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Giant Cell Tumour of Tendon Sheath

Giant cell tumour of tendon sheath (a.k.a. tenosynovial giant cell tumour, localised pigmented villonodular synovitis).

38 citationsUpdated Oct 2026
Illustration: Giant Cell Tumour of Tendon Sheath

Overview

Giant cell tumour of tendon sheath (GCTTS) is a common benign neoplasm of the hand that is locally aggressive and carries the potential for osseous invasion [6, 10]. While recurrence remains the primary clinical risk, it typically manifests within 36 months of excision [4, 9]. In rare instances, the tumour presents as a lytic osseous lesion through uncharacteristic intraosseous invasion [3]. In a reviewed series of 133 cases, intraosseous expansion occurred in 11.3% of patients [18]. Although reports in the paediatric population are rare [6], the condition shares histological features with pigmented villonodular synovitis, both being benign synovial neoplasms with a capacity for local recurrence [11]. Clinically, GCTTS is frequently confused with fibroma of tendon sheath, as both present as well-circumscribed masses intimately involved with the tendon sheath [5]. Fibromas are sufficiently common to warrant inclusion in the differential diagnosis, comprising 7 of 208 soft tissue hand tumors excised over a 15-year period [2].

The proliferative activity of localized GCTTS, measured by the MIB-1 staining index, is not related to its high recurrence rate or local aggressiveness [14]. Complete surgical resection remains the treatment of choice for most patients with tenosynovial giant cell tumors [13]. Adequate resection should be performed at the initial procedure to mitigate recurrence [51]. For selected cases, curettage, cryosurgery, and cementation performed by experienced surgeons appear to be a safe, effective, and reliable method [44]. In the setting of recurrent giant cell tumour of the hand, en bloc resection of the tumour and reconstruction with an autograft should be considered [36]. Diffuse tenosynovial giant cell tumor disease presents specific challenges due to high recurrence rates [13].

Anatomy & Pathophysiology

Epidemiology and Demographics

Giant cell tumour of tendon sheath is the second most common tumour of the hand [20] and the second most common benign proliferative tumour in the upper extremities after ganglion cysts [27]. It is also identified as the most common benign neoplasm in the hand following the ganglion cyst [32]. These tumours are most frequently found in the fingers and among women in their fourth and fifth decades [27]. The male-to-female ratio for giant cell tumour of tendon sheath of the digits is 1:1.47 [26], with a mean age ranging from 32 to 51 years [26].

Etiology and Pathogenesis

The etiology of giant cell tumors of the tendon sheath is unknown [24]. Pathogenetic theories have included inflammatory process, trauma, immune mechanisms, and neoplasia [24]. It has been suggested that the lesion may be neoplastic, inflammatory, trauma-induced, immune-mediated or associated with abnormal lipid metabolism [20]. More recent reports, including deoxyribonucleic acid (DNA) analysis by flow cytometry, support a truly neoplastic nature for the lesion [20]. Inflammation resulting from reactive or regenerative hyperplasia is the generally accepted theory of pathogenesis [27]. Genetic factors have been observed in previous studies regarding the pathogenesis of these tumours [27]. A definite history of trauma was recorded in 5% of giant cell tumour of tendon sheath lesions [26].

Clinical Presentation and Symptoms

Giant cell tumors usually present as a solitary and firm slow-growing nodular lesion which affects the volar aspect of the hand [24]. These tumours are usually slow-growing, painless, benign and consist of soft tissue [27]. As the tumour grows, some patients may present with swelling, pain and limitation of movement [27]. Pain was reported in 15.7% of cases of giant cell tumour of tendon sheath of the digits [26], while sensory disturbances were reported in 4.57% of cases [26]. The most frequent tumour location was the index finger at 29.7% [26]. A giant cell tumor of tendon sheath can present as a trigger finger [1] or with intraosseous invasion as a lytic osseous lesion [3].

