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腱鞘巨细胞瘤（手指或拇指上的肿块） 资料

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

您可能会在手指或拇指上发现一个小的、坚硬的肿块。这是一种良性生长物，意味着它不是癌症。它位于腱鞘上，腱鞘是一种光滑的覆盖层，有助于肌腱顺畅滑动。大多数人最初发现这个肿块时没有疼痛感。它可能只是感觉像皮肤下的一个奇怪凸起。

随着肿块增大，它可能会压迫附近的神经或组织。您可能会在该特定部位感到钝痛或锐痛。当您使用手部时，疼痛通常会加重。需要抓握或捏取的任务，如打开罐子或拿手机，可能会变得不舒服。您可能还会注意到肿块附近的关节僵硬。

有些人会在夜间感到疼痛。这可能会使入睡或保持睡眠变得困难。侧卧在该手上会对肿块施加额外压力，导致搏动性或刺痛感。您可能会在醒来时发现手指僵硬，需要几分钟才能缓解。

日常活动可能会变得困难。简单的动作，如扣衬衫纽扣或塞上衣，可能会感觉别扭。伸手到背后扣文胸或调整衣物可能会引起疼痛。您可能会发现自己避免用那只手进行重体力劳动或重复性任务。

重要的是要知道，这个肿块在切除后可能会复发。局部复发见于高达 20% 的病例。大多数复发发生在手术后的头两年内。然而，一些患者在更长时间内仍处于复发风险中，复发可能发生在初始治疗后的十九至三十年。这就是为什么您的外科医生会随着时间的推移密切监测该区域。

如果您肿胀时间较长，或者肿胀是在受伤后开始的，则需要进行适当的影像学检查。这有助于排除其他疾病。虽然罕见，但软组织肿瘤可能模仿常见的损伤。保持警惕对于确保您获得正确的诊断和治疗至关重要。您的外科医生将指导您采取下一步措施来管理症状并预防并发症。

实际情况是什么

腱鞘巨细胞瘤是一种常见于手部的良性肿块。它通常出现在手指或拇指上。虽然名称听起来令人担忧，但这种生长物是良性的。这意味着它不会扩散到身体的其他部位。

肿块形成于覆盖肌腱的软组织中。肌腱是连接肌肉与骨骼的坚韧、绳索状纤维，使您能够弯曲和伸直手指。肿瘤在腱鞘（包裹这些纤维的保护性鞘管）内缓慢生长。

随着肿块扩大，它会压迫周围结构。这种压力正是导致您所感受到的症状的原因。您可能会注意到皮下有一个坚实且无痛的隆起。在某些情况下，这种生长物可能会刺激关节或限制活动。

尽管这些肿瘤是良性的，但在极少数情况下可能表现出侵袭性行为。它们在切除后有复发的倾向。因此，谨慎的治疗至关重要。您的外科医生将力求完整切除肿块，以降低复发风险。

将这种情况与其他手部肿块区分开来非常重要。有时，X 光或 MRI 等影像学检查无法清晰区分腱鞘巨细胞瘤与其他类型的生长物。因此，在决定治疗方案之前，精确的诊断至关重要。

虽然这些肿瘤在成人中最常见，但在儿童中则较为罕见。如果您手部出现肿块，您的外科医生会对其进行仔细评估。他们将确定是否存在这种特定类型的生长物，并为您制定最佳的治疗方案。

我们能采取的措施

在洛克汉普顿 Mater 私人医院，Kieran Hirpara 医生首先通过确认肿块的性质来应对这种情况。影像学检查有助于我们将腱鞘巨细胞瘤与其他原因区分开来，尽管它有时可能与其他软组织问题相似。我们在选择治疗方案前会先明确诊断。

对于许多患者，我们从保守治疗开始。这包括改变活动方式以减少手指或拇指的负担，以及进行手部治疗以保持关节活动顺畅。如果存在疼痛或肿胀，我们可能会建议服用抗炎药物或注射可的松以减轻局部炎症。这些步骤旨在通过非手术方式管理症状并改善功能。我们通常会给予这种方法充分的尝试，以观察其是否能提供足够的缓解。

