Home
中文
English தமிழ் Português 中文 Tiếng Việt Filipino ਪੰਜਾਬੀ 自动翻译 — 英文版本为权威版本。

腱鞘巨细胞瘤（手指或拇指上的肿块） 资料 In-depth

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能已经注意到手指或拇指上有一个小而坚硬的肿块。它通常不痛，且往往感觉固定不动，而不是在皮肤下移动。肿块的形状可能是光滑的，也可能略有凹凸不平。

大多数这类肿块位于关节附近。手指最末端的关节是常见部位，肿块可出现在手指的背侧、掌侧或侧面。食指受累的情况比其他手指更常见。

对许多人来说，肿块本身很少造成困扰。疼痛并不总是伴随出现，但当疼痛发生时，它往往恰好位于肿块处或邻近的关节。有些人会注意到手指出现卡顿或锁定现象，或关节周围肿胀。少数人如果肿块压迫到邻近的神经，会感到刺痛或麻木。

由于肿块靠近肌腱——即手指运动时起滑动作用的索状结构——某些日常活动可能会变得不便。您可能会发现拧开罐盖、舒适地握笔、打字或扣扣子变得更加困难。任何在肿块所在处弯曲或挤压手指的动作都可能使其症状更加明显。

这些肿块生长缓慢。许多人在数月甚至数年内一直带着肿块生活，之后才去就诊。没有典型的夜间或晨起加重的模式，您所做的任何事都不会使其恶化。

有几个值得了解的要点。这种肿块是良性的，意味着它不是癌症，也不会扩散到身体其他部位。它也很常见：女性比男性更常出现，通常出现在约32至51岁之间，尽管也可能更早或更晚出现。它通常与外伤无关。

与外科医生需要明确的主要事项是彻底切除肿块，因为如果残留任何组织，这些肿块可能会复发。

实际发生了什么

您的手指有两条细绳状结构，称为肌腱，从手掌延伸至指尖。它们的作用类似于拉动木偶手指的线：当肌肉收缩时，肌腱滑动，手指随之弯曲。每条肌腱都在一个光滑的鞘管内滑动，有点像围绕移动管道的密封垫圈，以保持滑动顺畅。

腱鞘巨细胞瘤是构成该鞘管的组织过度增生。这个名字听起来令人担忧，但它描述的是组织在显微镜下的外观，而非其生物学行为。它是良性的，不是癌症。肿块从鞘管本身缓慢生长，因此触感固定，而不是在皮下滚动。

随着肿块增大，它会压迫周围结构。这解释了您注意到的大多数症状。压迫肌腱可能导致卡顿或交锁，以及邻近关节周围的肿胀。压迫神经可能导致刺痛或麻木。疼痛的发生率可能比您预期的要低，许多此类肿块根本不会引起疼痛。

存在两种主要模式。大多数肿块是单个、边界清晰的结节，边缘分明，如同胶囊中的豌豆。其余的由两个或多个互不相连的独立部分组成，这一点很重要，因为分散的碎片更难完全切除。偶尔，肿块会压迫邻近的骨骼，留下浅凹而非侵蚀骨质。

目前尚不清楚这种过度增生的确切原因。公认的观点是，鞘管组织对某种刺激产生反应并开始增殖，基因可能也起一定作用。外伤仅极少情况下是诱因。

实际要点很简单：肿块是指尖某一局部位置的问题，治疗目标是将其完全切除，以防复发。

我们如何处理

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会从适合您病情的最微创方案入手。患者通常由全科医生（GP）转诊至我们的诊所；如果理疗师建议您就诊，您仍需获得全科医生的转诊才能符合 Medicare 报销资格。在首次就诊时，我们会采集病史，检查您的手指，并在必要时安排影像学检查（如扫描）以确认肿块的性质。

对于此类肿块，您在家庭环境中几乎没有能使其缩小的有效方法。如果肿块出现卡顿或使某些任务变得困难，我们可能会建议您在一段时间内改变该手的使用方式。手部治疗旨在保持手指舒适地活动，并缓解肿块旁肌腱的任何刺激。我们通常会对此进行充分尝试，然后再考虑其他措施。

这些肿块并非由炎症引起，因此止痛药和抗炎药无法使肿块本身缩小。如果肿块引起不适，简单的止痛措施可在等待评估期间缓解症状。

大多数此类肿块不会自行消失，公认的治疗方法是完全切除肿块。由于肿块起源于腱鞘，手术旨在切除肿块及其附着的小片腱鞘。切除该附着部位至关重要：当附着部位随肿块一并切除时，这些肿块在术后平均约三年内未再复发。如果残留任何组织，肿块可能会复发，约七分之一的人因此需要接受第二次手术。由两个或更多独立部分组成的肿块比单一肿块更容易复发，因此我们会对此类情况格外谨慎。

