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What is Tenosynovial Giant Cell Tumor?
Written by Medicover Team and Medically Reviewed by Dr Chakilam Venugopal , Orthopedics
Tenosynovial Giant Cell Tumor (TGCT) is a noncancerous (benign) growth that develops in the soft tissue around joints, tendons, or bursae. It often affects larger joints, such as the knees, hips, or ankles.
Though it doesn't spread like cancer, it can grow and press on nearby structures, sometimes causing pain, swelling, stiffness, or limited movement.
In some cases, it can even weaken nearby bones.
Treatment usually involves surgery, and in some instances, radiation therapy may be needed.
What are the Types of Tenosynovial Giant Cell Tumor?
Tenosynovial Giant Cell Tumors (TGCTs) are rare, benign growths that generally affect the synovial lining of joints, tendons, or bursae.
These tumors can be classified into two main types, depending on their location and behavior:
Localized Tenosynovial Giant Cell Tumor (LGCT)
- This type typically affects a single tendon or joint. The growth is often confined, leading to pain, swelling, and restricted joint movement. It's commonly seen in younger to middle-aged adults.
- For example, Tenosynovial Giant Cell Tumor of Tendon Sheath is a common variant, where the tumor forms around the tendons.
Diffuse Tenosynovial Giant Cell Tumor (DGCT)
- This variant involves a more widespread area, often affecting multiple joints or tendons. The Tenosynovial Giant Cell Tumor Diffuse Type is more aggressive and may cause significant joint deformities, severe pain, and even joint destruction if not treated early.
- A common site for this type of tumor is the Tenosynovial Giant Cell Tumor of Knee, where it can lead to swelling and pain, especially in the knee joint.
How Does a Tenosynovial Giant Cell Tumor Affect the Human Body?
A tenosynovial giant cell tumor (TGCT) affects the joints, tendons, or synovial lining by causing swelling, pain, joint stiffness, and reduced mobility. Over time, it can damage joint structures and limit movement if not treated effectively.
How Common are Tenosynovial Giant Cell Tumors?
Tenosynovial giant cell tumors (TGCTs) are a rare condition. They affect about 1 in 1 million people each year. Localised forms are more common and typically occur in the fingers, whereas diffuse types are less common but more aggressive, often involving larger joints, such as the knee or hip.
What are the Symptoms of Tenosynovial Giant Cell Tumor?
Symptoms of Tenosynovial Giant Cell Tumor (TGCT) may vary depending on the location and type (localized or diffuse), but common signs include:
- Joint swelling or a visible lump near a tendon or joint
- Mild to moderate pain, especially with movement
- Stiffness or reduced range of motion
- Clicking or locking in the joint
- Warmth or tenderness around the joint
- Slow, progressive onset of symptoms
Severe TGCT Symptoms (Especially in Diffuse TGCT)
- Persistent or worsening pain that limits daily activity
- Severe joint stiffness or immobility
- Erosion of bone or cartilage, visible on imaging
- Joint instability or deformity
- Recurrent swelling even after treatment
- Functional disability, requiring surgical intervention
What are the Causes of Tenosynovial Giant Cell Tumor (TGCT)?
The exact cause of tenosynovial giant cell tumor is not fully understood. However, researchers believe that several factors may contribute to its development:
Genetic Factors
A key cause is a mutation in the CSF1 gene (Colony Stimulating Factor 1). This mutation causes the body to produce excessive macrophage-like cells in the joint or tendon lining, resulting in abnormal tissue growth. This genetic change is seen in both localized and diffuse TGCT.
Chronic Inflammation
Ongoing inflammation in the joint lining (synovium) may trigger abnormal cell growth. Over time, this can lead to the formation of a tumor in the affected joint or tendon sheath.
Past Injury or Trauma
Although not a direct cause, past joint injuries or repetitive use may contribute; repeated stress or trauma can lead to inflammation, which may trigger the abnormal growth of cells in some individuals.
Hormonal Influence
TGCT is more commonly diagnosed in adults between the ages of 20 and 50 and is rare in children. This pattern suggests that hormones may play a role, although the exact link is still being studied.
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Get Second OpinionHow is Tenosynovial Giant Cell Tumor Diagnosed?
Accurate diagnosis of TGCTs requires a combination of clinical evaluation, imaging studies, and histopathological examination.
Clinical Evaluation
A thorough clinical evaluation is the first step in diagnosing TGCTs. Physicians will take a detailed medical history and perform a physical examination, focusing on the affected joint or tendon sheath.