当保守治疗未能带来足够改善，或肿块增大并影响手部功能时，我们会考虑手术。腱鞘巨细胞瘤是良性的，但切除后可能会复发。我们的目标是在保留关节和肌腱功能的前提下，进行彻底但保守的切除以去除肿块。在某些情况下，如果病变累及骨骼，我们可能会使用一种称为“刮除术”的技术，即刮除受影响区域，有时会用骨水泥填充该空间以支撑结构。

复发是一个已知的风险。大多数复发发生在最初两年内，但部分患者长期处于风险之中，复发可能发生在初始治疗后的长达三十年内。我们会在术后密切监测您，以便尽早发现任何变化。如果发生复发，进一步手术仍然有效。既往治疗（如骨水泥填充）似乎不会降低通过单纯刮除或广泛切除治疗复发的有效性。

在肿瘤广泛或手术难以切除的罕见情况下，放射治疗可能是一个选择。研究表明，放射治疗可以有效控制肿瘤，十年无进展率高达 85%。当手术不可行时，这是一种安全有效的替代方案。

我们将治疗视为共同决策的过程。我们会与您讨论风险、益处及复发的可能性。我们的目标是在长期内控制局部病变并保留手部功能。无论是通过治疗、药物还是手术，我们都会根据您的具体需求和疾病程度量身定制治疗方案。

预期情况

腱鞘巨细胞瘤是手指或拇指上常见的良性肿块。虽然它是良性的，但切除后可能会复发。大多数复发发生在最初两年内。然而，部分患者长期处于复发风险中，复发可能在初次治疗后的十九至三十年发生。

如果您不处理该肿块，它可能会持续存在或缓慢增大。它很少自行消退。由于这些肿瘤可能具有局部侵袭性，您的外科医生可能会建议切除，以防止进一步生长并保护关节功能。

手术后，您的手部需要时间愈合。在恢复活动能力时，您可能会经历一些肿胀和僵硬。大多数人会在几周内恢复正常日常活动，但完全恢复力量可能需要更长时间。我们会密切监测您的恢复情况，以确保关节保持稳定和功能。

在极少数情况下，肿瘤细胞可能残留在手术瘢痕中，导致软组织复发。这就是为什么我们 meticulous 关注手术细节的原因。如果肿瘤复发，通常可以通过仔细刮除或更广泛的切除再次治疗。这些重复手术是有效的，不会降低您长期控制病情的机会。

对于大多数患者，预后是积极的。您可以期望保持手部的全部功能。我们的目标是实现持久且保留关节功能的效果。虽然保持警惕很重要，但您无需过度担忧。定期复查有助于我们及早发现任何变化。通过适当的护理，您可以在未来多年保持手部健康且活动自如。

何时就诊

如果您发现手指或拇指上有一个持续存在且不消退的肿块，请咨询您的全科医生（GP）。如果疼痛在休息后未缓解，或肿块导致手部无力、卡顿或不稳定，请要求专科医生进行评估。如果症状突然加重或影响睡眠或工作，请立即就医。即使受伤后，长期肿胀也可能表明存在严重疾病，需要在手术前进行适当的影像学检查。早期评估有助于预防并发症，并确保手部功能的最佳预后。

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, 3].
  • Recurrence is the primary risk associated with giant cell tumors of the tendon sheaths in the hand [2, 3].
  • Recurrence of giant cell tumors of the tendon sheaths in the hand typically occurs within 36 months of excision [2].
  • Complete surgical resection remains the treatment of choice for most patients with tenosynovial giant cell tumors [6].
  • Diffuse disease in tenosynovial giant cell tumors presents challenges due to high recurrence rates [6].
  • In cases of infiltrative giant cell tumor of the tendon sheath, radiation therapy may provide local tumor control with preservation of hand function [1].
  • 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 the tendon sheath [7].
  • 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 of giant cell tumor of the tendon sheath in the hand [8].

Anatomy & Pathophysiology

  • Radiation therapy may provide local tumor control with preservation of hand function in cases of infiltrative Giant Cell Tumor of the Tendon Sheath (GCTTS) [1].
  • Surgical treatment for Pigmented Villonodular Synovitis (PVNS) led to good functional results with an average Enneking score of 92% of normal limb function [10].
  • Patients with diffuse Pigmented Villonodular Synovitis reported good functional outcomes without evidence of recurrence in a 19-patient cohort with an average follow-up of almost 7 years [22].
  • Satisfactory functional results in diffuse Pigmented Villonodular Synovitis mirror the status of the underlying joint [42].