手术是您与我们共同做出的决定。如果肿块较小、无痛且不妨碍活动，观察是一个合理的选择。如果肿块在生长、出现卡顿、压迫神经或每天困扰您，切除通常是下一步。手术本身有专门的页面，其中解释了手术内容及恢复过程。

预期情况

该肿块的预后稳定而非剧烈变化。它是良性的，因此不会扩散到身体其他部位。它生长缓慢，且大多数肿块不会自行消失。如果不予处理，它通常保持原样或逐渐缓慢增大，因此许多人最终选择将其切除。

需要重点规划的是肿块复发的可能性。大约每七人中有一人需要接受第二次手术，因为首次手术时可能残留了部分组织。当复发发生时，通常发生在首次切除后的36个月内。某些肿块比其他肿块更容易复发：由两个或更多独立部分组成的肿块，以及长入肌腱或关节囊（关节周围的袖状结构）的肿块。如果您的肿块属于这些类型，您的外科医生术后会进行更密切的随访观察。

当肿块被完全切除时，疗效在长期随访中表现良好。接受此类手术的患者通常能保持良好的手部功能，在一组术后随访人群中，功能测量值为正常水平的92%。该组中部分患者患有位于关节深部的类似肿块，并接受关节镜手术（微创手术）治疗，在接近七年后仍未复发。对于肌腱鞘上一种相关但更罕见的肿块，将其连同附着点一并切除后，在平均约三年的随访期内未见复发。

如果肿块被证实为在鞘内更广泛扩散的类型，或者术后复发，仍有其他治疗选择。放射治疗，即一种针对性的X射线疗程，有时可以在控制肿块的同时保持手部正常功能。

因此，现实的情况是：肿块不会自行消失，切除手术对大多数人效果良好，术后几年内需要主要关注的是复发，通常发生在头三年内。

何时就医

如果您的手指或拇指上出现一个坚硬的肿块，且数周后仍未消退，或者肿块正在缓慢增大，请咨询您的全科医生。如果肿块出现卡顿或锁定现象，周围关节肿胀，或者您注意到手指有刺痛感或麻木感（这可能意味着肿块正在压迫神经），请要求专科医生评估。疼痛在此类病症中较少见，但如果肿块变得有压痛，或妨碍您的工作或日常活动，也值得进行评估。这些肿块是良性的，因此不存在紧急情况，且不会扩散。主要不建议拖延数年的原因是：肿块在肌腱旁停留的时间越长，对周围结构的压迫可能越严重，而较小的肿块更容易被完全切除。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您自身治疗决策所需的范围。腱鞘巨细胞瘤值得额外阅读，因为其核心问题在于复发，且证据表明，复发更多由单个肿瘤的生物学特性驱动，而非由切除方式决定。

复发是肿瘤的特性，而不仅仅是手术的问题

对于肿块复发的直觉性解释是手术中残留了部分肿瘤。一项针对605例指部病例的系统性综述得出了相反的结论：肿瘤的内在生物学特性在复发中似乎比肿瘤位置或局部侵袭性起着更根本的作用，作者呼吁开展更大规模的前瞻性研究，以识别哪些肿瘤易于复发 [1]。

在手术前告知患者这一点确实非常有用。在规范执行的切除术后发生复发，是这种肿瘤的已知行为表现，而非手术失误的证据。

治疗为择期进行，不采取任何措施也是一个切实可行的选择

一旦开始计划手术，人们很容易忽视这一点。一线治疗的原则是完整切除，但治疗绝非紧急，且手术指征应与症状、进展、部位及患者自身情况相权衡 [4]。

对于体积小、无痛且缓慢生长的结节，观察等待是一个合理的选择。该肿瘤为良性且不会扩散，因此支持手术的理由在于功能、大小及不适感——而非危险性。

但有两个手术因素确实重要

生物学并非全部。在一项针对941例局限性腱鞘巨细胞瘤患者的研究中，与切除术后复发相关的因素是较大的肿瘤体积和初始采用关节镜治疗。鉴于并发症发生率相对较低且功能预后良好，作者建议，在可能的情况下，对高风险病例采用开放入路并完整切除，以降低复发率 [2]。

相反的观点是，一项针对1,448例患者的综述显示，关节镜切除在四个关节的局限性型病变中均被证明有效；而在弥漫型病变中，关节镜滑膜切除术仅在膝关节中显示出疗效 [3]。