Imaging Studies
- Magnetic Resonance Imaging (MRI): MRI is the imaging modality of choice for TGCT diagnosis. It provides detailed images of soft tissues, allowing for the assessment of tumour size, extent, and involvement of surrounding structures.
- X-rays: While not as detailed as an MRI, X-rays can help identify bone erosion or joint space narrowing associated with TGCTs.
Tenosynovial giant cell tumor radiology can also be explored using CT scans or X-rays to assess any bony involvement or to rule out other causes of swelling.
Histopathological Examination
A definitive diagnosis is achieved through histopathological examination of a biopsy specimen. The presence of characteristic multinucleated giant cells, hemosiderin-laden macrophages, and synovial hyperplasia confirms the diagnosis of TGCT.
What are the Treatment Options for Tenosynovial Giant Cell Tumor?
The primary goals of treating TGCT are to alleviate symptoms, maintain joint function, and prevent recurrence. The type of tumor, localized or diffuse, as well as its size and location, help determine the best treatment approach.
Surgery (Primary Treatment)
Surgery is the most common and effective treatment for TGCT:
- Arthroscopic Surgery: This minimally invasive option is often used for smaller, localized TGCTs. Surgeons use a small camera (arthroscope) and tools through tiny cuts to remove the tumor with less damage to nearby tissue.
- Open Surgery: For larger or diffuse TGCTs, open surgery may be needed. It allows for better access to remove the entire tumor, especially when it involves more profound or multiple areas of a joint.
Additional Therapies (If Needed)
Sometimes, other treatments are used to reduce recurrence or help when surgery isn't enough:
- Radiation Therapy: Radiation can be given after surgery to help prevent the tumor from coming back. It's more common for diffuse TGCT or when complete removal isn't possible.
- Targeted Drug Therapy: Medications like tyrosine kinase inhibitors (e.g., imatinib) block the CSF1 receptor, which is involved in the growth of tumours. These are helpful in cases where surgery isn't an option or the tumor returns.
By combining surgery with additional treatments as needed, most patients achieve good results and regain their function. Regular follow-ups are crucial for monitoring potential recurrence.
When to See a Doctor for a Tenosynovial Giant Cell Tumor (TGCT)?
You should see a doctor if you notice:
- Persistent swelling or a lump near a joint or tendon
- Joint pain or stiffness that doesn't improve with rest
- Reduced range of motion or joint feels locked
- Unexplained warmth or tenderness in the joint
- Recurrent joint symptoms after past TGCT treatment
Early evaluation helps diagnose the condition accurately and prevent joint damage from occurring. Don't wait if symptoms persist for more than a few weeks or begin to interfere with your daily activities.
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How Can I Prevent A Tenosynovial Giant Cell Tumor?
There's no known way to completely prevent TGCT, as it typically occurs due to changes in the cells that line joints or tendons, rather than due to injury or lifestyle factors.
While you can't prevent it, you can
- Pay attention to joint pain or swelling
- See a doctor early if symptoms don't go away
- Go for regular checkups if you've had TGCT before
- Avoid repeated stress or injuries to your joints
Early diagnosis and regular follow-up can help manage the tumor and prevent it from coming back.
Prognosis and Recurrence of Tenosynovial Giant Cell Tumor (TGCT)
The overall outlook for individuals with TGCT is generally good, especially in cases where the tumour is localised. However, recurrence is a known concern, particularly with diffuse TGCT, which tends to be more aggressive.
Recurrence Rates
- Localized TGCT: These tumors have a low chance of coming back. Recurrence rates typically range from 5% to 15%, especially if the cancer is fully removed during surgery.
- Diffuse TGCT: These tumors are more likely to return, with recurrence rates as high as 45% in some studies. Their wider spread within the joint makes complete removal more difficult.
Long-Term Outlook
The long-term outcome depends on several factors, including:
- How much of the tumor was removed
- Whether additional treatments (like radiation or medication) were used
- The location and severity of the tumor
Most people recover well, but regular checkups and imaging tests are important to catch and treat any signs of recurrence early.
Our Experience Treating Tenosynovial Giant Cell Tumor (TGCT)
At Medicover Hospitals, we have helped many patients with Tenosynovial Giant Cell Tumors recover through personalized care and expert treatment. Our orthopedic and oncology teams work together to diagnose TGCT early and plan the best course of action, usually surgical removal.
We use advanced imaging tools to locate the tumor and ensure complete removal. When needed, we also offer supportive therapies like physical therapy and follow-up care to restore joint function and prevent recurrence.
With early treatment and close monitoring, our patients regain comfort and mobility, returning to their normal routines with confidence.
