Giant cell tumor of the tendon sheath - recurrence

Discussion:

The differential for hypointesne lesions on both T1 and T2 weighted images in the hand commonly includes: giant cell tumor of the tendon sheath (GCTTS) (aka: PVNS of the tendon sheath), gouty tophi, anything with calcification (i.e. synovial osteochondromatosis), rice bodies and chronic blood. GCTTS is T1 and T2 hypointense due to hemosiderin accumulation, similar to chronic blood products.

This case is unique because GCTTS usually presents with a focal mass that respects the boundaries of the enveloping tendon sheath. The history of "multiple surgeries" in this case explains the spread of the tumor to multiple tendon sheath compartments and beyond into the dorsum of the hand, because the sheath was violated at the time of surgery, likely seeding tissue in muliple locations and/or with incomplete removal of the inital mass(es).

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