Histology and Classification

The giant cell tumour of tendon sheath has been classified as being of fibrohistiocytic origin [30]. The disease spectrum is described by a number of terms due to varied morphology, including pigmented villonodular synovitis for less well circumscribed tumours that grow more diffusely and incorporate haemosiderin pigment [30]. Different names used to describe these lesions include giant cell tumour of tendon sheath, pigmented villonodular synovitis, fibrous xanthoma, benign synovioma and sclerosing haemangioma [20].

Type I: Defined as single lesions [26], this classification includes a nodular or multinodular lesion surrounded by a capsule [27]. Type II: Defined as two or more distinct tumours that were not joined together [26], this classification describes tumours with no connective tissue membrane and satellite, diffuse or multicentric nodules [27].

Type I tumours (single lesions) were more frequently detected than type II tumours in a systematic review, with 78.7% and 21.3% respectively [26].

Prognostic Markers

nm23 expression was absent in 21% of giant cell tumours and this was associated with a highly significant risk of local recurrence (P<0.0001) [30]. Multivariate analysis showed nm23 expression to be more reliable than other clinicopathological parameters for predicting outcome in giant cell tumours of tendon sheath [30].

Classification

Al-Qattan Classification: The Al-Qattan classification categorizes giant cell tumour of tendon sheath (GCTTS) into two main types based on whether the entire tumour is surrounded by one pseudocapsule as assessed by the surgeon during surgery [20]. Type I consists of nodular or multinodular lesions surrounded by a capsule [27]. Type II describes tumours with no connective tissue membrane and satellite, diffuse, or multicentric nodules [27]. This system categorizes GCTTS according to the risk of recurrence [27].

Recurrence Patterns: In a prospective study of 43 consecutive cases, none of the 30 Type I tumours recurred [20]. Conversely, recurrence occurred in five out of 13 Type II tumours [20]. Second recurrences were observed with Type II B and C tumours but not with Type II A tumours [20]. A systematic review found that Type I tumours (single lesions) were more frequently detected (78.7%) than Type II tumours (two or more distinct tumours that were not joined together) (21.3%) [26]. Type II tumours are associated with a higher risk of recurrence compared to Type I tumours [26].

Other Considerations: GCTTS has been referred to by historic names including pigmented villonodular synovitis, fibrous xanthoma, benign synovioma, and sclerosing haemangioma [20]. The term pigmented villonodular synovitis is largely a descriptive phrase for less well-circumscribed giant cell tumours that grow more diffusely and incorporate haemosiderin pigment [30]. GCTTS are considered to be the extra-articular equivalent of localised pigmented villonodular synovitis [46]. Intra-articular giant cell tumor of tendon sheath and pigmented villonodular synovitis are histologically similar, usually benign tumors characterized by synovial involvement (GCTTS) or overgrowth (PVNS) [28]. The World Health Organization classifies diffuse pigmented villonodular synovitis as 'diffuse-type giant cell tumour' (Dt-GCT) with ICD-O code 9251/0 [46].

Clinical Presentation

Giant cell tumor of tendon sheath (GCTTS) is the second most common tumor of the hand [20] and the second most common benign proliferative tumour in the upper extremities after ganglion cysts [27]. The lesion typically presents as a solitary, firm, slow-growing nodular mass beneath the skin [19, 24]. It is usually not tender to palpation [19] and is often asymptomatic; however, as the tumor grows, patients may present with swelling, pain, and limitation of movement [27]. In a systematic review of 605 patients, pain was reported in 15.7% of cases and sensory disturbances in 4.57% [26]. A definite history of trauma was recorded in 5% of lesions [26].

