JLE

Médecine et chirurgie du pied

MENU

Tenosynovial Giant-Cell Tumors of the Foot and Ankle: a Retrospective Review about 28 Cases Volume 36, issue 4, Décembre 2020

Tables


  • Tableau 1

  • Tableau 2

  • Tableau 3

  • Tableau 4

  • Tableau 5

  • Tableau 6
Authors

Introduction

Tenosynovial giant-cell tumors (TCGTs) are benign soft tissue tumors that can arise from the synovial lining of the joint, tendon or bursa. The lesion can either be present as a localized or diffused form which can arise intra-articularly or extra-articularly. Foot and Ankle TCGTs are rare and a few studies have focused on this localization. We decided to perform a retrospective analysis of TCGTs cases in order to identify factors which are associated with local recurrence and functional outcomes.

Material and method

We retrospectively reviewed 28 patients with histologically confirmed TCGTs. 13 were localized form. All the available imaging (MRI scans, CT scans, plain radiographs or echography) were reviewed for the location and type of TCGTs. The outcome was assessed using validated Foot outcome scores (TESS and AOFAS). Post-operative MRI was realized to assess local recurrence.

Results

The mean age of the patients was 42 years with a female predominance. 15% of the cases were localized to the ankle, 18% to the midfoot and 32% in the forefoot. The mean duration of symptoms before treatment was 21.7 months. Surgical resections were performed on 25 patients (90%). 23 patients (82%) were reviewed at an average follow up of 64 months. The mean TESS score was 84.2 and the mean AOFAS score was 78.2 for the overall group and 83% of patients were satisfied with the results. Clinical results were better in localized form and worse in case or recurrence in diffuse TCGTs. Our review identified 7 patients (28%) with recurrence. The mean recurrence–free interval after resection of the lesion was 29 months. They were more frequently observed in extra-articular form (36%). In case of recurrence, the functional outcome was more affected in the diffuse TCGTs.

Discussion

Complete surgical resection remains the main treatment of TCGTs. Our study showed satisfactory results consistent with the literature despite a high surgical recurrence rate in localized form. Therefore, we advise a wide synovectomy in localized and extra articular TCGTs. In the future, neoadjuvant targeted therapy could be interesting in association with surgical resection to reduce local recurrence or rapid progression in partial resection of diffused TCGTs.