Clinical management of tenosynovial giant cell tumors

Emin Kursat Bulut; Coskun Ulucakoy; Muzeyyen Burcu Kaplan; Ethem Toptas; Sefik Murat Arikan; Mehmet Serkan Cetin; Ismail Burak Atalay

doi:10.52312/jdrs.2026.2906

Emin Kursat Bulut¹, Coskun Ulucakoy², Muzeyyen Burcu Kaplan³, Ethem Toptas², Sefik Murat Arikan⁴, Mehmet Serkan Cetin⁵, Ismail Burak Atalay²

¹Department of Orthopedics and Traumatology, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, Türkiye
²Department of Orthopedics and Traumatology, Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Türkiye
³Department of Pathology, Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Türkiye
⁴Department of Orthopedics and Traumatology, Gazi University, Ankara, Türkiye
⁵Department of Cardiology, Ankara Bilkent City Hospital, Ankara, Türkiye

Keywords: Pigmented villonodular synovitis, soft tissue tumor, tendon sheath, diffuse type, tenosynovial giant cell tumor.

Abstract

Objectives: This study aims to evaluate the demographic characteristics, anatomical distribution, diagnostic and treatment patterns, postoperative complications, recurrence rates, and recurrence-associated factors in patients diagnosed with tenosynovial giant cell tumors (TGCTs).

Patients and methods: A total of 246 patients diagnosed with TGCT and treated between January 2010 and March 2021, were retrospectively analyzed. Pre- and postoperative data of the patients were recorded. Histopathological diagnosis was reviewed, and tumors were classified as localized TGCT and diffuse-type TGCT. Recurrence was defined as the reappearance of a lesion at the same location following an initially complete surgical excision. Survival time was defined as the time elapsed since surgery. Recurrence-free survival was calculated from the date of the surgical procedure to the date of recurrence or the last follow-up.

Results: Of a total of 246 patients included in the study, 87 were male and 159 were female with a mean age of 44.3 ± 16.3 (range, 18 to 75) years. The lesions were most commonly located in the hand (62.6%), predominantly at the phalangeal level (89.6%). Foot involvement was mainly at the ankle region (40.8%), while the knee was the third most frequently affected site (15%), with 64.8% of knee lesions being intra-articular. Multiple lesions were observed in 3.3% of patients. Small joints were involved in 63% of cases. Excisional biopsy was the most common diagnostic approach (63.8%), followed by Tru-Cut biopsy (23.2%) and incisional biopsy (8.5%), while macroscopically complete marginal resection was performed in 4.5% of cases. Postoperative complications occurred in 15.4% of patients, including infection, sensory deficits, hematoma, motion restriction, and vascular complications. The median follow-up was 43 months, and recurrence occurred in 15.4% of patients, of whom 76.3% required reoperation.

Conclusion: Our study results suggest that TGCT is associated with a notable recurrence rate and postoperative morbidity. Accurate diagnosis, complete surgical excision, and long-term follow-up are essential for optimal management. Recurrence may be associated with factors such as pain at presentation, presence of multiple lesions, delayed treatment, and postoperative infection. Adequate surgical excision with sufficient margins is of utmost importance in reducing the risk of recurrence.

Citation: Bulut EK, Ulucakoy C, Kaplan MB, Toptas E, Arikan SM, Cetin MS, et al. Clinical management of tenosynovial giant cell tumors. Jt Dis Relat Surg 2026;37(3):838-850. doi: 10.52312/ jdrs.2026.2906.