Tumores de Células Gigantes da Bainha dos Tendões (Nódulo no Dedo ou Polegar)

Patients › Hand

O tumor de células gigantes da bainha do tendão é um nódulo comum, benigno (não canceroso), em um dedo ou polegar. O que o causa, como é diagnosticado e removido, e com que frequência recidiva.

Updated Jun 2026

Uma ilustração desenhada à mão de um nódulo benigno de partes moles na lateral de um dedo. — Sob o microscópio, um tumor de células gigantes da bainha do tendão é composto por aglomerados de células gigantes multinucleadas (as células escuras e com aspecto irregular) misturadas com células mononucleares menores. É benigno, e é essa aparência de células gigantes que dá o nome à lesão. Kieran Hirpara 4.0

O tumor de células gigantes da bainha do tendão é um caroço comum, benigno (não canceroso), em um dedo ou polegar. É o segundo tipo de caroço mais comum na mão, após o cisto sinovial. Cresce lentamente, não se espalha para outras partes do corpo e geralmente é removido por meio de uma pequena cirurgia, embora possa, por vezes, recidivar. Esta página explica o que é, como é diagnosticado, o que envolve a sua remoção e com que frequência recidiva.

O que é

O tumor de células gigantes da bainha dos tendões cresce a partir do revestimento de uma bainha do tendão ou da articulação vizinha (a sinóvia, o tecido lubrificante que permite o deslizamento dos tendões). O nome "células gigantes" descreve a aparência ao microscópio, onde aglomerados de células grandes, multinucleadas, estão misturados com células menores. Isso não diz nada sobre o seu comportamento: trata-se de um crescimento benigno que permanece na mão. Os médicos às vezes o denominam tumor de células gigantes tenossinovial localizado.

Onde aparece e como se sente

Quase sempre surge num dedo ou polegar, frequentemente na palma ou na lateral, próximo de uma das articulações do dedo. Tipicamente, é:

firme e elástica, em vez de mole, e de crescimento lento
geralmente indolor, embora possa doer ou prender à medida que aumenta
sólida, pelo que (ao contrário de um cisto ganglionar cheio de líquido) não brilha quando uma lanterna é colocada contra ela

À medida que cresce, pode dificultar a flexão completa do dedo e, ocasionalmente, comprimir um pequeno nervo, causando formigueiro. Raramente, um tumor de longa data cria uma cavidade lisa no osso adjacente, o que é visível numa radiografia.

Como é diagnosticado

O seu cirurgião pode frequentemente reconhecê-lo através do exame do nódulo. Uma ecografia ajuda a confirmar que é sólido, em vez de conter o líquido de um cisto sinovial. Para um nódulo maior, mais profundo ou recidivante, uma ressonância magnética (RM) mostra até onde se estende e tem uma aparência bastante característica (aparece escuro em certas sequências devido a um pigmento contendo ferro no tecido). Uma radiografia é adicionada se o nódulo parecer envolver o osso adjacente. O diagnóstico é confirmado com certeza quando o nódulo removido é examinado ao microscópio.

Tratamento: remoção do nódulo

O tratamento habitual é uma pequena cirurgia para removê-lo, denominada excisão marginal, geralmente realizada em regime de ambulatório sob anestesia local ou geral. Através de uma pequena incisão, o cirurgião remove todo o nódulo, juntamente com quaisquer nódulos satélites menores e a bainha envolvida, trabalhando cuidadosamente ao redor dos nervos, vasos sanguíneos e tendões próximos. A remoção de todo o tumor, em vez de apenas o nódulo aparente, é o que reduz a probabilidade de recorrência. Não existem comprimidos ou injeções que provoquem a redução deste tipo de nódulo.

Frequência de recorrência

Este nódulo pode retornar após a cirurgia. Nas séries publicadas, aproximadamente 1 em 7 a 1 em 5 casos apresentam recorrência (cerca de 10 a 20 em 100). A recorrência é mais provável quando havia vários nódulos, quando o tumor envolvia tendões ou osso, ou quando parte do tecido foi deixada para trás na primeira cirurgia. A maioria das recorrências manifesta-se nos primeiros dois anos, razão pela qual o seu cirurgião irá acompanhar a área durante esse período, embora, em casos raros, um nódulo possa retornar muitos anos depois. Se ocorrer recorrência, a sua remoção pode geralmente ser realizada novamente.

Recuperação

A maioria das pessoas retorna para casa no mesmo dia com um curativo e, por vezes, uma tala leve. A movimentação suave do dedo nas fases iniciais ajuda a prevenir a rigidez, e um terapeuta da mão pode orientar esse processo, se necessário. Os pontos são geralmente removidos por volta de duas semanas. Pode esperar utilizar a mão para tarefas leves dentro de alguns dias e retomar o uso completo ao longo de algumas semanas, conforme a tolerância e as orientações do seu cirurgião. Proteger a cicatriz da exposição solar e massageá-la após a cicatrização completa ajuda a melhorar a sua aparência.