Demographics and Location: GCTTS most commonly affects the volar aspect of the hand [24] and is found most frequently in the fingers [27]. The index finger is the most frequent tumor location, accounting for 29.7% of cases in a systematic review of 605 patients [26]. The condition predominantly affects women in their fourth and fifth decades [27], with a male-to-female ratio of 1:1.47 and a mean age ranging from 32 to 51 years in the same review [26]. Multifocal lesions are rarely described and commonly involve the same finger or the volar aspect of different fingers [24]. Type I tumours (single lesions) were more frequently detected (78.7%) than type II tumours (two or more distinct tumours that were not joined together) (21.3%) [26].

Atypical Presentations: GCTTS can present as a trigger finger [1], a trigger wrist [21], or with carpal tunnel syndrome [23]. Intraosseous expansion occurs in 11.3% of a reviewed series of 133 cases [18]. When intraosseous invasion is present, the tumor can present as a lytic osseous lesion [3].

Differential Diagnosis: Fibromas of tendon sheath are clinically usually confused with GCTTS, as both are well circumscribed and intimately involved with the tendon sheath [5]. Calcifying aponeurotic fibroma presents as a painless mass primarily on the volar surface of the hands and must be considered in the differential diagnosis [33].

Imaging: Radiographs will demonstrate no specific findings for GCTTS [19], though radiography can be helpful in evaluating cortical destruction but is not helpful in the definitive diagnosis [27]. Ultrasound is useful in distinguishing GCTTS from ganglion cysts [19]. Magnetic resonance imaging (MRI) is the most useful examination for diagnosis and treatment planning [27].

Investigations

MRI: Magnetic resonance imaging is the investigation of choice for diagnosing tumour-like lesions of the infrapatellar fat pad [106] and is essential to diagnose localized pigmented villonodular synovitis, accurately defining its localization and treatment strategy [107]. While MRI provides valuable clues for tenosynovial giant cell tumour, definitive diagnosis relies on histopathological confirmation [109]. Although MRI findings and location might help in the diagnosis of tenosynovial giant cell tumors, careful assessment is mandatory, especially in unusual locations [108]. The absence of disease on MRI should not be used as the sole criterion in determining whether a repeat resection should be performed for unsuspected soft tissue sarcomas of the hand [104].

Other Considerations: A careful physical examination is essential to direct care and future testing if indicated, as diagnostic tests such as imaging and serum laboratory studies can be expensive, time consuming, and often nonspecific [37]. Clinically, fibroma of tendon sheath is usually confused with giant cell tumor of tendon sheath (GCTTS), both being well circumscribed and intimately involved with tendon sheath [5]. Fibromas of tendon sheath are common enough to be considered in the differential diagnosis of a soft tissue tumor in the hand, as they comprised 7 of 208 soft tissue hand tumors excised over a 15-year period [2]. Calcified aponeurotic fibroma is a rare tumor that presents as a painless mass primarily on the volar surface of the hands and plantar aspects of the feet in juveniles and must be considered in the differential diagnosis of GCT of the tendon sheaths or sarcomas, especially in young patients [33].

Giant cell tumour of tendon sheath can present as a trigger finger, with one case report representing the first reported instance of this presentation [1]. A giant cell tumour of the tendon sheath can cause trigger wrist [21]. A diffuse giant cell tumor of the tendon sheath can arise from the carpal tunnel of the wrist, presenting with mild carpal tunnel syndrome and a mid-palmar swelling [23]. Giant cell tumors of the tendon sheaths in the hand are benign lesions where recurrence is the primary risk, typically occurring within 36 months of excision [4]. Pigmented villonoid synovitis and giant-cell tumor of tendon sheath are benign synovial neoplasms with the potential for local recurrence [11]. Giant cell tumor of tendon sheath (GCTTS) is locally aggressive and has the possibility of osseous invasion [10]. Complete surgical resection remains the treatment of choice for most patients with tenosynovial giant cell tumors, though diffuse disease presents challenges due to high recurrence rates [13].

Treatment

Non-Operative

The provided evidence does not support conservative management as a primary treatment modality for giant cell tumor of tendon sheath (GCTTS). Surgical intervention is the standard of care, with non-operative options such as weight loss, physical therapy, NSAIDs, or injections not indicated in the available literature.

