TENOSYNOVIAL Giant Cell Tumors 😎-1.pptx

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1. ORTHOPAEDICS - PATHOLOGY INTEGRATED SESSION-20/06/24 DEPARTMENT OF ORTHOPAEDIC SURGERY, ESIC MC & HOSPITAL, KK NAGAR.

2. CASE - 2 TENOSYNOVIAL GIANT CELL TUMOR OF RIGHT THUMB

3. CHIEF COMPLAINTS C/o swelling in Right thumb × 2 years C /o pain in right thumb × 2 months

4. H ISTORY OF PRESENTING ILLNESS Patient was apparently normal 2 years back after which he developed swelling over the right thumb which was insidious in onset, gradually progressed to the current size, He developed pain over the right thumb for the past two months which was dull aching and non radiating in nature No aggravating and relieving factors No h/o loss of weight No h/o loss of appetite

5. PAST HISTORY Newly diagnosed Type 2 Diabetes mellitus on meal plan No other Co morbidities No h/o previous surgeries in the past FAMILY HISTORY - Nil significant

6. EXAMINATION GENERAL EXAMINATION AND SYSTEMIC EXAMINATION FINDINGS WERE NORMAL

7. CLINICAL PICTURE

8. LOCAL EXAMINATION Patient had a swelling over the palmar aspect of the right thumb which was approximately 2×3 cm ,non-tender,soft to firm in consistency,mobile,non adherent,skin is pinchable

9. X-RAY After en bloc excision

10. X-RAY FINDINGS

11. CT MRI

12. CT MRI FINDINGS

13. FNAC

14. INTRODUCTION Distinct neoplasm arising from non-bone forming supportive connective tissue of marrow with network of stromal cells regularly interspersed with giant cells DEFINITION

15. EPIDEMIOLOGY 5% of all skeletal tumors 21% of benign tumors Incidence is 30% of all bone tumors in india

16. AGE OF PRES ENTATION 70% of patients 20-40 years 10% > 65 years

17. LOCATIONS Epiphyseo-metaphyseal region of long bones, usually eccentrical GCT is described from all bones except middle ear bones Axial skeleton - 8% UL: LL - 1:3

18. Intra articular extension -10% Trans osseous extension - 5%

19. CLINICAL FEATURES Pain Swelling Restricted ROM Muscle wasting Neurological signs Pathological fracture (10-15%)

20. CLINICAL PICTURE Overlying skin is stretched,shiny with no engorged veins PALPATION smooth to variable consistency, predominantly bony Tenderness may or may not be present EGG SHELL CRACKLING : Elicitable when there is pathological fracture or too much thinning of cortex

21. EVALUATION Radiology: Tumour will show largely sharply circumscribed area of reduced density usually eccentrically located in the epiphysis , beginning subcortically and extending towards metaphysis , soap bubble appearance, multilocular and trabeculated appearance, cortical thinning, no sclerotic rim or new bone formation

22. Computed tomography Helps in confirming the integrity of the cortex and outlining the tumour extent Subcortical destruction can be well appreciated with a CT scan Limitations - Soft tissue extension of tumour and relationship with adjacent structures cannot be seen

23. MRI With MRI, the morphologic analysis and extent of disease into surrounding soft tissue can be assessed As in CT scan, subcortical destruction can be well appreciated by multiplanar MRI Intramedullary tumors best appreciated in T1 weighted images Extra osseous tumors in T2 weighted images

24. Angiography - to check relationship of major vessels to large tumors Radionuclide scintigraphy - GCT takes up increase uptake of technetium 99 Tumour marker - TACP ( Total Serum Acid Phosphatase) Correlates with tumour size

25. BIOPSY Final diagnostic tool for diagnosis of GCT Sample can be taken from FINE NEEDLE ASPIRATION CORE NEEDLE BIOPSY OPEN INCISIONAL BIOPSY EXCISIONAL BIOPSY

26. Gross appearance Composed of ragged , very friable, readily bleeding tissue containing variously sized cavitations and small cysts Colour varies from reddish brown to chocolate color in which vascular tissue predominates , greyish to mottled where connective tissue predominates No evidence of periosteal new bone formation Inner wall lined by fibrous capsule,septae extend onwards to partition the tumor