What is the role of radiography in the diagnosis of giant cell tumor of the tendon sheath?

Updated: Aug 06, 2019
  • Author: James R Verheyden, MD; Chief Editor: Harris Gellman, MD  more...
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Answer

Plain radiographs demonstrate a benign-appearing circumscribed soft-tissue shadow in 50% of cases. These radiographs also show cortical erosion of the bone due to a pressure effect of the adjacent mass on the cortex in 10-20% of cases (see the images below).

Radiograph demonstrates cortical erosion from the Radiograph demonstrates cortical erosion from the pressure effect of the adjacent mass on the radial aspect of the proximal phalanx.
Radiograph demonstrates the bony erosion associate Radiograph demonstrates the bony erosion associated with some giant cell tumors of the tendon sheath and shows the unmineralized soft-tissue shadow of the mass.

True bone invasion is not typical and is suggestive of an aggressive neoplasm.

Cortical erosion from these tumors is more common in the feet than elsewhere because the strong ligaments in this region frequently prevent outward tumor growth.

Occasionally, intralesional soft-tissue calcification is seen with giant cell tumors of the tendon sheath. This intralesional calcification can be confused with synovial chondromatosis, periosteal chondroma, or calcific tendinitis.

On rare occasions when extensive cortical erosion is present, the lesion may have a radiographic appearance suggestive of a periosteal chondroma (see the images below).

Radiograph demonstrates cortical erosion from the Radiograph demonstrates cortical erosion from the pressure effect of the overlying giant cell tumor of the tendon sheath. This apple-core effect is indicative of a primary soft-tissue mass that is causing external erosion, which should not be confused with a primary bone process such as periosteal chondroma.
Radiograph demonstrates cortical erosion from the Radiograph demonstrates cortical erosion from the pressure effect of the overlying giant cell tumor of the tendon sheath.

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