Loading...
 

Volume 34, Issue 4, December 2023



Sign in to download the Issue in PDF format.

Mediterr J Rheumatol 2022;33(4):453-4
Giant Cell Tumour Presenting with Chronic Ankle-Joint Pain
Authors Information
  1. Internal Medicine Department, Nicosia General Hospital, Nicosia, Cyprus
  2. Aristotle University of Thessaloniki, Thessaloniki, Greece
  3. Rheumatology Department, Nicosia General Hospital, Nicosia, Cyprus
Abstract
This paper has no abstract.

Cite this article as: Flourou C, Tofarides A, Papanicolaou E, Liampas A, Psarelis S. Giant Cell Tumour Presenting with Chronic Ankle-Joint Pain. Mediterr J Rheumatol 2022;33(4):453-4.

Article Submitted: 23 Sep 2021; Article Accepted: 25 Oct 2021; Available Online: 31 Dec 2022

 

https://doi.org/10.31138/mjr.33.4.453

This work is licensed under a Creative Commons Attribution 4.0 International License.

©2022 The Author(s).

Full Text

A 62-year-old patient, non-smoker, with prior medical history of hypertension was referred to Rheumatology.  The patient described pain and right (RT) ankle-joint swelling. He mentioned a gradually progressive pain in his joints, that amplified with exercise. He also denied any recent trauma or overuse. He had no fever, chills, sweats, or other constitutional symptoms.
Following a physical examination revealed swelling of ankle-joint, moderate pain on palpation, without redness or warmth difference between his left (LT) ankle-joint. Metatarsal joints were not affected and no other significant signs from musculoskeletal system were observed.
X-ray imaging of the RT foot did not reveal any signs of fractures, osteoarthritis or chondrocalcinosis and no joint effusion was presented.
The laboratory workup was unremarkable with normal inflammatory markers, normal RF, uric acid, and no autoantibodies. Serological test came back normal.
Ultrasound sonography revealed a heterogeneous mass on the outer front portion of the ankle (Figure 1A). Further Magnetic Resonance Imaging confirmed the presence of a solid heterogenous mass with dimensions 1.6x2.5x2.8cm (Figure 1B).


Figure 1A. Ultrasound Sonography of the RT ankle-joint showing heterogeneous lesion with irregular margin to the outer front portion of the ankle.
 




Figure 1B. Magnetic Resonance Imaging scan (T1-W) demonstrating a solid heterogeneous lesion with dimensions 1.6x2.5x2.8cm.
 




Over the next weeks, surgical resection of the mass was performed as to undergo further histopathological analysis.
The microscopical examination confirmed the diagnosis of a classic benign giant cell tumour of the tendon sheath. The tumour presented a small hyperchromatic fused oval shaped cells with several large osteoclasts such as multinucleated giant cells scattered throughout with few dilated vessels and oedema but no cellular atypia (Figure 2).


Figure 2. The microscopic study with Hematoxylin and Eosin (H&E) stainings showing multinucleated giant cells.
 



The patient recovered fully within few weeks. Tenosynovial giant cell tumours are rare1 lesion arising from synovia of joints or tendon sheaths. They always involve a single joint: most commonly, the knee or ankle joint limiting joint function and destroying the adjacent bones.3 The principal treatment is tumour resection and limited data support radiation therapy due to the risk of long-term toxicity.4 
This case is useful to remind that joint involvement with chronic pain (over the six-week duration) required further evaluation with imaging tools when osteoarthritis exacerbation, crystal arthropathy, infectious and systemic rheumatic diseases are carefully ruled out. 

 

CONFLICT OF INTEREST

The authors declare no conflict of interest.

References
  1. Ehrenstein V, Andersen SL, Qazi I, Sankar N, Pedersen AB, Sikorski R, et al. Tenosynovial Giant Cell Tumor: Incidence, Prevalence, Patient Characteristics, and Recurrence. A Registry-based Cohort Study in Denmark. J Rheumatol 2017;44:1476.
  2. Hamlin HR, Stabler A, Maier M, Refior HJ. Pigmented villonodular synovitis. Review of 20 cases. J Rheumatol 2001;28:1620.
  3. Müller LP, Bitzer M, Degreif J, Rommens PM. Pigmented villonodular synovitis of the shoulder: review and case report. Knee Surg Sports Traumatol Arthrosc 1999;7:249.
  4. Ogilvie-Harris DJ, Weisleder L. Arthroscopic synovectomy of the knee: is it helpful? Arthroscopy 1995;11:91.