调和这两者：对于小型、局限性且边界清晰的病变，两种入路均可行。随着体积增大，以及对于弥漫型病变，完整开放切除的支持证据更为充分。其原因是机械性的：该肿瘤以指状突起围绕肌腱、神经和关节延伸，而最容易被遗漏的部分是那些藏在必须被抬起并直接检查的结构后方的部分。

命名为何重要

该疾病目前归类于腱鞘巨细胞瘤，涵盖手部局限性型以及既往被称为色素性绒毛结节性滑膜炎的弥漫性关节内型 [4]。它们是同一疾病在不同部位和生长模式下的表现。

如果您查阅相关主题，了解这一点很有价值，因为搜索会返回关于膝部和髋部的资料，这些资料描述的是该疾病的弥漫性形式，而弥漫性疾病的复发率远高于局限性指部病变。将膝关节的数据应用于手指肿块会夸大风险。

放射治疗在其中的定位

对于复发或无法完全切除的弥漫性疾病，有时会考虑辅助放射治疗。一项荟萃分析发现，开放滑膜切除术，或滑膜切除术联合围手术期放射治疗，与弥漫性色素性绒毛结节性滑膜炎的复发率降低相关，同时呼吁开展大型长期前瞻性研究以证实这一结论 [5]。

对于局限性指部肿瘤（这是手部病例的绝大多数），此问题并不存在。它属于弥漫性、复发性、关节源性谱系的另一端，此处提及它仅因搜索该疾病名称时会检索到相关内容。

它不是什么

尽管名称如此，这是一种良性肿瘤。它不会扩散到身体其他部位。 “肿瘤”一词在此处承载了不应有的沉重含义，且关于复发的担忧在于反复的局部手术、僵硬以及神经邻近性，而非癌症。

参考文献

[1] Fotiadis E, Papadopoulos A, Svarnas T, Akritopoulos P, Sachinis NP, Chalidis BE. 指部腱鞘巨细胞瘤。系统综述。Hand (N Y). 2011;6(3):244-9. https://doi.org/10.1007/s11552-011-9341-9

[2] Mastboom M, Staals E, Verspoor F, Rueten-Budde A, Stacchiotti S, Palmerini E, et al. 大关节局限性腱鞘巨细胞瘤的手术治疗：基于31个国际肉瘤中心多中心汇总数据库的研究。J Bone Joint Surg Am. 2019;101(14):1309-18. https://doi.org/10.2106/JBJS.18.01147

[3] Noailles T, Brulefert K, Briand S, Longis P, Andrieu K, Chalopin A, et al. 腱鞘巨细胞瘤：开放手术还是关节镜滑膜切除术？文献系统综述。Orthop Traumatol Surg Res. 2017;103(5):809-14. https://doi.org/10.1016/j.otsr.2017.03.016

[4] Gouin F, Noailles T. 腱鞘巨细胞瘤的局限性和弥漫性形式（原称腱鞘巨细胞瘤和色素性绒毛结节性滑膜炎）。Orthop Traumatol Surg Res. 2017;103(1):S91-S97. https://doi.org/10.1016/j.otsr.2016.11.002

[5] Mollon B, Lee A, Busse JW, Griffin AM, Ferguson PC, Wunder JS, et al. 手术滑膜切除术和放射治疗对膝关节色素性绒毛结节性滑膜炎复发率的影响。Bone Joint J. 2015;97-B(4):550-7. https://doi.org/10.1302/0301-620X.97B4.34907

Reviewed by Kieran Hirpara · 28 April 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Giant cell tumors of the tendon sheaths in the hand are benign lesions [2].
  • Recurrence is the primary risk for giant cell tumors of the tendon sheaths in the hand [2].
  • Recurrence for giant cell tumors of the tendon sheaths typically occurs within 36 months of excision [2].
  • Giant cell tumors of the synovial sheaths in the hand are benign lesions [3].
  • Recurrence is the primary risk for giant cell tumors of the synovial sheaths in the hand [3].
  • Complete surgical resection remains the treatment of choice for most patients with tenosynovial giant cell tumors [7].
  • Diffuse tenosynovial giant cell tumor disease presents challenges due to high recurrence rates [7].
  • In cases of infiltrative GCTTS, radiation therapy may provide local tumor control with preservation of hand function [1].