Classification

  • Giant cell tumors of the synovial sheaths in the hand are benign lesions [3].
  • Tenosynovial giant cell tumors include pigmented villonovular synovitis [6].
  • Fibroma of the tendon sheath is a distinct entity from giant cell tumor of the tendon sheath [7].
  • Epiphyseal chondromatous giant cell tumors represent a distinct clinical entity of essentially benign giant cell tumors [9].
  • Giant cell tumors of bone in the hand are a rare condition [4].
  • Giant cell tumors of the distal radius are classified into Grades 1, 2, and 3 [14].
  • Tumors with extension limited to a single site of palmar cortical perforation are classified as grade 3(p) [35].
  • Campanacci grade III giant cell tumours of the distal radius are a specific classification subset [40].
  • Direct involvement of the extensor tendons, flexor tendons, or joint capsule places patients in a high-risk category with respect to recurrence [25].
  • Grade III lesions, particularly with extensive soft tissue involvement, represent a subset of patients at higher risk of recurrence [18, 12].

Clinical Presentation

  • Giant cell tumors of the tendon sheaths in the hand are benign synovial neoplasms [21].
  • Giant cell tumors of the tendon sheaths in the hand have the potential for local recurrence [21].
  • Recurrence is the primary risk for giant cell tumors of the tendon sheaths in the hand [2, 3].
  • Direct involvement of the extensor tendons, flexor tendons, or joint capsule puts patients in a high-risk category with respect to recurrence [25].

Investigations

  • Radiation therapy may provide local tumor control with preservation of hand function in cases of infiltrative giant cell tumor of the tendon sheath [1].
  • 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].
  • Giant cell tumors of the synovial sheaths in the hand are benign lesions in which recurrence is the primary risk [3].
  • 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 [6].
  • 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 of the hand [7].
  • Pigmented villonoid synovitis and giant-cell tumor of tendon sheath are benign synovial neoplasms with the potential for local recurrence [21].
  • Although MRI findings and location might help in the diagnosis of a tenosynovial giant cell tumor, careful assessment is mandatory, especially in unusual locations [33].
  • Pigmented villonodular synovitis of the shoulder is extremely rare, with clinical and radiological findings generally being nonspecific and often mimicking a malignancy [38].

Treatment

  • 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 morbidity while maximizing disease control [4].
  • 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 [5].
  • 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 in the hand [8].
  • Conservative treatments yielded good results without amputation for epiphyseal chondromatous giant cell tumors of the upper end of the humerus [9].
  • Centralization of the ulna is a simple and effective modality of reconstruction following resection of Campanacci Grade 3 giant cell tumor of the distal radius [11].
  • En bloc resection and matched nonvascularized toe phalangeal transfer for Campanacci Grade 2 or 3 giant cell tumor of the phalanges resulted in a functional tumor-free digit with a low complication rate and no recurrences [13].
  • Intralesional excision appears to be more appropriate for the treatment of local lesions (Grades 1 and 2) than Grade 3 giant cell tumors of the distal radius [14].
  • 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 [17].
  • Selective use of curettage and cementing is recommended in Grade III giant cell tumor lesions, particularly with extensive soft tissue involvement [18].
  • Intralesional excision with cautery and methylmethacrylate provides a reliable method of treatment of giant cell tumors with good long-term functional results [19].
  • 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 [27].
  • Repeated curettage with adjuvants eventually resulted in the cure for all patients and is therefore a reasonable treatment for both primary and recurrent giant cell tumor of the small bones of the hands and feet [28].
  • 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 that may be accompanied by major complications [29].
  • Non-surgical treatment has a similar risk of complications to intralesional nerve-sparing surgery and has better functional outcomes than intralesional nerve-sparing surgery for giant cell tumor of the sacrum, but patients must remain on therapy over time [32].

Complications

  • Well-designed studies combining recurrence rates from several hand surgery centers are needed to better demonstrate associated risk factors for recurrence [8].
  • Subsets of patients with giant cell tumor of bone are at higher risk of recurrence and should be clinically followed more closely [12].
  • Metachronous multicentric giant cell tumor can present with long disease-free intervals, such as 24 years between initial presentation and multicentric recurrence [15].

