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   Introduction
   Case Report
   Case 1
   Case 2
   Discussion
   References
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CASE REPORTS
Year : 1999  |  Volume : 65  |  Issue : 6  |  Page : 288-289

Giant cell synovioma following physical trauma




Correspondence Address:
Sanjiv Grover


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Source of Support: None, Conflict of Interest: None


PMID: 20921690

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How to cite this article:
Grover S, Singh G, Dash K, Te. Giant cell synovioma following physical trauma. Indian J Dermatol Venereol Leprol 1999;65:288-9

How to cite this URL:
Grover S, Singh G, Dash K, Te. Giant cell synovioma following physical trauma. Indian J Dermatol Venereol Leprol [serial online] 1999 [cited 2019 Jun 17];65:288-9. Available from: http://www.ijdvl.com/text.asp?1999/65/6/288/4843





  Introduction Top


Giant cell synovioma (GCS) is a dermal or subcutaneous nodule usually arising on the fingers, but may also appear over the hand, wrist or toes. This benign tumour arises from the tendon sheath and is presumably a reactive process to an unknown aetiology.[1] It doesn't resolve spontaneously but may extend to the skin or into the adjacent joint space.[2] Due to the paucity of such cases in literature, we report two cases of GCS. We also propose physical trauma as one of the aetiological factors precipitating this condition.


  Case Report Top



  Case 1 Top


A 35-year-old man developed a gradually increasing painless swelling over the right fifth finger following an injury while playing volleyball five years ago. Examination revealed a lobulated, firm, non tender, subcutaneous nodule 3cm x 3cm large over the proximal palmar aspect of right fifth finger. Movements of the interphalangeal and metacarpophalangeal joints were normal. X-ray of the finger revealed only soft tissue swelling. FNAC of the mass revealed clumps and sheets of spindle cells with occasional scattered multinucleated giant cells, and no atypical or inflammatory cells. Excision biopsy revealed dense fibroblastic stroma studded with multinucleated giant cells and absence of pallisading; confirming the diagnosis of GCS.


  Case 2 Top


A 65-year-old man reported with a painless hard swelling over the right middle finger increasing over 10 years. It appeared gradually after years of driving a two wheeler moped, wherein the end of the clutch grip pressed and rubbed against the finger while driving. Examination revealed a solitary, multilobulated, nontender, hard, subcutaneous nodule 4cm x 4cm large over the proximal palmar aspect of right middle finger. Finger movements were normal. X-ray of the finger revealed no bony defect or calcification. FNAC of the mass showed a few spindle cells with scattered multinucleated giant cells. Excision biopsy revealed a lobulated mass with an indistinct capsule. Spindle shaped cells in sheets and nodular aggregates gates were studded with numerous osteoclast-like giant cells, confirming the diagnosis of GCS [Figure - 1]


  Discussion Top


Giant cell synovioma usually appears in midlife and is usually asymptomatic, but occasionally the affected digit could be painful or stiff. Though osteoarthritis is reportedly associated, both our cases did not have this condition.[3]

An important observation in our cases was the causal relation of physical trauma to the onset of GCS. In the first case, a direct blunt physical injury presumably damaged the synovial sheath of the flexor tendon of the finger and produced GCS. There is no direct blunt injury in the second case, but one may infer subclinical injury to the synovium following chronic pressure and friction induced by the clutch grip of the vehicle which the man drove for many years.

Clinically, the condition may mimic dermatofibroma, fibrous papule of the finger, fibrokeratoma and ganglion cyst. But histological appearance of spindle shaped fibroblasts, and scattered giant cells is characteristic. These giant cells may resemble osteoclasts.[4]

Recurrence after removal in 25% cases and malignant degeneration has been reported as complications.[3] Though four months and one year of follow up in the first and second cases respectively have not revealed any of these , it is still imperative to continue surveillance. In addition, a high clinical index of suspicion should be maintained to diagnose GCS in subcutaneous nodules of traumatic aetiology.



 
  References Top

1.Lever WF, Schaumberg-Lever G. Histopathology of the Skin. 7th ed, Philadelphia: Lippincott, 1990;669.  Back to cited text no. 1    
2.Fyfe IS, Mac-Farlane AU. Pigmented villonodular synovitis of the hand. Hand 1980;12:179-188.  Back to cited text no. 2    
3.King DT, Millman AJ, Gurevitch AW, et al. Giant cell tumor of the tendon sheath involving the skin. Arch Dermatol 1978;114:944-946.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Carstens PHB. Gaint cell tumors of tendon sheath. Arch Pathol 1978;102:99-103.  Back to cited text no. 4    


    Figures

[Figure - 1]



 

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