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1mediterranean journal
of RHEUMATOLOGY
33 4
2022
2022 The Author(s).
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CASE REPORT
Giant Cell Tumour Presenting with Chronic Ankle-Joint Pain
Christina Flourou1,2, Andreas Tofarides1, Eleni Papanicolaou1, Andreas Liampas1, Savvas Psarelis3
internal Medicine Department, Nicosia General Hospital, Nicosia, Cyprus, 2Aristotle University of Thessaloniki, Thessaloniki, Greece, 3Rheumatology Department, Nicosia General Hospital, Nicosia, Cyprus
Mediterr J Rheumatol 2022;33(4):453-4 https://doi.org/10.31138/mjr.33.4.453
Article Submitted: 23 Sep 2021; Article Accepted: 25 Oct 2021; Available Online: 31 Dec 2022
Keywords: giant cell tumour, chronic pain, ankle-joint
ABBREVIATIONS
LT: Left RT: Right
A 62-year-old patient, non-smoker, with prior medical history of hypertension was referred to Rheumatology. The patient described pain and right (RT) ankle-joint swelling. He mentioned a gradually progressive pain in his joints, that amplified with exercise. He also denied any recent trauma or overuse. He had no fever, chills, sweats, or other constitutional symptoms. Following a physical examination revealed swelling of ankle-joint, moderate pain on palpation, without redness or warmth difference between his left (LT) ankle-joint. Metatarsal joints were not affected and no other significant signs from musculoskeletal system were observed. X-ray imaging of the RT foot did not reveal any signs of fractures, osteoarthritis or chondrocalcinosis and no joint effusion was presented.
The laboratory workup was unremarkable with normal inflammatory markers, normal RF, uric acid, and no autoantibodies. Serological test came back normal. Ultrasound sonography revealed a heterogeneous mass on the outer front portion of the ankle (Figure 1A). Further Magnetic Resonance Imaging confirmed the presence of a solid heterogenous mass with dimensions
1.6x2.5x2.8cm (Figure 1B).
Over the next weeks, surgical resection of the mass was performed as to undergo further histo-pathological analysis. The microscopical examination confirmed
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Figure 1. Ultrasound Sonography of the RT ankle-joint showing heterogeneous lesion with irregular margin to the outer front portion of the ankle (A). Magnetic Resonance Imaging scan (T1-W) demonstrating a solid heterogeneous lesion with dimensions 1.6x2.5x2.8cm (B).
Corresponding Author:
Christina Flourou Internal Medicine Department Nicosia General Hospital Lemesou, Strovolos, Cyprus Tel.: +357 99 32 1849 E-mail: christinafl@hotmail.gr
Cite this article as: Flourou C, Tofarides A, Papanicolaou E, Liampas A, Psarelis S. Giant Cell Tumour Presenting with Chronic Ankle-Joint 453 Pain. Mediterr J Rheumatol 2022;33(4):453-4.
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the diagnosis of a classic benign giant cell tumour of the tendon sheath. The tumour presented a small hy-perchromatic fused oval shaped cells with several large osteoclasts such as multinucleated giant cells scattered throughout with few dilated vessels and oedema but no cellular atypia (Figure 2).
The patient recovered fully within few weeks. Tenosynovial giant cell tumours are rare1 lesion arising from synovia of joints or tendon sheaths. They always involve a single joint: most commonly, the knee or ankle joint limiting joint function and destroying the adjacent bones.3 The principal treatment is tumour resection and limited data support radiation therapy due to the risk of long-term toxicity.4
This case is useful to remind that joint involvement with chronic pain (over the six-week duration) required further evaluation with imaging tools when osteoarthritis exacerbation, crystal arthropathy, infectious and systemic rheumatic diseases are carefully ruled out.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
REFERENCES
1. Ehrenstein V, Andersen SL, Qazi I, Sankar N, Pedersen AB, Sikorski R, et al. Tenosynovial Giant Cell Tumor: Incidence, Prevalence, Patient Characteristics, and Recurrence. A Registry-based Cohort Study in Denmark. J Rheumatol 2017;44:1476.
2. Hamlin HR, Stabler A, Maier M, Refior HJ. Pigmented villonodular synovitis. Review of 20 cases. J Rheumatol 2001;28:1620.
3. Müller LP, Bitzer M, Degreif J, Rommens PM. Pigmented villonodular synovitis of the shoulder: review and case report. Knee Surg Sports Traumatol Arthrosc 1999;7:249.
4. Ogilvie-Harris DJ, Weisleder L. Arthroscopic synovectomy of the knee: is it helpful? Arthroscopy 1995;11:91.
Figure 2. Left eye fundus photograph of posterior pole showing numerous flame-shaped superficial retinal haemorrhages, some with white centre (Roth spot) and peri-papillary subretinal haemorrhages.