Anatomy & Pathophysiology

Epidemiology & Demographics

  • Giant cell tumours of tendon sheath (GCTTS) are the second most common benign proliferative tumours in the upper extremities after ganglion cysts [65].
  • GCTTS are usually slow-growing, painless, benign, and consist of soft tissue [65].
  • GCTTS are most commonly found in the fingers and among women in their fourth and fifth decades [65].
  • In a systematic review of 605 patients, the male-to-female ratio for GCTTS of the digits was 1:1.47 [11].
  • In a study of 64 cases, the male-to-female ratio for GCTTS was 1:1.66 [25].
  • In a series of 12 patients, the mean age for GCTTS was 29.5 years, ranging from 10 to 53 years [23].
  • In a study of 64 cases, the age of patients ranged from 15 to 77 years with a mean age of 45 years [25].

Clinical Presentation & Location

  • GCTTS are usually asymptomatic, but as the tumour grows, patients may present with swelling, pain, and limitation of movement [65].
  • In a systematic review of 605 patients, pain was reported in 15.7% of cases and sensory disturbances in 4.57% [11].
  • In a systematic review of 605 patients, a definite history of trauma was recorded in 5% of lesions [11].
  • In a systematic review of 605 patients, the most frequent tumour location was the index finger (29.7%) [11].
  • In a study of 64 cases, the most frequent location of the tumor was the long finger in 23.5% of patients [25].
  • In a study of 64 cases, lesions were found over the thumb in 20.3% of patients [25].
  • In a study of 64 cases, lesions were found over the index finger in 20.3% of patients [25].
  • In a study of 64 cases, lesions were found over the hand in 20.3% of patients [25].
  • In a series of 12 patients, the most common presentation was with a mass over the hand, with a predilection to the thumb (n=7) [23].

Morphology & Histology

  • Type I GCTTS are defined as nodular or multinodular lesions surrounded by a capsule [65].
  • Type II GCTTS are defined as tumours with no connective tissue membrane and satellite, diffuse, or multicentric nodules [65].
  • In a systematic review of 605 patients, Type I tumours (single lesions) were detected in 78.7% of cases [11].
  • In a systematic review of 605 patients, Type II tumours (two or more distinct tumours that were not joined together) were detected in 21.3% of cases [11].
  • Microscopically, all GCTTS tumors contained multinucleated giant cells, histiocytes, and haemosiderin deposits [25].
  • Macroscopically, the average size of GCTTS tumors was 1.35 cm, with a range of 0.3 cm to 5 cm [25].

Pathogenesis & Etiology

  • GCTTS originate from the synovial membrane, tendon sheath, or synovial bursa [65].
  • The pathogenesis of GCTTS remains unclear [65].
  • Inflammation resulting from reactive or regenerative hyperplasia is the generally accepted theory of pathogenesis for GCTTS [65].
  • Genetic factors have been observed in previous studies regarding GCTTS pathogenesis [65].

Imaging & Local Invasion

  • Radiography can be helpful in evaluating cortical destruction but is not helpful in the definitive diagnosis of GCTTS [65].
  • Magnetic resonance imaging (MRI) is the most useful examination for the diagnosis and treatment planning of GCTTS [65].
  • In a series of 12 patients, radiological changes in the form of bony indentation were seen in only 2 cases [23].
  • In a study of 64 cases, bone erosion was found in 3 patients (4.7%) [25].
  • In a study of 64 cases, tendon involvement occurred in 7 cases (10.9%), with a flexor-to-extensor ratio of 4:3 [25].
  • In a study of 64 cases, involvement of the neurovascular bundle was presented in 7 patients (10.9%) [25].

Classification

  • Giant cell tumour of tendon sheath (GCTTS) is classified into two main types based on whether the entire tumour is surrounded by one pseudocapsule [56].
  • Type I GCTTS consists of single lesions [11].
  • Type II GCTTS consists of two or more distinct tumours that are not joined together [11].
  • Type I tumours were detected in 78.7% of patients in a systematic review of 605 patients [11].
  • Type II tumours were detected in 21.3% of patients in a systematic review of 605 patients [11].
  • In a prospective study of 43 cases, none of the 30 Type I tumours recurred [56].
  • In a prospective study of 43 cases, recurrence occurred in five out of 13 Type II tumours [56].
  • Second recurrences were observed with Type II B and C tumours but not with Type II A tumours [56].
  • Type II tumours are associated with a higher risk of recurrence compared to Type I tumours [11].
  • The Al-Qattan classification is used to classify GCTTS lesions based on capsule thickness, lobulation, satellite lesions, and diffuse or multicentric nature [23].

