gms | German Medical Science

Objectives: This case study highlights a tenosynovial giant cell tumor, a benign soft tissue growth of the flexor tendon sheath in the distal forearm.

Methods: The patient, a 47-year-old woman, consulted her doctor because of a mobile swelling in her left palmar wrist, accompanied by numbness and tingling in her left adominant hand by night for 6 months. Further examination through ultrasound and magnet resonance imaging showed the presence of a space-occupying mass displacing the flexor tendons and compressing the left median nerve. With a collaborative approach involving hand surgeons, an orthopedic tumor surgeon and radiologists, surgical removal of the encapsulated tumor was performed, without a previous biopsy. The pathology confirmed a nodular tenosynovial giant cell tumor, with no evidence of malignancy. The patient showed good results six weeks post-operation with a complete improvement in pain and sensation.

Results and conclusion: We present this case in order to have valuable insights into the best practices for diagnosing and managing tenosynovial giant cell tumors and serving as an useful resource for healthcare professionals, who are treating patients with this rare condition. Moreover, it is crucial for determining the most appropriate multidisciplinary treatment plan after magnet resonance imaging to avoid a delay in diagnosis, including an evaluation of a biopsy, ultimately, whether or not to perform a fine or core needle biopsy. In highly suggestive cases a biopsy can be avoided to ensure the best possible outcome for each patient tailored to the individual symptoms and general health. The choice of treatment is the removal of the entire tumor, if feasible along with a margin of normal tissue, to ensure that all of the abnormal cells are removed.