patients in whom operative resection would have been difficult or was not feasible, with a ten-year lack of progression rate of 85 percent. [21] (10.2106/00004623-199911000-00008)
[L5] If the vertebral body and the posterior arch are affected, curettage of the lesion is insufficient to prevent tumor recurrence. [22] (10.1016/j.otsr.2010.05.009)
[L4] The application of a temporary dorsal plaster backslab to unstable distal radius fractures causes insignificant further displacement. [23] (10.1177/1753193408097859)
[L4] The authors conclude that radiation therapy is a safe and effective treatment option for benign giant cell tumors of bone. [27] (10.1097/01.blo.0000069890.31220.b4)
[L5] Local recurrence is seen in ≤20% of cases, and a second local intralesional procedure is typically sufficient in cases that are detected early. [29] (10.5435/jaaos-21-02-118)
[L4] Reconstruction after wide excision by nonvascularized fibular graft is a viable alternative for giant cell tumors of the lower end of radius though it is a challenging procedure and may be accompanied by major complications. [31] (10.1007/s00402-010-1059-6)
[L4] This tumor should be treated with conservative but thorough excision. [32] (10.1097/01.blo.0000129555.37075.74)
[L3] The authors recommend intralesional surgery with polymethylmethacrylate for the majority of primary GCTs. [33] (10.1007/s11999-010-1501-7)
[L4] Primary parosteal osteosarcoma of the finger is a rare tumor with characteristic radiographic and microscopic appearance. [36] (10.1016/j.jhsa.2019.08.006)
[L4] The use of CT and whole body bone scans may prove beneficial when indicated, particularly after the occurrence of a second tumor focus. [38] (10.1097/01.blo.0000063784.32430.b0)
[Case_report] We experienced an extremely rare case of FTS in the hand of a 3-year-old child. [39] (10.1186/s12891-020-03728-x)
[L4] Reversed vascularised toe joint transfer should be considered as an option for reconstruction of joint defects in a single finger, especially in a young active patient, and has shown good short- to medium-term results. [42] (10.1177/1753193408089048)
[L4] Florid reactive periostitis should be considered in cases of soft tissue swelling adjacent to hand bones showing pseudomalignant or pseudoinflammatory features. [45] (10.1016/j.jhsa.2013.08.115)

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