腱鞘巨细胞瘤

腱鞘巨细胞瘤阴亮，左翠娥，张道岩，冷培基腱鞘巨细胞瘤（ＧａｉｎｔＣｅｌｌＴｕｍｏｒｏｆＴｅｎｄｏｎＳｈｅａｔｈ）又称结节性腱鞘炎，为一种少见的腱鞘或滑膜内衬组织的良性病损。主要发生在手与足部，肿物一般较小，术前确诊困难，为提高对本病的认识，减作者单位...     

腱鞘巨细胞瘤

腱鞘巨细胞瘤又名局限性结节性腱鞘炎、巨细胞性腱鞘炎、滑膜纤维黄色瘤，首先由Ｃｈａｓｓａｉｇｎａｃ以“腱鞘癌”报告（１８５２年），直至１９１５年Ｂｅｅｋｍａｎ才定为“腱鞘巨细胞瘤”。国内李静１９５９年首先报告一例，以后有零星报道，我院从１９８９年～１９...     

腱鞘巨细胞瘤一例报告

1病例报告 患者男,35岁,于1996年11月9日发现左拇指近节指腹有一包块,约米粒大小,质硬,无疼痛,左拇指活动良好,肿块逐渐增大,1997年10月23日手术切除,病理诊断:"左拇指腱鞘囊肿".1998年8月16日发现左拇指远节指腹及左小指掌指关节处肿块,逐渐增大,无疼痛,手术切除后病理诊断为"腱鞘巨细胞瘤",1999年2月再次复发,频繁活动后有痛感.查体:左拇指近远节指腹、左小指近节及掌指关节处和前臂远端多发肿块,质硬、表面光滑,可活动.X线平片见左拇指及小指末节指腹肿大,可见囊形软组织肿块,边界清,拇指末节指骨见弧形压迹.     

25例手足腱鞘巨细胞瘤MRI分析

[目的]分析手足腱鞘巨细胞瘤（giant cell tumors of the tendon sheath,GCTTS）的MRI表现,以提高对其认识和诊断水平。[方法]回顾性分析25例经手术病理证实的手足部GCTTS患者的MRI表现特点。[结果]25例手足部GCTTS中,局限型20例,弥漫型5例,所有病例均可见软组织肿块紧贴或包绕肌腱生长,其中5例可见邻近骨质侵蚀。病灶信号与正常骨胳肌相比,T1WI上19例呈等信号,4例呈等低信号,2例呈低信号;T2WI上信号表现多样化,9例呈混杂信号,6例呈高信号,4例呈稍高信号,6例呈低信号;12例增强扫描后,9例病灶呈明显不均匀强化,3例呈明显均匀强化。[结论]手足GCTTS以局限型多见,MRI上表现有特征性,MRI检查对疾病诊断、治疗方案制定等可提供可靠依据。     

腱鞘巨细胞瘤(附9例报告)

目的探讨腱鞘巨细胞瘤手术的临床效果.方法3例首次治疗病例,采取包囊外界限性切除,6例复发病例,采用广泛切除术,术后3例进行放疗,6例术后未行任何治疗,观察临床疗效.结果9例均无复发.结论手术切除彻底,术后一般不会复发.     

全程鞘管切开手术治疗复发性腱鞘巨细胞瘤

目的 探讨全程鞘管切开治疗复发性腱鞘巨细胞瘤的临床应用.方法 对8例复发性腱鞘巨细胞瘤术中采用全程鞘管切开,对肿瘤彻底切除.结果 全组肿瘤均彻底干净切除,对降低复发率有一定疗效,术后无畸形发生,手指的外形及其功能没有影响.结论 全程鞘管切开治疗复发性腱鞘巨细胞瘤疗效满意,复发率低.对手指的外形及其功能没有影响.     