Operative

Indications: Marginal excision is the treatment of choice for GCTTS [32]. Surgical excision is the most commonly accepted treatment [27] and is required to address the primary risk of recurrence associated with these tumors [4, 9].

Surgical Approach / Technique: Successful outcomes depend on preoperative planning aided by tissue diagnosis via fine needle aspiration cytology, wide surgical exposure, and meticulous dissection using magnification [31]. The surgeon must ensure complete excision of the tumor and removal of any residual satellite nodules to mitigate factors predisposing to recurrence [32]. A magnifying loupe is utilized to facilitate a careful search for satellite lesions and to respect surrounding structures [32]. Preoperative diagnosis and meticulous surgical technique are identified as the only predictive factors for recurrence in a series of 14 cases [31].

Adjuncts: In cases of infiltrative GCTTS, radiation therapy may provide local tumor control with preservation of hand function [43].

Other Considerations: GCTTS is a locally aggressive benign tumor that may involve osseous invasion [10] and can present with uncharacteristic intraosseous invasion as a lytic osseous lesion [3]. Diffuse disease presents challenges due to high recurrence rates [13]. Recurrence rates tend to be high, with variable rates reported by different authors [19]. The average recurrence rate in the literature is about 15% [32], though only 3 cases (4.7%) of 64 patients reported recurrence in a study comparing literature results with local experience [32]. A recent prospective study of 213 cases showed 27 recurrences (13%) at a minimum 3-year follow-up [19]. Recurrence typically occurs within 36 months of excision [4]. Of recurrent tumors, those involving the extensor tendon, flexor tendon, or joint capsule had the highest risk of recurrence [19]. Close monitoring and/or adjuvant treatment is recommended for tumors involving the extensor tendon, flexor tendon, or joint capsule [19]. In a prospective study of 43 consecutive cases, none of the type I tumours (n=30) recurred [20]. Recurrence occurred in five out of 13 type II tumours [20]. Second recurrences were seen with type II B and C, but not type II A tumours [20].

Complications

Recurrence

Recurrence is the primary risk associated with giant cell tumors of the tendon sheaths in the hand [4]. A systematic review of 605 patients identified an overall tumour recurrence rate of 14.8% [26], while a prospective study of 213 cases reported 27 recurrences (13%) at a minimum 3-year follow-up [19]. In a smaller study of 64 cases, only 3 cases (4.7%) reported recurrence [32]. Type II tumours are associated with higher recurrence rates than Type I tumours [26]. Specifically, in a prospective study of 43 cases, none of the type I tumours recurred, but recurrence occurred in five out of 13 type II tumours [20]. Second recurrences were observed with type II B and C tumours, but not type II A tumours [20]. Tumors involving the extensor tendon, flexor tendon, or joint capsule carry the highest risk of recurrence [19].

Local Invasion and Aggressiveness

GCTTS may present with uncharacteristic intraosseous invasion appearing as a lytic osseous lesion [3]. Intraosseous expansion occurs in 11.3% of a reviewed series of 133 cases [18]. The possibility of osseous invasion is referenced in the context of GCTTS being locally aggressive [10]. Marginal excision is often difficult to perform due to the strict adherence of the tumor to the tendon or neurovascular bundles [32].

Atypical Presentations and Complications

Giant cell tumor of tendon sheath can present as a trigger finger [1]. A diffuse giant cell tumor of the tendon sheath arising from the carpal tunnel can present with mild carpal tunnel syndrome [23]. Multifocal lesions are rarely described and commonly involve the same finger or the volar aspect of different fingers [24]. Multiple giant cell tumors of the tendon sheath can involve both flexor and extensor tendons in a single digit [16]. A rare case of diffuse tenosynovial giant cell tumor of the forearm soft tissues has been reported [17].

