Giant Cell Tumour of Tendon Sheath (Lump on a Finger or Thumb) Info In-depth Evidence
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Patients › Hand
A giant cell tumour of tendon sheath is a common, benign (non-cancerous) lump on a finger or thumb. What causes it, how it is diagnosed and removed, and how often it comes back.
A giant cell tumour of tendon sheath is a common, benign (non-cancerous) lump on a finger or thumb. It is the second most common lump in the hand after a ganglion cyst. It grows slowly, does not spread to other parts of the body, and is usually removed with a small operation, though it can sometimes come back. This page explains what it is, how it is diagnosed, what removing it involves, and how often it returns.
What it is
A giant cell tumour of tendon sheath grows from the lining of a tendon sheath or the neighbouring joint (the synovium, the slippery tissue that lets tendons glide). The name "giant cell" describes how it looks under the microscope, where clusters of large, many-nucleated cells are mixed with smaller cells. It says nothing about how it behaves: this is a benign growth that stays in the hand. Doctors sometimes call it a localised tenosynovial giant cell tumour.
Where it appears and what it feels like
It almost always sits on a finger or thumb, often on the palm or side, close to one of the finger joints. Typically it is:
- firm and rubbery, rather than soft, and slow to grow
- usually painless, though it can ache or catch as it enlarges
- solid, so (unlike a fluid-filled ganglion) it does not glow when a torch is held against it
As it grows it can make it harder to fully bend the finger, and occasionally it presses on a small nerve and causes tingling. Rarely, a long-standing tumour presses a smooth hollow into the bone beside it, which shows up on an X-ray.
How it is diagnosed
Your surgeon can often recognise it from examining the lump. An ultrasound scan helps confirm it is solid rather than the fluid of a ganglion. For a larger, deeper or recurrent lump, an MRI scan shows how far it extends and has a fairly characteristic appearance (it looks dark on certain sequences because of an iron-containing pigment in the tissue). An X-ray is added if the lump appears to involve nearby bone. The diagnosis is confirmed for certain when the removed lump is examined under the microscope.
Treatment: removing the lump
The usual treatment is a small operation to remove it, called a marginal excision, typically as a day case under local or general anaesthetic. Through a small incision the surgeon removes the whole nodule, along with any smaller satellite nodules and the involved sheath, working carefully around the nearby nerves, blood vessels and tendons. Removing all of the tumour, rather than just the obvious lump, is what lowers the chance of it returning. There are no tablets or injections that make this type of lump shrink.
How often it comes back
This lump can return after surgery. Across published series, roughly 1 in 7 to 1 in 5 come back (about 10 to 20 in 100). Recurrence is more likely when there were several nodules, when the tumour had wrapped around tendons or bone, or when some was left behind at the first operation. Most recurrences show up within the first two years, which is why your surgeon will keep an eye on the area during that period, although in rare cases a lump can return many years later. If it does come back, it can usually be removed again.
Recovery
Most people go home the same day with a dressing, and sometimes a light splint. Moving the finger gently early on helps prevent stiffness, and a hand therapist can guide this if needed. Stitches are usually removed at about two weeks. You can expect to use the hand for light tasks within a few days and to build back to fuller use over a few weeks, guided by comfort and your surgeon's advice. Protecting the scar from the sun and massaging it once healed helps it settle.
Advanced reading: the deeper science (optional)
This section goes a step deeper, at a student level. It is not needed to understand or treat the lump, but it explains what drives this tumour and why it sometimes returns.
What drives the growth
A giant cell tumour of tendon sheath is the localised form of a family of growths called tenosynovial giant cell tumours. The engine behind them is overproduction of a signalling protein called CSF1 (colony-stimulating factor 1), usually triggered by a small swap of genetic material between chromosomes in a minority of the tumour cells. Those cells release CSF1, which draws large numbers of immune cells (macrophages) in from the bloodstream. Most of the lump is actually made of these recruited cells rather than the original abnormal ones, which is an unusual way for a growth to build itself.
What it looks like under the microscope and on a scan
Under the microscope the lump is a mix of smaller mononuclear cells, foamy fat-filled macrophages, and the multinucleated giant cells that give it its name. It also contains haemosiderin, an iron-rich pigment left behind by tiny old bleeds within the tissue. That iron is why the lump often appears dark on certain MRI sequences, a feature that helps tell it apart from a fluid-filled ganglion before any surgery.
