A Rare Giant Cell Tumor of the Tendon Sheath of the Dorsal Hand in a Child

Copyright 2014 The Korean Society of Plastic and Reconstructive Surgeons This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. characteristics and boundaries of the mass. MRI revealed a 2.8 × 3.3 cm lobulated subcutaneous soft tissue mass that was in contact with extensor digitorum tendon of the right hand, located dorsal to the second to fourth metacarpal bones (Fig. 2). It showed intermediate or dark signal intensity on both T1-weighted and T2-weighted images, and mild homogenous enhancement on contrast images. The mass was strongly suspected to be a giant cell tumor or fibroma originating from the tendon sheath. Based on clinical findings and imaging, we decided to perform surgical excision of the mass with a suspicion of giant cell tumor or fibroma of the tendon sheath. The operation was performed under general anesthesia with surgical tourniquet. After making an incision in the middle of the swelling, we performed subcutaneous dissection. A poorly encapsulated mass was also successfully dissected and excised without sacrificing any tendons or neurovascular structures (Fig. 3). After irrigation and hemostasis, the incision was closed and a Penrose drain placed. The drain was removed on the second postoperative day, and the wound healed uneventfully. Cytological assays were negative for malignant cells and hemosiderin-laden macrophages, which would have implied previous hemorrhage. Pathologic findings revealed a 2.5 × 1.5 cm giant cell tumor of the tendon sheath (Fig. 4). The patient underwent an uneventful one-year course of postoperative follow-up without recurrence. GCTTS is a slow-growing soft tissue mass that Giant cell tumors of the tendon sheath (GCTTS) are benign soft tissue neoplasms of the synovial lining. The peak incidence occurs in the third to fifth decades of life with a slight female predominance, and is very rarely reported in children under the age of 10 years [1]. GCTTS occurs as a firm, nodular mass, most commonly on the volar aspects of the fingers and hands [2]. In this article, we report a rare case of a child who developed a GCTTS in the dorsal aspect of the hand. An 8-year-old boy presented to our clinic with a painless swelling on the dorsum of the right hand (Fig. 1). Medical history indicated that he had been healthy and had no underlying diseases. The mass was first noted one year prior to presentation, and had grown progressively since. At the first visit, the mass protruded from the metacarpal area of the right hand dorsum, and was approximately 2 cm in diameter (Fig. 1). The mass was firm, not freely movable, and was not tender. Magnetic resonance imaging (MRI) was performed to evaluate the