Recovery

Other Considerations: Recurrent tumors involving the extensor tendon, flexor tendon, or joint capsule carry the highest risk of recurrence [19]. At 9 years' follow-up, a patient with giant cell tumor of the scaphoid was disease-free and clinical function remained excellent [111].

Key Evidence

  • [L5] The authors believe this patient represents the first reported case of a giant cell tumor of tendon sheath presenting as a trigger finger. [1] (10.1016/s0363-5023(85)80172-6)
  • [L4] Fibromas of tendon sheath are common enough to be considered in the differential diagnosis of a soft tissue tumor in the hand, as they comprised 7 of 208 soft tissue hand tumors excised over a 15-year period. [2] (10.1016/0363-5023(94)90184-8)
  • [L5] The paper describes a giant cell tumor of tendon sheath (GCTTS) with uncharacteristic intraosseous invasion presenting as a lytic osseous lesion. [3] (10.1016/s0363-5023(05)80148-0)
  • [L4] Giant cell tumors of the tendon sheaths in the hand are benign lesions where recurrence is the primary risk, typically occurring within 36 months of excision. [4] (10.1016/j.otsr.2013.03.008)
  • [L5] Clinically it is usually confused with GCTTS, both being well circumscribed and intimately involved with tendon sheath. [5] (10.1016/s0363-5023(84)80031-3)
  • [L4] Giant cell tumour of tendon sheath is a common benign tumour of the hand that can be locally recurrent after excision, and reports in the paediatric population are rare, with this case believed to be the youngest reported. [6] (10.1177/1753193412455792)
  • [L4] Giant cell tumors of the synovial sheaths in the hand are benign lesions in which recurrence is the primary risk. [9] (10.1016/j.jhsa.2013.08.051)
  • [L5] The authors agree that giant cell tumor of tendon sheath (GCTTS) is locally aggressive and made reference to the possibility of osseous invasion. [10] (10.1016/j.jhsa.2013.04.049)
  • [L4] Pigmented villonoid synovitis and giant-cell tumor of tendon sheath are benign synovial neoplasms with the potential for local recurrence. [11] (10.2106/00004623-198466010-00012)
  • [L5] Complete surgical resection remains the treatment of choice for most patients with tenosynovial giant cell tumors, though diffuse disease presents challenges due to high recurrence rates. [13] (10.5435/jaaos-d-24-01255)
  • [L4] The proliferative activity of localized giant cell tumour of tendon sheath, measured by the MIB-1 staining index, is not related to its high recurrence rate and local aggressiveness. [14] (10.1016/j.jhsb.2004.06.012)
  • [L5] [16] (10.1142/s2424835518720189)
  • [L5] The study reports a rare case of diffuse tenosynovial giant cell tumor of the forearm soft tissues in a 23-year-old woman. [17] (10.1016/s1297-3203(01)00040-3)
  • [L4] Intraosseous expansion of giant cell tumors of the tendon sheath (GCTTS) is not as rare as the literature suggests, occurring in 11.3% of a reviewed series of 133 cases. [18] (10.1016/s0363-5023(98)80062-2)
  • [L5] [19] (10.1016/j.jhsa.2010.08.015)
  • [L3] [20] (10.1054/jhsb.2000.0522)
  • [L5] A case of giant cell tumour of the tendon sheath causing trigger wrist is reported. [21] (10.1016/s0266-7681(85)80038-3)
  • [L5] The authors report a case of a diffuse giant cell tumor of the tendon sheath arising from the carpal tunnel of the wrist in a 42-year-old woman, presenting with mild carpal tunnel syndrome and a mid-palmar swelling. [23] (10.1016/j.main.2012.08.006)
  • [L5] [24] (10.1007/s12593-015-0185-3)
  • [L1] [26] (10.1007/s11552-011-9341-9)
  • [L4] [27] (10.1177/17531934231222401)
  • [Case_report] [28] (10.1016/j.jhsa.2014.11.010)
  • [L3] [30] (10.1016/s0266-7681(98)80084-3)
  • [L4] [31] (10.1007/s12593-010-0020-9)
  • [L4] [32] (10.11138/gchir/2013.34.5.149)
  • [L5] Calcified aponeurotic fibroma is a rare tumor that presents as a painless mass primarily on the volar surface of the hands and plantar aspects of the feet in juveniles and must be considered in the differential diagnosis of GCT of the tendon sheaths or sarcomas, especially in young patients. [33] (10.1016/j.jhsa.2006.04.011)
  • [L4] En bloc resection of the tumour and reconstruction with an autograft should be considered in the treatment of recurrent giant cell tumour of the hand. [36] (10.1016/s0266-7681(98)80197-6)
  • [L4] In cases of infiltrative GCTTS, radiation therapy may provide local tumor control with preservation of hand function. [43] (10.1016/j.jhsa.2012.01.011)
  • [L4] Curettage, cryosurgery, and cementation performed by experienced surgeons appears to be a safe, effective, and reliable method for treating selected giant cell tumors of the hand. [44] (10.1053/jhsu.2001.22525)
  • [L4] [46] (10.1302/0301-620x.95b3.30192)
  • [L5] Adequate resection of a giant cell tumor should be done at the initial procedure. [51] (10.1016/s0363-5023(77)80123-8)
  • [L3] The absence of disease on MRI should not be used as the sole criterion in determining whether a repeat resection should be performed. [104] (10.1016/j.jhsa.2010.05.009)
  • [L4] MRI is the investigation of choice for diagnosing these tumour-like lesions. [106] (10.1007/s00167-009-1034-3)
  • [L4] Magnetic resonance imaging is essential to diagnose this pathologic condition and to define accurately its localization and treatment strategy. [107] (10.1007/s00167-011-1747-y)
  • [L4] Although MRI findings and location might help in the diagnosis of a T-GCT, careful assessment is mandatory, especially in unusual locations. [108] (10.1186/s12891-016-1050-7)
  • [L4] MRI provides valuable clues, but definitive diagnosis relies on histopathological confirmation. [109] (10.1186/s12891-026-09563-w)
  • [L5] At 9 years' follow-up, the patient was disease-free and clinical function remained excellent. [111] (10.1016/0363-5023(94)90105-8)

