Tenosynovial giant cell tumors in unusual locations detected by positron emission tomography imaging confused with malignant tumors: report of two cases.
BACKGROUND
A tenosynovial giant cell tumor (T-GCT) is a benign synovial tumor arising from the synovium, bursae, or tendon sheath. It can be intra- or extra-articular and localized or diffuse. Diffuse T-GCT is considered as a locally aggressive. Positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose with computed tomography (FDG PET/CT) is widely used to differentiate malignant from benign tumors and to detect distant metastasis. However, FDG PET/CT is limited by false-positive findings. In this study, we present two cases of T-GCT that developed in unusual locations and were confused with malignant tumors. The final diagnoses were histologically confirmed as T-GCTs.


METHODS
Case 1. A 45-year-old Japanese female presented with a left choroidal melanoma and an abnormal lesion adjacent to the first cervical (C1) lamina confirmed by a PET scan (maximum standardized uptake value [SUVmax] =9.9 g/ml). MRI of the neck also detected a soft tissue mass (14.6 × 7.7 × 7 mm) adjacent to the C1 lamina. The choroidal melanoma was treated by heavy carbon ion radiotherapy. Although the size of the C1 soft tissue tumor remained unchanged, a CT-guided biopsy confirmed the diagnosis of the neck mass as a T-GCT. Case 2. A 15-year-old Japanese male with multiple type 1 neurofibromatosis presented with a soft tissue mass (26.1 × 24.7 × 11.5 mm) of the extra-articular hip joint that was coincidentally detected by FDG PET/CT during examination of a mediastinal soft tissue mass. SUVmax of the mediastinal lesion was 2.6 g/ml and of the hip lesion was 12.8 g/ml. Thus, differentiation from a malignant tumor, such as a malignant peripheral nerve sheath tumor, was necessary. An open biopsy was performed, and the frozen section was diagnosed as T-GCT. The tumor was excised, and the final histological diagnosis confirmed T-GCT.


CONCLUSIONS
T-GCT can show high FDG uptake, which might be confused with malignancy. Although MRI findings and location might help in the diagnosis of a T-GCT, careful assessment is mandatory, especially in unusual locations.
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, 920-8641, Ishikawa-ken, Japan. a_take@med.kanazawa-u.ac.jp.
Akihiko
A
Takeuchi
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, 920-8641, Ishikawa-ken, Japan.
Norio
N
Yamamoto
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, 920-8641, Ishikawa-ken, Japan.
Katsuhiro
K
Hayashi
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, 920-8641, Ishikawa-ken, Japan.
Shinji
S
Miwa
Department of Ophthalmology, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, 920-8641, Ishikawa-ken, Japan.
Masayuki
M
Takahira
Department of Orthopaedic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, 920-0293, Ishikawa-ken, Japan.
Kiyokazu
K
Fukui
Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, 920-0293, Ishikawa-ken, Japan.
Taku
T
Oikawa
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, 920-8641, Ishikawa-ken, Japan.
Hiroyuki
H
Tsuchiya
D000293:Adolescent; D003937:Diagnosis, Differential; D005260:Female; D000070779:Giant Cell Tumor of Tendon Sheath / Q000150:complications / Q000175:diagnosis*; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D009456:Neurofibromatosis 1 / Q000150:complications / Q000175:diagnosis*; D000072078:Positron Emission Tomography Computed Tomography; D012983:Soft Tissue Neoplasms / Q000150:complications / Q000175:diagnosis*
Biopsy; FDG PET/CT; Malignant tumor; Tenosynovial giant cell tumor