PDF(Pubmed)
Abstract：
BACKGROUND: Tenosynovial giant cell tumor (TGCT) is a neoplastic, inflammatory disease with a benign but aggressive course that often presents as localized (TGCT-L) and diffuse (TGCT-D) forms based on the growth pattern and clinical behavior. For TGCT-L, simple excision of the diseased synovial tissue is the preferred treatment option, while for TGCT-D, adequate synovectomy is usually tricky but is essential. However, approximately 44% of TGCT-D cases will relapse after surgery alone. Thus, the optimal treatment strategy in patients with TGCT-D is evolving, and standalone surgical resection can no longer be regarded as the only treatment. The previous studies have shown that postoperative adjuvant radiotherapy can reduce recurrence in TGCT, especially in patients with incomplete synovectomy.
UNASSIGNED: In the first case, a 54-year-old male presented with recurrent pain and swelling of the right knee with a protracted disease course (≥10 years). The other patient is a 64-year-old male who developed swelling, pain, abnormal bending, and limited movement of the left knee without obvious inducement.
UNASSIGNED: Clinical and imaging examinations can provide a definitive diagnosis, and pathology is the gold standard. TGCT-D was confirmed by postoperative pathology. After the operation, the patients underwent an MRI re-examination and showed that the lesions of the knee were not completely resected.
METHODS: Arthroscopic synovectomy was performed on the patients, and postoperative pathology was confirmed as TGCT-D. Because of incomplete synovectomy, the 2 cases received image-guided, intensity-modulated radiotherapy (IG-IMRT) after the operation.
RESULTS: The follow-up time was 1 year, no evidence of disease progression was found in MRI. No obvious adverse effects associated with radiotherapy were detected during the follow-up period.
CONCLUSIONS: These cases and reviews illustrate the necessity of radiotherapy for TGCT-D and that IG-IMRT is a safe and effective method for treating TGCT-D of the knee.
UNASSIGNED: In the first case, a 54-year-old male presented with recurrent pain and swelling of the right knee with a protracted disease course (≥10 years). The other patient is a 64-year-old male who developed swelling, pain, abnormal bending, and limited movement of the left knee without obvious inducement.
UNASSIGNED: Clinical and imaging examinations can provide a definitive diagnosis, and pathology is the gold standard. TGCT-D was confirmed by postoperative pathology. After the operation, the patients underwent an MRI re-examination and showed that the lesions of the knee were not completely resected.
METHODS: Arthroscopic synovectomy was performed on the patients, and postoperative pathology was confirmed as TGCT-D. Because of incomplete synovectomy, the 2 cases received image-guided, intensity-modulated radiotherapy (IG-IMRT) after the operation.
RESULTS: The follow-up time was 1 year, no evidence of disease progression was found in MRI. No obvious adverse effects associated with radiotherapy were detected during the follow-up period.
CONCLUSIONS: These cases and reviews illustrate the necessity of radiotherapy for TGCT-D and that IG-IMRT is a safe and effective method for treating TGCT-D of the knee.
摘要：
背景：肌腱滑膜巨细胞瘤（TGCT）是一种肿瘤，炎症性疾病具有良性但侵袭性的过程，通常表现为基于生长模式和临床行为的局部（TGCT-L）和弥漫性（TGCT-D）形式。对于TGCT-L,病变滑膜组织的简单切除是首选的治疗选择，而对于TGCT-D,充分的滑膜切除术通常是棘手的，但至关重要。然而,约44%的TGCT-D病例仅在手术后复发.因此，TGCT-D患者的最佳治疗策略正在演变，单独的手术切除不再被视为唯一的治疗方法。既往研究表明术后辅助放疗可减少TGCT复发,尤其是不完全滑膜切除术的患者。
■在第一种情况下，一名54岁男性患者出现反复疼痛和右膝肿胀,病程延长(≥10年).另一名患者是一名64岁的男性，他出现了肿胀，疼痛,异常弯曲,左膝活动受限，无明显诱因。
■临床和影像学检查可以提供明确的诊断，病理学是黄金标准.TGCT-D经术后病理证实。手术后,患者接受了MRI复查,显示膝关节病变未完全切除.
方法：对患者进行关节镜滑膜切除术，术后病理证实为TGCT-D。因为滑膜切除术不全,2例接受图像引导，术后进行调强放疗(IG-IMRT)。
结果：随访时间为1年，在MRI中没有发现疾病进展的证据.随访期间未发现与放疗相关的明显不良反应。
结论：这些病例和综述说明了TGCT-D放疗的必要性，IG-IMRT是治疗膝关节TGCT-D的安全有效方法。
■在第一种情况下，一名54岁男性患者出现反复疼痛和右膝肿胀,病程延长(≥10年).另一名患者是一名64岁的男性，他出现了肿胀，疼痛,异常弯曲,左膝活动受限，无明显诱因。
■临床和影像学检查可以提供明确的诊断，病理学是黄金标准.TGCT-D经术后病理证实。手术后,患者接受了MRI复查,显示膝关节病变未完全切除.
方法：对患者进行关节镜滑膜切除术，术后病理证实为TGCT-D。因为滑膜切除术不全,2例接受图像引导，术后进行调强放疗(IG-IMRT)。
结果：随访时间为1年，在MRI中没有发现疾病进展的证据.随访期间未发现与放疗相关的明显不良反应。
结论：这些病例和综述说明了TGCT-D放疗的必要性，IG-IMRT是治疗膝关节TGCT-D的安全有效方法。
