Artikel
Teno-synovial giant cell-tumor or pigmented villo-nodular synovitis. A bi-national retrospective multi-center study on 173 cases
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Autoren
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J. Bruns
- Agaplesion Diakonieklinikum Hamburg, Schwerpunkt orthopädische Chirurgie, Hamburg, Germany
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V. Ewerbeck
- Orthopädische Universitätsklinik Heidelberg, Abt. Orthopädie I, Heidelberg, Germany
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R. Kotz
- Wien, Austria
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R. Windhager
- Universitätsklinik für Orthopädie, Wien, Austria
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J. Hassenpflug
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Orthopädische Klinik, Kiel, Germany
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H.-R. Dürr
- Ludwig-Maximilians-Universität, Orthopädische Klinik u. Poliklinik, München, Germany
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DGOOC-Arbeitsgemeinschaft 4: Tumoren des Haltungs- und Bewegungsapparates
| Veröffentlicht: | 18. Oktober 2011 |
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Gliederung
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Questionnaire: Giant cell tumors of synovial tissue such as the diffuse pigmented villonodular synovitis or the nodular giant-cell tumor of joints and tendon sheaths are rare benign diseases. Due to the rarity of the lesion experiences in a single institution are limited. Hence we started a retrospective multi-center study.
Methods: Using a standardized questionnaire regarding clinical symptoms, location, type of the disease, method of surgical therapy, number of recurrences, use of adjuvant therapies and functional outcome.
Results and Conclusions: Ten centers contributed to this study over a period of 18 years. Overall, data from 173 patients could be sampled. The disease was mostly seen in joints (75%), less frequently in tendon sheaths (21%) and rarely in bursae (4%). In joints patients suffered mainly from the diffuse type (64% vs. 36% nodular in joints). In tendon sheaths the relation diffuse vs. nodular was about even, and in bursae most often the nodular type of disease was found. Regarding the anatomical region the knee was the main region. Reported symptoms were swelling, pain and a limited range of motion. The main diagnostic tool was MRI.
Regarding therapy we found institutions with an experience on more than 20 patients had a distinctly lower rate of recurrence than those with less than 20 cases. In knee joints lesions treated with open synovectomy lesser recurrencies were observed than those treated arthroscopically.
Because of the high rate of recurrence the use of adjuvant treatments as radiosynoviortheses or radiotherapy is recommended in the literature. The overall rate of applications of such methods was rather low in our study. But, those patients who received one of the adjuvant therapies after the first surgery did not show any recurrence. In contrast, those patients in whom an adjuvant therapy had been used after at least one recurrence further recurrencies were seen in 14%.
Functional results were classified as excellent in 26%, good in 58%, fair in 14% and poor in 2%.
In conclusion, giant cell tumor of tendon sheath should be treated in an institution experienced with this lesion. Arthroscopic therapy of the diffuse type of disease is followed by a higher rate of recurrences than treatment with open synovectomy. The diffuse type should be additionaly treated with either radiosynoviorthesis or percutaneous radiation.