Em profundidade

Esta seção aprofunda o tema, em nível acadêmico. Não é necessária para compreender ou tratar o nódulo, mas explica o que impulsiona esse tumor e por que ele às vezes retorna.

O que impulsiona o crescimento

O tumor de células gigantes da bainha dos tendões é a forma localizada de um grupo de neoplasias chamado tumor de células gigantes sinovial. O motor por trás dessas lesões é a superprodução de uma proteína sinalizadora chamada CSF1 (fator estimulador de colônias 1), geralmente desencadeada por uma pequena troca de material genético entre cromossomos em uma minoria das células tumorais. Essas células liberam CSF1, que atrai grandes números de células imunes (macrófagos) da corrente sanguínea. A maior parte do nódulo é composta por essas células recrutadas, e não pelas células anormais originais, o que representa uma forma incomum de uma neoplasia se estruturar.

Aparência ao microscópio e na imagem

Ao microscópio, o nódulo é uma mistura de células mononucleares menores, macrófagos espumosos repletos de gordura e as células gigantes multinucleadas que lhe dão o nome. Também contém hemosiderina, um pigmento rico em ferro deixado para trás por pequenos sangramentos antigos no tecido. Esse ferro é a razão pela qual o nódulo frequentemente aparece escuro em certas sequências de ressonância magnética, uma característica que ajuda a diferenciá-lo de um cisto sinovial (ganglion) cheio de fluido antes de qualquer cirurgia.

Localizada versus difusa, e por que pode recidivar

Os nódulos comuns dos dedos e do polegar são do tipo localizado, que é bem delimitado e geralmente removido por completo. Um tipo difuso menos comum se espalha mais amplamente através do revestimento articular (o mesmo processo que, numa articulação grande, é chamado de sinovite vilonodular pigmentada). O tipo difuso é mais difícil de remover por completo e recidiva com mais frequência. Mesmo o tipo localizado pode recidivar se pequenos nódulos satélites forem deixados para trás, razão pela qual o cirurgião remove o nódulo inteiro e a bainha envolvida ao seu redor, em vez de apenas a parte visível.

Quando os comprimidos têm um papel

Para os raros tumores difusos que não podem ser removidos cirurgicamente ou que continuam a recidivar, medicamentos que bloqueiam o sinal CSF1 (inibidores do receptor CSF1) podem reduzi-los. Estes são reservados para casos difíceis e não são utilizados para o nódulo comum e facilmente removível no dedo, que é tratado diretamente pela cirurgia.

Quando procurar ajuda

Consulte o seu médico de família ou um cirurgião da mão se tiver um nódulo firme no dedo ou polegar que não desaparece, cresce lentamente, limita o movimento do dedo ou causa dormência ou formigamento. Após a cirurgia, informe o seu cirurgião se notar um novo nódulo dentro ou próximo da cicatriz, pois este pode ser um sinal de recorrência do tumor e deve ser avaliado precocemente.

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)

References

[1] Benign Bony and Soft Tissue Tumors of the Hand. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.08.015 [2] Giant cell tumour of tendon sheath in a 4-year-old boy. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412455792 [3] Soft-Tissue Recurrence of Giant-Cell Tumor of Bone after Irridiation and Excision. The Journal of Bone & Joint Surgery. 1967. DOI: 10.2106/00004623-196749020-00016 [4] Impact Severity of Local Recurrence in Giant Cell Tumor of Bone. Clinical Orthopaedics and Related Research. 2005. DOI: 10.1097/01.blo.0000180055.76969.08 [5] Glomus Tumor of Digital Nerve: Case Report. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.035 [6] Malignant Tumors of the Hand and Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200611000-00013 [7] Giant Cell Tumor of Bone: Are We Stratifying Results Appropriately?. Clinical Orthopaedics & Related Research. 2012. DOI: 10.1007/s11999-011-2172-8 [8] Giant cell tumour of hand bones: outcomes of treatment. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211007820 [9] Malignant and Metastatic Tumors of the Hand. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.08.014 [10] Phalangeal transfer for recurrent giant-cell tumor of the phalanx of a finger in a nine-year-old child. A case report with forty-one-year follow-up.. The Journal of Bone & Joint Surgery. 1994. DOI: 10.2106/00004623-199412000-00015 [11] Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?. Clinical Orthopaedics & Related Research. 2015. DOI: 10.1007/s11999-014-4054-3 [12] Late recurrence of giant-cell tumor of bone. A report of four cases.. The Journal of Bone & Joint Surgery. 1994. 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