人工关节置换治疗膝部骨巨细胞瘤

目的 探讨人工关节置换治疗膝部骨巨细胞瘤的适应证及影响疗效的因素。方法 对8例8膝人工全膝关节置换术进行临床分析和总结。结果 人工全膝关节置换术治疗骨巨细胞瘤8例，随访1～7年，平均2年3个月，无1例复发，无感染、松动和折断现象。应用HSS膝关节评分标准进行分析，优7例，良1例，优良率为100％。结论 严重膝关节部原发性骨巨细胞瘤采用肿瘤段截除，人工全膝关节置换的手术方法，效果满意。     

腱鞘巨细胞瘤27例分析

腱鞘巨细胞瘤是来自滑膜组织的肿瘤,起于小关节及腱鞘的滑膜层,常见于手与足部,确切病因不清,有人认为其属于炎症病变;靠近骨皮质者,可产生对骨的压痕,但少有骨破坏。有学者认为伴骨破坏的腱鞘巨细胞瘤具有更高的侵袭性，术后容易复发。多数学者认为其自主性生长，肿物内异倍染色体的出现并呈克隆性生长，具有肿瘤的特性，属于肿瘤病变。     

Solitary multinodular giant cell tumor of tendon sheath.

We present a 74 year old man with a solitary multinodular tumor of the right thumb and an adenocarcinoma of the prostate. Histologic examination of the hand tumor revealed a giant cell tumor of tendon sheath.     

Fibroma of tendon sheath

This report describes a 60-year-old woman with a fibroma of tendon sheath of left hand. Ultrastructural study of the tumor reveals the nature of the tumor cells as fibroblasts, thus distinguishing it from the more common giant cell tumor of tendon sheath believed to be derived from synovial cells.     

大关节弥漫型腱鞘巨细胞瘤的影像学诊断

目的 探讨大关节弥漫型腱鞘巨细胞瘤（diffuse giant cell tumor of tendon sheath,D-GCTTS）的影像学表现特点。 方法　回顾性分析11例经手术病理证实的D-GCTTS患者的影像学资料。所有患者均行X线及MRI检查,7例行CT检查。 结果　X线检查均表现为关节旁见密度略高于肌肉的软组织肿块影,其中7例关节面下方见骨质破坏,边界较清楚;7例行CT平扫显示软组织肿块和骨质破坏征象较X线平片清晰,呈跨关节性骨质破坏,边缘硬化,软组织肿块内未见钙化。MRI检查显示病灶范围较CT清楚,9例均表现为骨旁、关节旁软组织肿块影,呈分叶状、团状,边界清楚,信号不均匀,各序列以低信号为主;6例增强后病灶呈中等度或明显不均匀强化;骨质破坏7 例,骨质破坏区信号与软组织肿块一致;关节积液 2 例。结论　大关节弥漫型腱鞘巨细胞瘤的影像表现具有一定特征性,结合X线平片、CT表现的骨质破坏情况及MRI病灶出现特征性的双低信号,可作出明确诊断。     

Fibroma of tendon sheath

Three cases of fibromas involving tendon sheath of right index finger, left ring finger, and tibial ligament in a 62-, a 54-, and a 30-year-old male patient, respectively, are described. Two cases (1 and 2) represented painless, slowly enlarging masses that limited motion of the involved digits. The third case was discovered at surgery during the repair of a tibial ligament after a motorcycle accident. Following surgical excisions, no recurrences were present 18 months and 9 months after resection. The fibromas of tendon sheath origin are distinct entities and should be separated from other lesions of tendon sheaths. Trauma should be considered as the etiology. The fibromas are benign lesions but may recur.     

A multidisciplinary approach to giant cell tumors of tendon sheath and synovium—A critical appraisal of literature and treatment proposal

Giant cell tumors deriving from synovium are classified into a localized (GCT of tendon sheath; GCT‐TS) and diffuse form (diffuse‐type GCT, Dt‐GCT). We propose a multidisciplinary management based upon a systematic review and authors' opinion. Open excision for GCT‐TS and open synovectomy (plus excision) for Dt‐GCT is advised to reduce the relatively high recurrence risk. External beam radiotherapy should be considered in severe cases, as Dt‐GCT commonly extends extra‐articular. J. Surg. Oncol. 2013;107:433–445. © 2012 Wiley Periodicals, Inc.     