Localised versus diffuse, and why it can recur
The common finger and thumb lumps are the localised type, which is well defined and usually removed completely. A less common diffuse type spreads more widely through a joint lining (the same process that, in a large joint, is called pigmented villonodular synovitis). The diffuse type is harder to remove fully and comes back more often. Even the localised type can return if small satellite nodules are left behind, which is why the surgeon takes out the whole lump and the involved sheath around it rather than just the obvious part.
When tablets have a role
For the rare diffuse tumours that cannot be removed surgically, or that keep returning, medicines that block the CSF1 signal (CSF1-receptor inhibitors) can shrink them. These are reserved for difficult cases and are not used for the ordinary, easily removed finger lump, which surgery deals with directly.
When to see someone
See your GP or a hand surgeon if you have a firm lump on a finger or thumb that does not go away, slowly grows, limits how the finger moves, or causes numbness or tingling. After surgery, let your surgeon know if you notice a new lump in or near the scar, as this can be a sign the tumour is returning and is worth checking early.
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. DOI: 10.2106/00004623-199408000-00013 [13] Dilemmas in Distinguishing Between Tumor and the Posttraumatic Lesion with Surgical or Pathologic Correlation. Clinics in Sports Medicine. 2013. DOI: 10.1016/j.csm.2013.03.008 [14] Superficial Angiomyxoma of the Thumb Mimicking a Malignant Bone Tumor: Case Report. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.01.004 [15] Spread of Squamous Cell Carcinoma From the Thumb to the Small Finger via the Flexor Tendon Sheaths. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.06.012 [16] A High-grade Sarcoma Arising in a Patient With Recurrent Benign Giant Cell Tumor of the Proximal Tibia While Receiving Treatment With Denosumab. Clinical Orthopaedics & Related Research. 2015. DOI: 10.1007/s11999-015-4249-2 [17] CORR Insights®: Is Treatment with Denosumab Associated with Local Recurrence in Patients with Giant Cell Tumor of Bone Treated with Curettage? A Systematic Review. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001217 [18] Recurrence of giant-cell tumors of the long bones after curettage and packing with cement.. The Journal of Bone & Joint Surgery. 1994. DOI: 10.2106/00004623-199412000-00009 [19] Aneurysmal bone cyst and giant cell tumor of bone of the hand and distal radius. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.03.016 [20] Oncologic Conditions That Simulate Common Sports Injuries. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-04-223 [21] Megavoltage Radiation Therapy for Axial and Inoperable Giant-Cell Tumor of Bone. The Journal of Bone & Joint Surgery. 1999. DOI: 10.2106/00004623-199911000-00008 [22] Giant cells tumor recurrence at the third lumbar vertebra. Orthopaedics & Traumatology: Surgery & Research. 2010. DOI: 10.1016/j.otsr.2010.05.009 [23] Resection of a giant cell tumour of the proximal phalanx and reconstruction by iliac crest graft. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408097859 [27] Radiation Therapy for Giant Cell Tumors of Bone. Clinical Orthopaedics & Related Research. 2003. DOI: 10.1097/01.blo.0000069890.31220.b4 [29] Giant Cell Tumor of Bone. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/jaaos-21-02-118 [31] Autogenous non-vascularized fibula for treatment of giant cell tumor of distal end radius. Archives of Orthopaedic and Trauma Surgery. 2010. DOI: 10.1007/s00402-010-1059-6 [32] Skeletal Metastasis in Tricholemmal Carcinoma. Clinical Orthopaedics & Related Research. 2004. DOI: 10.1097/01.blo.0000129555.37075.74 [33] Giant Cell Tumor of Bone: Risk Factors for Recurrence. Clinical Orthopaedics & Related Research. 2011. DOI: 10.1007/s11999-010-1501-7 [36] Parosteal Osteosarcoma of the Proximal Phalanx of a Finger. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.08.006 [38] Multicentric Giant Cell Tumor of Bone: A Case Report and Review of the Literature. Clinical Orthopaedics & Related Research. 2003. DOI: 10.1097/01.blo.0000063784.32430.b0 [39] Fibroma of tendon sheath of the hand in a 3-year-old boy: a case report. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03728-x [42] Vascularised Joint Transfer in the Management of Recurrent Giant Cell Tumour of the Second Metacarpal. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408089048 [45] Florid Reactive Periostitis of the Metacarpal and Phalanx: 2 Case Reports. The Journal of Hand Surgery*. 2013. DOI: 10.1016/j.jhsa.2013.08.115
