Clin Orthop Surg.  2014 Jun;6(2):242-244. 10.4055/cios.2014.6.2.242.

A Tenosynovial Giant Cell Tumor Arising from Femoral Attachment of the Anterior Cruciate Ligament

• Lee JH
• Wang SI

• KMID: 1784674
• DOI: http://doi.org/10.4055/cios.2014.6.2.242

Abstract

The localized type of tenosynovial giant cell tumor usually occurs on the palmar side of fingers and toes. Tenosynovial giant cell tumors of the tendon sheath are rarely intra-articular. We report a giant cell tumor of the tendon sheath arising from femoral attachment of the anterior cruciate ligament and its treatment with arthroscopy in a 28-year-old man.

Keyword

Knee; Anterior cruciate ligament; Tenosynovial giant cell tumor

MeSH Terms

Adult
Anterior Cruciate Ligament/pathology/surgery
Arthroscopy
Femur
Giant Cell Tumors/diagnosis/surgery
Humans
Knee
Male
Synovitis, Pigmented Villonodular/diagnosis/*surgery
Tendons/*pathology

Figure

• 

  Fig. 1 (A, B) Coronal and sagittal T1-weighted images demonstrated that the soft tissue mass was isointense to muscle and obscured the anterior cruciate ligament. (C) T2-weighted sagittal magnetic resonance image showed heterogenous, intermediate to low signal intensity, which was slightly higher than that of skeletal muscle.

• 

  Fig. 2 (A) The mass was located behind the anterior cruciate ligament, close to the femoral attachment site. It was round in shape, measuring about 20 mm × 11 mm in diameter with a reddish-brown color. (B) It was excised with the use of a motorized instrument and basket forceps by piecemeal.

• 

  Fig. 3 Microscopic appearance of the tumor. (A) The basic cellular composition of the tumor was well-defined polygonal mononuclear cells with a scanty, faintly eosinophilic cytoplasm. In some areas, there were bands or sheets of amorphous collagen (H&E, ×100). (B) Foci of xanthoma cells with foamy cytoplasm and vacuoles were present, accompanied by branching capillaries. Multinucleated giant cells had abundant eosinophilic cytoplasm and contained eight or more nuclei (H&E, ×400).

Reference

1. Weiss SW, Goldblum JR. Enzinger and Weiss's soft tissue tumors. 4th ed. Philadelphia, PA: Mosby;2001. p. 1037–1062.

2. Kuhnen C, Muller KM, Rabstein S, Kasprzynski A, Herter P. Tenosynovial giant cell tumor. Pathologe. 2005; 26(2):96–110.

3. Otsuka Y, Mizuta H, Nakamura E, Kudo S, Inoue S, Takagi K. Tenosynovial giant-cell tumor arising from the anterior cruciate ligament of the knee. Arthroscopy. 1996; 12(4):496–499.

4. Jones FE, Soule EH, Coventry MB. Fibrous xanthoma of synovium (giant-cell tumor of tendon sheath, pigmented nodular synovitis): a study of one hundred and eighteen cases. J Bone Joint Surg Am. 1969; 51(1):76–86.

5. Miettinen MM. Diagnostic soft tissue pathology. Philadelphia, PA: Churchill Livingstone;2003. p. 489–502.

6. Wood GS, Beckstead JH, Medeiros LJ, Kempson RL, Warnke RA. The cells of giant cell tumor of tendon sheath resemble osteoclasts. Am J Surg Pathol. 1988; 12(6):444–452.