Articular degeneration after subchondral cementation for giant cell tumors at the knee

PurposeTo quantify joint degeneration and the clinical outcome after curettage and cementation in subchondral giant cell tumors of the bone (GCTB) at the knee.MethodsWe conducted a retrospective analysis of 14 consecutive patients (seven female, seven male) with a mean age of 34 years (range 19–51) who underwent curettage and subchondral cementation for a biopsy-confirmed GCTB at the distal femur or the proximal tibia between August 2001 and August 2017, with a mean follow-up period of 54.6 months (range 16.1–156 months). The Whole-Organ Magnetic Resonance Imaging Score (WORMS), Kellgren-Lawrence (KL) classification, and Musculo-Skeletal Tumor Society (MSTS) score were assessed.ResultsRadiological degeneration progressed from preoperative to the latest follow-up, with a median WORMS from 2.0 to 4.0 (p = 0.006); meanwhile, the median KL score remained at 0 (p = 0.102). Progressive degeneration (WORMS) tended to be associated with the proximity of the tumor to the articular cartilage (mean 1.57 mm; range 0–12 mm) (p = 0.085). The most common degenerative findings were cartilage lesions (n = 11), synovitis (n = 5), and osteophytes (n = 4). Mean MSTS score increased from 23.1 (preoperatively) to 28.3 at the latest follow-up (p < 0.01).Seven patients (50%) were treated for a local recurrence, with six revision surgeries performed. Removal of the cement spacer and filling of the cavity with a cancellous autograft was performed in seven patients. Conversion to a total knee arthroplasty was performed in one patient for local tumor control.ConclusionsCementation following the curettage of GCTB around the knee is associated with slight degeneration at medium-term follow-up and leads to a significant reduction in pain. Removal of the cement and reconstruction with an autograft may be beneficial in the long term.     

Giant cell tumour of the tendon sheath of the hand: A pictorial essay

Giant cell tumour of the tendon sheath is a soft tissue mass found occasionally in the hand. Its diagnosis can be readily made preoperatively if the characteristic MRI features are appreciated. This pictorial essay demonstrates and describes the imaging findings correlated with histopathological findings in a group of patients with proven giant cell tumour of the tendon sheath.     

年龄与脊柱骨巨细胞瘤预后关系的研究进展

骨巨细胞瘤（GCT）是一种有局部侵袭性的良性骨肿瘤。女性较男性多见,并且好发于20～40岁的青壮年[1-3]。骨巨细胞瘤的生物学行为较特殊,术后易复发。目前临床实践中常从肿瘤影像或病理等方面来分析其生物学行为,并对其预后进行判断。而以往骨巨细胞瘤的研究报道,不同年龄段患者术后复发率存在差异[4-5],提示年龄可能是影响骨巨细胞瘤生物学行为及预后的因素。但由于以往的研究多为全身骨骼骨巨细胞瘤的病例,并未明确反映出年龄与脊柱骨巨细胞瘤复发之间的关系。     

病灶内切除与整块切除治疗骨巨细胞瘤的比较研究——4个相关研究的Meta分析

目的用Meta分析的方法对国内外已发表的高质量的有关比较病灶内切除术和整块切除术对骨巨细胞瘤患者术后复发率和并发症发生率影响的临床研究进行综合定量分析，为骨巨细胞瘤的外科治疗模式的选择提供参考依据。方法收集已公开发表的有关病灶内切除与整块切除治疗骨巨细胞瘤所有随访严密的随机对照研究或设计良好的非随机对照研究，按Meta分析的要求对检索到的原始研究的质量进行评估，对符合条件的所有研究结果用Meta分析专用统计软件RevMan4．2版进行统计分析，计算病灶内切除术相对整块切除术其复发及并发症发生危险的优势比（OR），评价病灶内切除术与整块切除术对GCT患者复发及并发症发生的影响。结果符合纳入标准的文献4篇，总样本量156例。其中病灶内切除术组83例，复发8例，发生并发症5例；整块切除术组73例，复发2例，发生并发症26例；合并OR复发=3．16，95％可信区间0．81～12．30，合并OR并发症=0．12，95％可信区间0．04～0．32。结论两种手术治疗模式对术后GCT复发的影响无统计学意义，还不能说明两种术式术后GCT复发率有差别。两种手术治疗模式对术后并发症发生的影响有统计学意义，病灶内切除组的并发症发生优势比整块切除组低88％。