This tumor was
once thought to be a cancer of a tendon sheath. It is now known to be a benign
non-cancerous tumor of a tendon sheath. These masses are generally found on the
toes, top of the foot or sides of the foot. They are always closely associated
with a tendon sheath. They can also occur deep inside the foot. They slowly
enlarge but never grow any larger than 4cm in size. They are firm irregular
masses that are commonly painful. The pain seems to be a result of the tumor
pressing firmly on the surrounding tissues and due to the interference with the
function of the tendon that the mass is growing from. As the tendon grows it
can press so firmly on the bone it lays next to, that it can cause erosion of
the bone. It is because of this erosion of bone that the tumor was once thought
to be cancerous. Cancerous tumors can have the characteristic of invading bone
through aggressive and destructive means. The erosion of the bone associated
with giant cell tumors is due to pressure on the bone and not due to the
invasion of the bone by the tumor. Other common soft tissues masses that may
occur in the foot are ganglions, fibromas.
The diagnosis of
a giant cell tumor is generally made by a pathologist following removal of the
mass. Clinical history of the mass may give the surgeon an idea of what they
might expect when removing the mass. X-rays may show the shadow of the mass,
and in 10-20% of the cases, may demonstrate bone erosion. The mass is firm and
nodular, and always connected to a tendon. A MRI may be useful in determining
the extent or size of the mass.
giant cell tumors is the excision of the tumor. Some physicians may attempt to
inject the mass with cortisone in an attempt to shrink the mass.
excision of giant cell tumors is generally performed in an out patient surgery
center. Depending on the location of the mass the surgery may be performed
under a local anesthesia, with intravenous sedation or general anesthesia.
Following administration of the anesthesia an incision is placed over the mass.
The mass is then carefully dissected free from the surrounding soft tissues.
Following the closure of the surgical site a gauze compressive dressing is
applied. Depending upon the location of the mass the surgeon may apply a splint
or below the knee cast. In some instances the surgeon may perfer that the
patient use crutches for a few days or for as long as three weeks.
period depends upon the location of the mass and the extent of the soft tissue
dissection necessary to remove the mass. The sutures are left in place for 10
to 14 days. During this period of time the patient should limit their
activities and keep the foot elevated above their heart. It is also important
to keep the bandage in place and keep the surgical site dry. If the patient has
been instructed to wear a removable cast or use crutches it is important that
they follow the surgeonís instructions. Time off from work will depend upon the
level of activity required of the job and the shoes necessary for work.
Generally a minimum of one week off from work is necessary. If the patient can
return to work while wearing a cast and they are allowed to perform light duty
then they may be able to return to work after one week.
The surgery is
generally successful and without complications. However, as with any surgical
procedure there are potential complications. Possible complications include,
infection, excessive swelling, delays in healing, tendon or nerve injury.
Because the mass is a growth from a tendon, removal of the mass may require the
excision of a portion of healthy tendon. This can weaken the tendon or cause
scaring of the tendon. Additionally there may be small skin nerves in the area
of the tumor that may have to be sacrificed when removing the mass. If this
occurs there may be small areas of patchy numbness on the skin following the
procedure. This is generally not a significant problem. On occasion a nerve may
get bound down in scar tissue and cause pain following the surgery. Recurrence
of the mass is also possible but generally not considered a complication of the