Clinical Presentation

  • Giant cell tumors of the tendon sheaths in the hand are benign lesions where recurrence is the primary risk [2].
  • Giant cell tumors of the synovial sheaths in the hand are benign lesions in which recurrence is the primary risk [3].
  • Pigmented villonodular synovitis and giant-cell tumor of tendon sheath are benign synovial neoplasms with the potential for local recurrence [38].
  • Patients with giant cell tumor of tendon sheath may present with a discrete mass or with joint swelling, pain, or locking or catching [26].
  • The most frequent tumour location for giant cell tumour of tendon sheath of the digits is the index finger, accounting for 29.7% of cases [11].
  • In a series of 91 finger tumors, 31 occurred at the distal joints, with 18 on the dorsal aspect and 13 distributed about evenly on the radial, ulnar, and volar aspects [22].
  • The tumors were usually firm, lobulated, and non-tender [22].
  • The masses were somewhat fixed [22].
  • Pain was reported in 15.7% of cases of giant cell tumour of tendon sheath of the digits [11].
  • Sensory disturbances were reported in 4.57% of cases of giant cell tumour of tendon sheath of the digits [11].
  • A definite history of trauma was recorded in 5% of lesions [11].
  • The male-to-female ratio for giant cell tumour of tendon sheath of the digits was 1:1.47 [11].
  • The mean age for giant cell tumour of tendon sheath of the digits ranged from 32 to 51 years [11].
  • Type I tumours (single lesions) were more frequently detected (78.7%) than type II tumours (two or more distinct tumours that were not joined together) (21.3%) [11].
  • Type II tumours were associated with higher recurrence rates [11].
  • The overall recurrence rate for giant cell tumour of tendon sheath of the digits was 14.8% [11].
  • The duration of symptoms for finger tumors ranged from two weeks to fifteen years, with an average duration of thirty-eight months [22].
  • In a series of 12 patients, the mean age was 29.5 years, ranging from 10 to 53 years [23].
  • Radiological changes in the form of bony indentation were seen in only 2 cases out of 12 [23].
  • Direct involvement of the extensor tendons, flexor tendons, or joint capsule puts patients in a high-risk category with respect to recurrence [21].

Investigations

  • MRI findings and location might help in the diagnosis of tenosynovial giant cell tumors, but careful assessment is mandatory, especially in unusual locations [84].
  • Radiologists should be familiar with the imaging characteristic of giant cell tumors of the mobile spine with invasion of adjacent vertebrae [87].

Treatment

Surgical Excision

  • Complete surgical resection is the treatment of choice for most patients with tenosynovial giant cell tumors [7].
  • Total surgical excision ensuring removal of the attachment site (flexor sheath/palmar fascia) resulted in no local recurrences at a mean follow-up of 3.2 years [8].
  • En bloc resection and matched nonvascularized toe phalangeal transfer resulted in a functional tumor-free digit with a low complication rate and no recurrences for Campanacci Grade 2 or 3 giant cell tumors of the phalanges [17].
  • Repeated curettage with adjuvants eventually resulted in the cure for all patients and is a reasonable treatment for both primary and recurrent GCT of the small bones of the hands and feet [68].
  • Intralesional excision with local adjuvant therapy is recommended for the treatment of giant cell tumor of bone because it results in a good functional outcome compared to extralesional excision [63].
  • Intralesional excision with cautery and methylmethacrylate provides a reliable method of treatment of giant cell tumors with good long-term functional results [37].
  • 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 [6].
  • Intralesional excision appears to be more appropriate for the treatment of local lesions (eg, Grades 1 and 2) than Grade 3 GCTs of the distal radius [27].
  • 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 [4].
  • The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome [24].
  • 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 [73].
  • The use of a massive biocompatible bipolar unconstrained prosthesis is a viable treatment option for distal radius reconstruction after en-bloc resection of a giant cell tumour, offering rapid functional improvement without donor-site morbidity [62].
  • This is a simple and effective modality of reconstruction after resection of distal radial tumors [13].
  • Aggressive and malignant bone tumors of the second through fifth metacarpals generally require en bloc bone excision [18].
  • It is essential that an adequate, safe margin of normal tissue first be excised en bloc with the tumor for aggressive and malignant bone tumors of the second through fifth metacarpals [18].
  • Wide en bloc excision of soft tissue sarcomas with negative margins is required to achieve local control of the lesion [18].
  • At a minimum, aggressive soft tissue tumors, such as bone tumors, require ray resection or removal of multiple rays [18].
  • Central palmar lesions more likely require sacrifice of three rays; those on the border are more likely than those in the center to be salvageable by removing just two rays [18].
  • In the presence of proximal, broader, and larger lesions, all four digits or the entire hand may have to be sacrificed to save the patient [18].
  • If a malignant tumor has broken into the midpalm and extends across the metacarpals, removal of all digital rays may be needed to gain an adequate soft tissue margin [18].
  • If a tumor extends proximally from the metacarpal level, a more proximal level of hand, wrist, or forearm amputation is required for safe tumor management [18].
  • Malignant soft tissue tumors in the palm or carpal tunnel often require at least partial hand amputation [18].
  • Below-elbow amputation is necessary to treat larger tumors [18].
  • This case offers a practical strategy for the surgical management of this rare hand tumor [5].