Recovery

  • Recurrence is the primary risk for giant cell tumors of the tendon sheaths in the hand, typically occurring within 36 months of excision [2].
  • Recurrence is the primary risk for giant cell tumors of the synovial sheaths in the hand [3].
  • Surgical treatment of pigmented villonous synovitis led to good functional results with an average Enneking score of 92% of normal limb function [10].
  • A patient with metachronous multicentric giant cell tumor had a disease-free interval of 24 years between the initial presentation and the multicentric recurrence [15].
  • The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome [20].
  • Patients with pigmented villonous synovitis of the hip managed with arthroscopic synovectomy reported good functional outcomes without evidence of recurrence in a cohort with an average follow-up of almost 7 years [22].
  • Tumor resection with negative margins is supported for giant cell tumors in the radius [26].

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)
  • [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. [5] (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. [6] (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. [7] (10.1177/1753193412469146)
  • [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. [8] (10.1186/s12891-019-2866-8)
  • [L4] The author concludes that these tumors represent a distinct clinical entity of essentially benign giant cell tumors that should be recognized in the literature, noting that conservative treatments yielded good results without amputation. [9] (10.1097/01.blo.0000229309.90265.df)
  • [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)
  • [L4] This is a simple and effective modality of reconstruction after resection of distal radial tumors. [11] (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. [12] (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. [13] (10.1016/j.jhsa.2024.06.013)
  • [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. [14] (10.1007/s11999-012-2464-7)
  • [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. [15] (10.1097/01.blo.0000068770.86536.e1)
  • [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. [17] (10.1016/j.otsr.2013.04.001)
  • [L4] We recommend selective use of this procedure in Grade III lesions, particularly with extensive soft tissue involvement. [18] (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. [19] (10.1097/01.blo.0000128280.59965.e3)
  • [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. [20] (10.1177/1558944717743598)
  • [L4] Pigmented villonoid synovitis and giant-cell tumor of tendon sheath are benign synovial neoplasms with the potential for local recurrence. [21] (10.2106/00004623-198466010-00012)
  • [L4] Patients reported good functional outcomes without evidence of recurrence in a 19 patient cohort with an average follow-up of almost 7 years. [22] (10.1177/2325967119s00413)
  • [L3] Direct involvement of the extensor tendons, flexor tendons, or joint capsule puts patients in a high-risk category with respect to recurrence. [25] (10.1016/j.jhsa.2009.12.004)
  • [L4] Findings support tumor resection with negative margins in the radius. [26] (10.1016/j.jhsa.2017.06.079)
  • [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. [27] (10.1007/s004020100317)
  • [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. [28] (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. [29] (10.1007/s00402-010-1059-6)
  • [L3] Non-surgical treatment has a similar risk of complications to intralesional nerve-sparing surgery and has better functional outcomes than intralesional nerve-sparing surgery, but patients must remain on therapy over time. [32] (10.1186/s12891-021-04907-0)
  • [L4] Although MRI findings and location might help in the diagnosis of a T-GCT, careful assessment is mandatory, especially in unusual locations. [33] (10.1186/s12891-016-1050-7)
  • [L4] Tumors with extension limited to a single site of palmar cortical perforation are classified as grade 3(p) and can be treated with intralesional treatment alone. [35] (10.1016/j.jhsa.2010.07.010)
  • [Case_report] PVNS of the shoulder is extremely rare, with clinical and radiological findings generally being nonspecific and often mimicking a malignancy. [38] (10.1007/s001670050158)
  • [L4] En bloc resection of Campanacci grade III giant cell tumours of the distal radius may reduce the local recurrence rate, and a prosthesis reconstruction is still an alternative option. [40] (10.1186/s12891-025-08851-1)
  • [L4] The satisfactory functional results mirror the status of the underlying joint. [42] (10.1097/01.blo.0000229345.57092.a2)

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] 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

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

[7] 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

[8] 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

[9] THE CLASSIC: Epiphyseal Chondromatous Giant Cell Tumors of the Upper End of the Humerus. Clinical Orthopaedics and Related Research. 2006. DOI: 10.1097/01.blo.0000229309.90265.df

[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

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