See Also

References

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[2] Fibroma of tendon sheath in the hand. The Journal of Hand Surgery. 1994. DOI: 10.1016/0363-5023(94)90184-8

[3] Giant cell tumor of tendon sheath with intraosseous invasion: A case report. The Journal of Hand Surgery. 1995. DOI: 10.1016/s0363-5023(05)80148-0

[4] Giant cell tumors of the tendon sheaths in the hand: Review of 96 patients with an average follow-up of 12 years. Orthopaedics & Traumatology: Surgery & Research. 2013. DOI: 10.1016/j.otsr.2013.03.008

[5] Fibroma of tendon sheath. The Journal of Hand Surgery. 1984. DOI: 10.1016/s0363-5023(84)80031-3

[6] Giant cell tumour of tendon sheath in a 4-year-old boy. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412455792

[9] Giant Cell Tumors of the Tendon Sheaths in the Hand: Review of 96 Patients With an Average Follow-Up of 12 Years. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.051

[10] Malignant Giant Cell Tumor of the Tendon Sheath. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.049

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[13] Tenosynovial Giant Cell Tumor and Pigmented Villonodular Synovitis. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01255

[14] The Effect of Cellular Proliferative Activity on Recurrence and Local Tumour Extent of Localized Giant Cell Tumour of Tendon Sheath. Journal of Hand Surgery. 2004. DOI: 10.1016/j.jhsb.2004.06.012

[16] Multiple Giant Cell Tumor of Tendon Sheath Involving Both Flexor and Extensor Tendons in a Single Digit: A Case Report and Review of the Literatures. The Journal of Hand Surgery (Asian-Pacific Volume). 2018. DOI: 10.1142/s2424835518720189

