Tenosynovial giant cell tumours: experience at an Australian tertiary referral centre for musculoskeletal tumours with minimum two-year follow-up

Raymond G Kim; Anthony W Maher; Sascha Karunaratne; Paul D Stalley; Richard A Boyle

doi:10.1302/2633-1462.411.BJO-2023-0116.R1

Tenosynovial giant cell tumours: experience at an Australian tertiary referral centre for musculoskeletal tumours with minimum two-year follow-up

Bone Jt Open. 2023 Nov 8;4(11):846-852. doi: 10.1302/2633-1462.411.BJO-2023-0116.R1.

Authors

Raymond G Kim^{1

2

3}, Anthony W Maher¹, Sascha Karunaratne^{4

5}, Paul D Stalley¹, Richard A Boyle¹

Affiliations

¹ Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
² Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ School of Medicine, Sydney Campus, The University of Notre Dame Australia, Sydney, New South Wales, Australia.
⁴ Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁵ Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

PMID: 37935246
PMCID: PMC10629998
DOI: 10.1302/2633-1462.411.BJO-2023-0116.R1

Abstract

Aims: Tenosynovial giant cell tumour (TGCT) is a rare benign tumour of the musculoskeletal system. Surgical management is fraught with challenges due to high recurrence rates. The aim of this study was to describe surgical treatment and evaluate surgical outcomes of TGCT at an Australian tertiary referral centre for musculoskeletal tumours and to identify factors affecting recurrence rates.

Methods: A prospective database of all patients with TGCT surgically managed by two orthopaedic oncology surgeons was reviewed. All cases irrespective of previous treatment were included and patients without follow-up were excluded. Pertinent tumour characteristics and surgical outcomes were collected for analysis.

Results: There were 111 total cases included in the study; 71 (64%) were female, the mean age was 36 years (SD 13.6), and the knee (n = 64; 57.7%) was the most commonly affected joint. In all, 60 patients (54.1%) had diffuse-type (D-TGCT) disease, and 94 patients (84.7%) presented therapy-naïve as "primary cases" (PC). The overall recurrence rate was 46.8% for TGCT. There was a statistically significant difference in recurrence rates between D-TGCT and localized disease (75.0% vs 13.7%, relative risk (RR) 3.40, 95% confidence interval (CI) 2.17 to 5.34; p < 0.001), and for those who were referred in the "revision cases" (RC) group compared to the PC group (82.4% vs 48.9%, RR 1.68, 95% CI 1.24 to 2.28; p = 0.011). Age, sex, tumour volume, and mean duration of symptoms were not associated with recurrence (p > 0.05).

Conclusion: Recurrence rates remain high even at a tertiary referral hospital. Highest rates are seen in D-TGCT and "revision cases". Due to the risks of recurrence, the complexity of surgery, and the need for adjuvant therapy, this paper further supports the management of TGCT in a tertiary referral multi-disciplinary orthopaedic oncology service.