Localized tenosynovial gigantocellular tumor of the ankle in an adolescent: case report and literature review
| Autor: | Dimnjaković, Damjan, Karakaš, Tin, Bojanić, Ivan |
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| Jazyk: | chorvatština |
| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Paediatria Croatica Volume 66 Issue 3-4 (online first) |
| ISSN: | 1846-405X 1330-1403 |
| Popis: | Tenosinovijalni gigantocelularni tumor (TGCT) je rijetka benigna monoartikularna bolest koja zahvaća sinovijalnu ovojnicu zgloba, tetive ili burze. Razlikujemo lokalizirani i difuzni oblik bolesti pri čemu je histološka slika kod oba oblika jednaka. Stopa pojavnosti lokaliziranog oblika TGCT-a (LTGCT) iznosi deset slučajeva na milijun ljudi od čega se u oko 5% svih slučajeva pojavljuje u gležnju. Prikazan je rijedak slučaj pojave LTGCT-a u prednjem dijelu gležnja u adolescentice koji se očitovao oteklinom i povremenim bolovima, napose pri sportskim aktivnostima. Na snimci magnetske rezonancije (MR) u prednjem je dijelu gležnja bila vidljiva heterogeno strukturirana, oštro ograničena tumorska tvorba, dok su sve ostale prikazane strukture bile urednih intenziteta signala i primjerene morfologije. Osim bezbolne otekline prednjeg dijela gležnja kliničkim je pregledom utvrđen i deficit dorzalne fleksije stopala. Zahvat je načinjen artroskopski, a tumorska se tvorba zbog svoje veličine nije mogla odstraniti u jednom komadu već se odstranila u dijelovima. Patohistološka analiza je utvrdila da je riječ o TGCT-u. Tijekom razdoblja praćenja od dvije godine bolesnica se nije žalila na tegobe s operiranim gležnjem, a na kontrolnim MR-ima nije zamijećen recidiv. Na TGCT valja pomisliti kao moguću diferencijalnu dijagnozu kod bolesti gležnja, napose kad se bol i oteklina pojave bez ozljede. Artroskopski zahvat je sigurna i učinkovita metoda liječenja LTGCT-a u gležnju ako ju izvodi iskusan operater kojeg prati uhodan tim, no valja istaknuti da se odabir načina kirurškog liječenja treba prilagoditi kako anatomskom položaju tvorbe u zglobu tako i procjeni i preferenciji kirurga. Tenosynovial giant cell tumor (TGCT) is a rare, benign monoarticular disease that affects the synovial lining of joint, tendon or bursa. We distinguish two forms of the disease, localized and diffuse forms, both of which are histologically identical. The incidence rate of the localized form of TGCT (LTGCT) is 10 cases per million people, of which about 5% of all cases occur in the ankle. We present a rare case of LTGCT in the anterior part of the ankle in an adolescent, which was manifested by swelling and occasional pain, especially during sports activities. On the magnetic resonance imaging (MRI) a heterogeneously structured, well encapsulated tumor was visible in the anterior part of the ankle. In addition to the painless swelling in the anterior part of the ankle, the physical examination revealed a deficit of dorsiflexion of the foot. The operation was performed arthroscopically but the tumor could not be removed in a single piece due to its size, so it was removed in multiple pieces. Histopathological analysis confirmed that the tumor was TGCT. During the two-year follow-up period, the patient did not have problems with the operated ankle and no recurrence of the disease was observed on control MRIs. TGCT should be considered as a possible differential diagnosis, especially when pain and swelling of the ankle occur without injury. Arthroscopic surgery is a safe and effective method of treatment if it is performed by an experienced surgeon backed by a welltrained team. The choice of the type of surgical treatment should be determined depending on the anatomical position of the formation in the joint and the surgeon’s assessment and preference. |
| Databáze: | OpenAIRE |
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