[17] Tumeur ténosynoviale à cellules géantes, diffuse des parties molles de l'avant-bras. À propos d'un cas. Chirurgie de la Main. 2001. DOI: 10.1016/s1297-3203(01)00040-3

[18] Intraosseous growth of giant cell tumors of the tendon sheath (localized nodular tenosynovitis) of the digits: Report of 15 cases. The Journal of Hand Surgery. 1998. DOI: 10.1016/s0363-5023(98)80062-2

[19] Benign Bony and Soft Tissue Tumors of the Hand. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.08.015

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[24] Multiple Giant Cell Tumors of the Tendon Sheath : Separate Volar and Dorsal Lesions Involving Three Digits of the Same Hand Following Repetitive Trauma. Journal of Hand and Microsurgery. 2015. DOI: 10.1007/s12593-015-0185-3

[26] Giant Cell Tumour of Tendon Sheath of the Digits. A Systematic Review. HAND. 2011. DOI: 10.1007/s11552-011-9341-9

[27] The effect of surgical factors on recurrence of tendon sheath giant cell tumours. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934231222401

[28] Recurrent Pigmented Villonodular Synovitis and Multifocal Giant Cell Tumor of the Tendon Sheath: Case Report. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.11.010

[30] Measurement of Invasive Potential Provides an Accurate Prognostic Marker for Giant Cell Tumour of Tendon Sheath. Journal of Hand Surgery. 1998. DOI: 10.1016/s0266-7681(98)80084-3

[31] Giant Cell Tumor of Tendon Sheath: Case Series and Review of Literature. Journal of Hand and Microsurgery. 2010. DOI: 10.1007/s12593-010-0020-9

[32] Giant cell tumor of tendon sheath: study of 64 cases and review of literature. Giornale di Chirurgia - Journal of Surgery. 2013. DOI: 10.11138/gchir/2013.34.5.149

[33] Calcifying Aponeurotic Fibroma of the Hand: Radiologic Differentiation from Giant Cell Tumors of the Tendon Sheath. The Journal of Hand Surgery. 2006. DOI: 10.1016/j.jhsa.2006.04.011

[36] Recurrent Metacarpal Giant Cell Tumour Treated by En Bloc Resection and Metatarsal Transfer. Journal of Hand Surgery. 1998. DOI: 10.1016/s0266-7681(98)80197-6

[37] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[43] Radiation Therapy for Infiltrative Giant Cell Tumor of the Tendon Sheath. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.01.011

[44] Giant cell tumor of the hand: Superior results with curettage, cryosurgery, and cementation. The Journal of Hand Surgery. 2001. DOI: 10.1053/jhsu.2001.22525

[46] Diffuse pigmented villonodular synovitis (diffuse-type giant cell tumour) of the foot and ankle. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b3.30192

[51] Extensive giant cell tumor of the finger: A case history. The Journal of Hand Surgery. 1977. DOI: 10.1016/s0363-5023(77)80123-8

[104] Predictive Value of Magnetic Resonance Imaging in Determining Presence of Residual Disease After Marginal Excision of Unsuspected Soft Tissue Sarcomas of the Hand. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.009

[106] Tumour‐like lesions of the infrapatellar fat pad. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-009-1034-3

[107] Arthroscopic treatment of localized pigmented villonodular synovitis of the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1747-y

[108] Tenosynovial giant cell tumors in unusual locations detected by positron emission tomography imaging confused with malignant tumors: report of two cases. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1050-7

[109] Two rare intra-articsular knee disorders with overlapping symptoms: separate case reports of tenosynovial giant cell tumour and lipoma arborescens and literature review. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09563-w

[111] Giant cell tumor of the scaphoid: A case report and review of the literature. The Journal of Hand Surgery. 1994. DOI: 10.1016/0363-5023(94)90105-8

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Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.