Recurrence and Risk Factors

  • Giant cell tumors of the tendon sheaths in the hand are benign lesions where recurrence is the primary risk, typically occurring within 36 months of excision [2].
  • In total, 14.8% of patients had tumour recurrence in a systematic review of giant cell tumour of tendon sheath of the digits [11].
  • Type II tumours (two or more distinct tumours that were not joined together) were associated with higher recurrence rates than Type I tumours (single lesions) [11].
  • Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence [12].
  • Diffuse disease presents challenges due to high recurrence rates for tenosynovial giant cell tumors [7].
  • Our recurrence rate was 4,7% (n=3) in a study of 64 cases of giant cell tumor of tendon sheath [25].
  • In 3 patients (4,7%) bone erosion was found, and in 7 cases (10,9%) tendon involvement was found in a study of 64 cases of giant cell tumor of tendon sheath [25].
  • In the three recurrence cases, surgical excision was difficult [25].
  • We recommend selective use of curettage and cementing in Grade III lesions, particularly with extensive soft tissue involvement [35].

Complications

  • The pooled recurrence rate for giant cell tumour of tendon sheath of the digits after surgical excision is 14.8% [11].
  • Type II tumours (two or more distinct tumours that were not joined together) are associated with higher recurrence rates than Type I tumours [11].
  • Direct involvement of the extensor tendons, flexor tendons, or joint capsule places patients in a high-risk category for recurrence [21].
  • Total surgical excision ensuring removal of the attachment site (flexor sheath/palmar fascia) resulted in no local recurrences at a mean follow-up of 3.2 years for fibroma of tendon sheath [8].
  • En bloc resection and matched nonvascularized toe phalangeal transfer for Campanacci Grade 2 or 3 giant cell tumor of the phalanges resulted in no recurrences [17].
  • Patients with giant cell tumor of bone who are at higher risk of recurrence should be clinically followed more closely [15].
  • Metachronous multicentric giant cell tumor can recur with a disease-free interval of up to 24 years [43].

Recovery

  • Recurrence for giant cell tumors of the tendon sheaths in the hand typically occurs within 36 months of excision [2].
  • Surgical treatment for pigmented villonodular synovitis led to good functional results with an average Enneking score of 92% of normal limb function [10].
  • Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence in giant cell tumor of tendon sheath [12].
  • Patients with pigmented villonodular synovitis of the hip managed with arthroscopic synovectomy reported good functional outcomes without evidence of recurrence in a 19 patient cohort with an average follow-up of almost 7 years [76].

