Tenosynovial Giant Cell Tumor (TGCT): Symptoms, Diagnosis & Treatment

Understanding Tenosynovial Giant Cell Tumors

Tenosynovial giant cell tumor (TGCT), previously known as pigmented villonodular synovitis (PVNS), is a rare benign tumor occurring in the synovial lining of joints, tendon sheaths and bursae. Understanding this condition is important for prompt diagnosis and appropriate management.

Who Develops TGCT Tumors?

TGCT often affects young adults between 30-50 years old and does not seem associated with specific risk factors. Cases occur slightly more often in females but can affect anyone. The tumors originate from the synovium, a thin membrane lining moveable joints and cushioning fluid-filled bursae or tendon sheaths.

Two Forms of TGCT

Two primary forms exist localized and diffuse. Localized TGCT forms a solitary, well-defined tumor mass while diffuse TGCT exhibits extensive growth within the joint lining, lacking defined borders.

Common Joints Affected by TGCT

The knee represents about 75% of cases, with tumors frequently occurring behind the kneecap or toward the thigh bone. Other common sites are the hip, ankle and elbow joints, with more diffuse forms often seen in the shoulder.

Presentation in the Knee

In the knee, people may feel an ache or sensation of fullness behind the kneecap. Swelling can develop from fluid accumulation. Locking, catching, stiffness or loss of full extension may occur if tumor growth impedes joint motion.

Symptoms in Other Joints

TGCT can produce joint-specific symptoms like:

• Hip - Pain or limping from femoral bone erosion.
• Wrist - Swelling, clicking noises, tingling or numbness if nerves are compressed.
• Ankle - Stiffness, instability, pain along the ankle bones.
• Elbow - Limited bending/straightening, elbow clicking or locking.

Getting an Accurate TGCT Diagnosis

Since symptoms mimic other joint conditions like arthritis or injuries, TGCT often goes undiagnosed initially. But specialized imaging and biopsy can confirm tumors.

Medical History

Docs first gather a detailed history about location, severity, duration of symptoms and impact on function. Family history of cancers or joint tumors may provide clues.

Physical Exam

They palpate suspicious masses and assess the joints range of motion, stability, alignment and swelling. Comparisons to the unaffected side help identify subtle abnormalities.

Imaging Tests

If TGCT is suspected, definitive imaging like MRI better defines tumor location, size and joint structures involved compared to X-rays. CT scans also provide valuable 3D detail.

Biopsy Analysis

Removing a small tissue sample then examining cells under a microscope can confirm giant cell tumor diagnosis and rule out cancers.

premire fois TGCT Treatment Considerations

TGCT treatment aims to eradicate tumors while retaining normal joint function. Available options range from non-invasive approaches to complete joint reconstruction when extensive destruction occurs.

Medication

Oral targeted drugs can show promise shrinking or stabilizing some diffuse TGCT growths to relieve symptoms and delay surgery.

Arthroscopic Surgery

For some accessible joint tumors, surgeons insert a fiberoptic camera and instruments through tiny incisions to remove masses while minimizing damage.

Open Surgery

Larger, invasive tumors often require traditional surgery and occasionally joint reconstruction. Meticulous removal prevents recurrence.

Radiation Synovectomy

Injecting radioactive isotopes can eliminate diffuse tumors inside joints when surgery risks further instability or stiffness.

Rehabilitation Needs After TGCT Treatment

Post-op rehab plays a crucial role regaining flexibility, strength and function. A customized program may involve:

• Gradually increased weightbearing.
• Stretching and range of motion exercises.
• Strengthening plans using resistance bands.
• Neuromuscular training for control and stability.
• Gait training and activity modifications.

Following activity guidelines for proper healing while returning activity levels as tolerated maximizes outcomes.

Monitoring and Preventing TGCT Recurrence

Despite appropriately aggressive treatment, diffuse TGCT recurrence risk remains around 15-25%. Ongoing monitoring helps detect tumors early when re-treatment is easiest. Patients should immediately report any familiar joint pain, swelling or catching sensations to their doctors.

Surveillance Scans

Routine follow-up MRIs at 6 or 12 month intervals can spot recurrences while tumors remain small and localized.

Bloodwork

Certain blood tumor markers may correlate with TGCT disease status, helping confirm scan findings.

Coping with a Rare Diagnosis

Receiving an uncommon cancer-like diagnosis can feel frightening and isolating. Connecting with community support groups helps patients process emotions and navigate treatments.

The Takeaway

While concerning, TGCT prognosis remains good with prompt care. Patients achieve optimal results through expert diagnosis, appropriate evidence-based treatment guided by a sarcoma specialist and dedicated rehab efforts.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.