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Beitragstitel How to approach diffuse Tenosynovial Giant-cell Tumors (dTSGCT) of the Knee Joint?
Beitragscode P39
  1. Pascal A. Schai LUKS Luzern und Wolhusen Vortragender
  2. Michael O. Kurrer Pathologikum
  3. G. Ulrich Exner Orthopädie Zentrum Zürich
Präsentationsform Poster
  • A05 - Knie
Abstract Introduction
TSGCT is differentiated into localized and diffuse subtypes. Diffuse TSGCT usually cannot be removed completely, leading to a high risk for recurrence. Reoperation especially in the popliteal region of the knee joint may become difficult because of scarring. A case of ex-tensive anterior and posterior involvement of the knee joint is presented to discuss tactics and technique regarding:
- timing of surgical interventions
- technique (open/arthroscopic/combined)
- indication for adjuvant treatment

M *1982, at 29 y suspected tumor development posteriorly to the PCL of the right knee, with inconclusive histology of arthroscopic biopsy. At 34 y, CT-guided biopsy approved diagnosis of dTSGCT; with only minimal restrictions initial observation was decided. Two years after biopsy, developing diffuse discomfort and limited ROM, the patient desired treatment. Imaging showed diffuse infiltration of popliteal structures. Open approach of the posterior masses and postponed arthroscopy for the anterior lesions depending upon the further development was decided.

Open tumor resection presented to be difficult due to adherence of the displaced vessels, almost forcing to abort the procedure. Finally subtotal resection of the popliteal lesions was achieved. Anterior arthroscopic approach performed three months later resulted in subtotal resection of the intraarticular tumor masses. At present, 3 y postoperatively, the knee joint is stable in terms of soft tissue mantle and functional parameters.

Because of the variant presentation, treatment of dTSGCT needs to be individualized. We have rejected radiotherapy (90Y synoviorthesis, radiation) because of the lack of hard data. Treatment with tyrosine kinase inhibitors or antibodies is considered promising, yet not generally available.
The optimum timing of surgery has not been analysed so far. Considering the high rate of recurrence with increasing difficulties for re-resections, resection should be postponed as long as possible.
Extended popliteal processes evidently need open approach. Whether anteriorly open or arthroscopic resection be preferred and if it should be combined with the posterior ap-proach in the same session remains discussed. For anterior tumor extension we prefer arthroscopy to reduce scarring making re-resections and arthroplasty more difficult. In se-lected patients with associated degenerative disease synovectomy combined with arthro-plasty may be indicated.