背景:踝关节弥漫性腱鞘膜巨细胞瘤(D-TSGCT)的侵袭模式和长期结果尚不清楚。
方法:纳入2011年至2023年在我科就诊的7例患者,经对比增强MRI诊断为踝关节D-TSGCT并进行病理诊断。研究了踝关节D-TSGCT在MRI上的侵袭模式。在全切除后随访超过7年的5例患者中,检查了复发率和临床症状。
结果:在7名患者中(1名男性/6名女性,平均年龄37.0±16.6岁,范围15-57年)与D-TSGCT的踝关节,最初表现的对比增强MRI显示踝关节侵犯,沿着腱鞘延伸,在距骨关节内,在100%的病例中,在三角肌韧带周围的86%,足底表面占43%,57%的骨间膜侵入,29%的跟腱周围,43%的骨轮关节有扇贝。从群众意识到首次访问的平均时间为51.9±80.0个月(范围1-240个月)。总切除,定义为切除MRI测量的所有肿瘤,最初对6/7患者进行。一名患者仅接受了肿瘤前部的部分切除术。在6例全切除的病例中,5例术后长期随访超过7年,一个病例手术后只有一年。5例患者在全切除后随访超过7年的长期结果如下:平均随访时间为125个月(范围89-171个月),100%的复发率,平均复发时间为27.5±19.2个月(范围7-60个月),和16%的再手术率。在最后的后续行动中,在2/5的患者(40%)的影像学检查中观察到骨关节炎的变化,在最初诊断时,他们两人在MRI上都出现了颅骨关节的扇贝。5例患者中有4例(80%)在最后一次随访中没有临床症状。
结论:踝关节D-TSGCT表现出沿着腱鞘的踝关节内外强烈的局部浸润模式,根治性切除可能很困难,复发率可能高于以前的报道。另一方面,有许多病例在复发后长期没有临床症状,踝关节D-TSGCT的手术指征需要考虑功能保留以及复发率。
BACKGROUND: The invasion patterns and long-term outcomes of diffuse tenosynovial giant cell tumor (D-TSGCT) of the ankle joint remain unclear.
METHODS: Seven patients who visited our department between 2011 and 2023 and were diagnosed with D-TSGCT of the ankle joint by contrast-enhanced MRI and a pathological diagnosis were included. The invasion patterns of ankle D-TSGCT on MRI were investigated. The recurrence rate and clinical symptoms were examined in five patients followed up for more than seven years after total resection.
RESULTS: In seven patients (1 male/6 females, mean age 37.0±16.6 years, range 15-57 years) with D-TSGCT of the ankle joint, contrast-enhanced MRI at the initial presentation showed invasion within the ankle joint, extending along the tendon sheath, within the talocalcaneal joint, and in the tarsal sinus in 100% of cases, around the deltoid ligament in 86%, within the plantar surface in 43%, invasion of the interosseous membrane in 57%, around the Achilles tendon in 29%, and scalloping on the talocrural joint in 43%. The mean time from mass awareness to the first visit was 51.9±80.0 months (range 1-240 months). Gross total resection, defined as the removal of all tumors as gauged by MRI, was initially performed on 6/7 patients. One patient underwent partial resection of only the anterior part of the tumor. Of the six cases in which gross total resection was performed, 5 had long-term follow-up of more than seven years post-operatively, and one case is still only one year post-operatively. The long-term results of five patients followed for more than seven years after total resection were as follows: a mean follow-up period of 125 months (range 89-171 months), a 100% recurrence rate, a mean time to recurrence of 27.5±19.2 months (range 7-60 months), and a 16% reoperation rate. In the last follow-up, osteoarthritic changes were observed radiographically in 2/5 patients (40%), both of whom had scalloping of the talocrural joint on MRI at the time of the initial diagnosis. Four of the five patients (80%) had no clinical symptoms in the last follow-up.
CONCLUSIONS: Ankle D-TSGCT presents with a strong local infiltrative pattern inside and outside the ankle joint along the tendon sheath, radical resection may be difficult, and the recurrence rate may be higher than previously reported. On the other hand, there are many cases that remain free of clinical symptoms in the long term after recurrence, and surgical indications for ankle D-TSGCT need to consider function preservation as well as recurrence rates.