Key Evidence

  • [L4] In cases of infiltrative GCTTS, radiation therapy may provide local tumor control with preservation of hand function. [1] (10.1016/j.jhsa.2012.01.011)
  • [L4] Giant cell tumors of the tendon sheaths in the hand are benign lesions where recurrence is the primary risk, typically occurring within 36 months of excision. [2] (10.1016/j.otsr.2013.03.008)
  • [L4] Giant cell tumors of the synovial sheaths in the hand are benign lesions in which recurrence is the primary risk. [3] (10.1016/j.jhsa.2013.08.051)
  • [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. [4] (10.1177/17531934211007820)
  • [Paper] This case offers a practical strategy for the surgical management of this rare hand tumor. [5] (10.1177/15589447261480384)
  • [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. [6] (10.1007/s11999-014-4054-3)
  • [L5] Complete surgical resection remains the treatment of choice for most patients with tenosynovial giant cell tumors, though diffuse disease presents challenges due to high recurrence rates. [7] (10.5435/jaaos-d-24-01255)
  • [L4] Total surgical excision ensuring removal of the attachment site (flexor sheath/palmar fascia) resulted in no local recurrences at a mean follow-up of 3.2 years. [8] (10.1177/1753193412469146)
  • [L4] Surgical treatment led to good functional results with an average Enneking score of 92% of normal limb function. [10] (10.1097/01.blo.0000224051.01873.fb)
  • [L1] [11] (10.1007/s11552-011-9341-9)
  • [L3] Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence. [12] (10.1186/s12891-019-2866-8)
  • [L4] This is a simple and effective modality of reconstruction after resection of distal radial tumors. [13] (10.1016/j.jhsa.2022.05.011)
  • [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. [15] (10.1007/s11999-011-2172-8)
  • [L4] En bloc resection and matched nonvascularized toe phalangeal transfer resulted in a functional tumor-free digit with a low complication rate and no recurrences. [17] (10.1016/j.jhsa.2024.06.013)
  • [L3] Direct involvement of the extensor tendons, flexor tendons, or joint capsule puts patients in a high-risk category with respect to recurrence. [21] (10.1016/j.jhsa.2009.12.004)
  • [L4] [22] (10.2106/00004623-196951010-00005)
  • [L4] [23] (10.1007/s12593-010-0020-9)
  • [L3] The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome. [24] (10.1177/1558944717743598)
  • [L4] [25] (10.11138/gchir/2013.34.5.149)
  • [Case_report] [26] (10.1016/j.jhsa.2014.11.010)
  • [L3] Based on data obtained from the number of studies available, intralesional excision appears to be more appropriate for the treatment of local lesions (eg, Grades 1 and 2) than Grade 3 GCTs of the distal radius. [27] (10.1007/s11999-012-2464-7)
  • [L4] We recommend selective use of this procedure in Grade III lesions, particularly with extensive soft tissue involvement. [35] (10.4103/0019-5413.77138)
  • [L4] Intralesional excision with cautery and methylmethacrylate provides a reliable method of treatment of giant cell tumors with good long-term functional results. [37] (10.1097/01.blo.0000128280.59965.e3)
  • [L4] Pigmented villonoid synovitis and giant-cell tumor of tendon sheath are benign synovial neoplasms with the potential for local recurrence. [38] (10.2106/00004623-198466010-00012)
  • [L4] This patient has the longest disease-free interval of a metachronous multicentric giant cell tumor reported to date, with 24 years passing between the initial presentation and the multicentric recurrence. [43] (10.1097/01.blo.0000068770.86536.e1)
  • [L3] [56] (10.1054/jhsb.2000.0522)
  • [Case_report] The use of a massive biocompatible bipolar unconstrained prosthesis is a viable treatment option for distal radius reconstruction after en-bloc resection of a giant cell tumour, offering rapid functional improvement without donor-site morbidity. [62] (10.1016/j.otsr.2013.04.001)
  • [L3] Intralesional excision with local adjuvant therapy is recommended for the treatment of giant cell tumor of bone because it results in a good functional outcome compared to extralesional excision. [63] (10.1007/s004020100317)
  • [L4] [65] (10.1177/17531934231222401)
  • [L3] Repeated curettage with adjuvants eventually resulted in the cure for all patients and is therefore a reasonable treatment for both primary and recurrent GCT of the small bones of the hands and feet. [68] (10.1302/0301-620x.95b6.30876)
  • [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. [73] (10.1007/s00402-010-1059-6)
  • [L4] Patients reported good functional outcomes without evidence of recurrence in a 19 patient cohort with an average follow-up of almost 7 years. [76] (10.1177/2325967119s00413)
  • [L4] Although MRI findings and location might help in the diagnosis of a T-GCT, careful assessment is mandatory, especially in unusual locations. [84] (10.1186/s12891-016-1050-7)
  • [L4] Radiologists should be familiar with this imaging characteristic. [87] (10.1186/s12891-021-04610-0)

References

[1] Radiation Therapy for Infiltrative Giant Cell Tumor of the Tendon Sheath. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.01.011

[2] Giant cell tumors of the tendon sheaths in the hand: Review of 96 patients with an average follow-up of 12 years. Orthopaedics & Traumatology: Surgery & Research. 2013. DOI: 10.1016/j.otsr.2013.03.008

[3] Giant Cell Tumors of the Tendon Sheaths in the Hand: Review of 96 Patients With an Average Follow-Up of 12 Years. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.051

[4] Giant cell tumour of hand bones: outcomes of treatment. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211007820

[5] Management of a Rare Digital Dermocutaneous Fibroma of the Flexor Tendon Sheath. HAND. 2026. DOI: 10.1177/15589447261480384

[6] 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

[7] Tenosynovial Giant Cell Tumor and Pigmented Villonodular Synovitis. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01255

[8] Fibroma of tendon sheath of the hand: a series of 20 patients with 23 tumours. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412469146

