Hand function salvage with imatinib in a recurrence of a giant cell tumour of the tendon sheath/local pigmented villonodular synovitis (PVNS)
DOI:
https://doi.org/10.1016/j.rccot.2017.04.007Keywords:
giant cell tumour of the tendon sheath, genosynovial giant cell tumour, pigmented villonodular synovitis, monoclonal antibodies, colony stimulating factor-1 receptor (CSF1R) inhibitor, imatinibAbstract
Giant cell tumour of the tendon sheath (GCTTS) is the second most common lesion of the hand and wrist, with 85% of these tumours occurring in the fingers. Its most frequent location is usually the three radial digits, especially in the distal interphalangeal joints. Overexpression of colony stimulating factor-1 (CSF1) has been seen in pigmented villonodular synovitis (PVNS) and tenosynovial giant cell tumours. The recurrence rate is reported as high as 50%. Recurrences are treated mainly with wide surgical resections that may involve amputation and functional compromise. The case is presented of a recurrent GCTTS in a female patient with a lesion arising from the flexor tendon sheath of her right thumb, invading and infiltrating the whole thenar region. Wide surgical excision was performed, and imatinib was administered as an adjuvant chemotherapeutic agent. Giant cell tumours may respond well to systemic therapy. This treatment option should be considered in patients in which adequate margins cannot be achieved, or in non-accessible areas. Adequate functional outcomes can be expected with combined surgical and pharmacological treatment.
Evidence level: IV.
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