[10] What Affects the Recurrence and Clinical Outcome of Pigmented Villonodular Synovitis?. Clinical Orthopaedics and Related Research. 2006. DOI: 10.1097/01.blo.0000224051.01873.fb

[11] Giant Cell Tumour of Tendon Sheath of the Digits. A Systematic Review. HAND. 2011. DOI: 10.1007/s11552-011-9341-9

[12] Giant cell tumor of tendon sheath in the hand: analysis of risk factors for recurrence in 50 cases. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2866-8

[13] Functional Outcomes of Centralization of the Ulna as a Method of Reconstruction Following Resection of Campanacci Grade 3 Giant Cell Tumor of the Distal Radius. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.05.011

[15] Giant Cell Tumor of Bone: Are We Stratifying Results Appropriately?. Clinical Orthopaedics & Related Research. 2012. DOI: 10.1007/s11999-011-2172-8

[17] Campanacci Grade 2 or 3 Giant Cell Tumor of the Phalanges: En Bloc Resection and Matched Nonvascularized Toe Phalangeal Transfer. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.06.013

[18] Green S Operative Hand Surgery. BOX 59.1 Ganglions of the Hand and Wrist > Finger Metacarpals.

[21] Recurrence of Giant Cell Tumors in the Hand: A Prospective Study. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.12.004

[22] Fibrous Xanthoma of Synovium (Giant-Cell Tumor of Tendon Sheath, Pigmented Nodular Synovitis). The Journal of Bone & Joint Surgery. 1969. DOI: 10.2106/00004623-196951010-00005

[23] Giant Cell Tumor of Tendon Sheath: Case Series and Review of Literature. Journal of Hand and Microsurgery. 2010. DOI: 10.1007/s12593-010-0020-9

[24] Extensor Carpi Ulnaris Tenodesis Versus No Stabilization After Wide Resection of Distal Ulna Giant Cell Tumors. HAND. 2017. DOI: 10.1177/1558944717743598

[25] Giant cell tumor of tendon sheath: study of 64 cases and review of literature. Giornale di Chirurgia - Journal of Surgery. 2013. DOI: 10.11138/gchir/2013.34.5.149

[26] Recurrent Pigmented Villonodular Synovitis and Multifocal Giant Cell Tumor of the Tendon Sheath: Case Report. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.11.010

[27] Which Treatment is the Best for Giant Cell Tumors of the Distal Radius? A Meta-analysis. Clinical Orthopaedics & Related Research. 2012. DOI: 10.1007/s11999-012-2464-7

[35] Local recurrences after curettage and cementing in long bone giant cell tumor. Indian Journal of Orthopaedics. 2011. DOI: 10.4103/0019-5413.77138

[37] Results of Giant Cell Tumor of Bone Treated With Intralesional Excision. Clinical Orthopaedics & Related Research. 2004. DOI: 10.1097/01.blo.0000128280.59965.e3

[38] Pigmented villonodular synovitis (giant-cell tumor of the tendon sheath and synovial membrane). A review of eighty-one cases.. The Journal of Bone & Joint Surgery. 1984. DOI: 10.2106/00004623-198466010-00012

[43] Metachronous Multicentric Giant Cell Tumor: A Case Report and Literature Review. Clinical Orthopaedics & Related Research. 2003. DOI: 10.1097/01.blo.0000068770.86536.e1

[56] Giant Cell Tumours of Tendon Sheath: Classification and Recurrence Rate. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2000.0522

[62] Massive wrist prosthesis for giant cell tumour of the distal radius: A case report with a 3-year follow-up. Orthopaedics & Traumatology: Surgery & Research. 2013. DOI: 10.1016/j.otsr.2013.04.001

[63] Oncologic and functional results after treatment of giant cell tumors of bone. Archives of Orthopaedic and Trauma Surgery. 2001. DOI: 10.1007/s004020100317

[65] The effect of surgical factors on recurrence of tendon sheath giant cell tumours. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934231222401

[68] Giant cell tumours of the small bones of the hands and feet. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b6.30876

[73] 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

[76] Pigmented Villonodular Synovitis of the Hip Managed with Arthroscopic Synovectomy: An Analysis of 19 Cases with up to 10-year Follow-up. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00413

[84] Tenosynovial giant cell tumors in unusual locations detected by positron emission tomography imaging confused with malignant tumors: report of two cases. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1050-7

[87] Giant cell tumors of the mobile spine with invasion of adjacent vertebrae: an unusual imaging finding. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04610-0

专业协会这些代表什么？→