Kaan GÜRBÜZ, Yakup EKİNCİ, Sabri BATIN, Alper ÇIRAKLI

ELDE KİTLE OLGULARINA YAKLAŞIMDA TENDON KILIFI DEV HÜCRELİ TÜMÖRÜN PREOPERATİF ÖN TANI SIKLIĞI VE NÜKSE ETKİSİ The Effect of Tendon Sheath Giant Cell Tumor on Preoperative Pre-Diagnosis and Recurrence in the Management of Hand Mass

ÖZET Amaç: Bu çalışmada, elde kitle tanısıyla ameliyat edilen ve patolojik tanısı tendon kılıfı dev hücreli tümör (TKDHT) olarak rapor edilen olguların ön tanı ile uyumu ve ön tanının nükse etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Ocak 2013 ile Aralık 2015 tarihleri arasında cerrahi olarak eksize edilen ve patoloji sonucu TKDHT gelen 58 olgu retrospektif olarak incelendi. Hastane kayıt sistemi ve hasta dosyaları taranarak veriler kaydedildi. Olgular yaş, cinsiyet, yön, lokalizasyon, ön tanı, patolojik hacim, takip süresi ve nüks açısından değerlendirildi. Elde edilen veriler istatistiksel olarak incelendi. Bulgular: Olguların kadın/erkek oranı 3/2; yaş ortalaması 44.81±18.14 yıl ve ortalama takip süresi 44.1±9.65 ay idi. 31 sağ ve 27 sol yerleşimli olan kitlelerin neredeyse tamamı fleksör yüzde lokalize idi. Kitlelerin patolojik hacmi ortalama 2.09±0,89 cm3 (0.08-12) iken nüks saptanan 5 olgunun (%8.62) kitle patolojik hacmi ise ortalama 2.46 cm3 (0.08-5.15) idi. Preoperatif ön tanısı bilinen olguların ancak %44,4’ünde patolojik tanı TKDHT idi. Sonuç: El lokalizasyonlu kitle cerrahisinin, basit bir işlem olarak görülmesi sebebiyle preoperatif ön hazırlıkları çoğu zaman özensiz yapılmaktadır. Kitle ön tanısının klinik muayene ile sınırlandırılmayarak, tetkiklerden faydalanılmasının nüks oranlarını azaltacağı kanısındayız. Anahtar Kelimeler: Dev hücreli tümör; Yumuşak doku; Tendon kılıfı; Cerrahi; Nüks ABSTRACT Objective: The purpose of this study was to evaluate the diagnosis, compliance with the pre-diagnosis, and the effect of the pre-diagnosis recurrence of tendon sheath giant cell tumor (TSGCT) cases operated for hand mass. Materials and Methods: Fifty-eight patients who underwent surgical excision between January 2013 and December 2015 and TSGCT as a result of pathology were evaluated retrospectively. Hospital record system and patient files were scanned and the data were recorded. The cases were evaluated in regarding as age, sex, side, localization, pre-diagnosis, pathological volume, follow-up time and recurrence. The data obtained were analyzed statistically. Results: Female to male ratio was 3/2; the mean age of the patients was 44.81 ± 18.14 years and the mean follow-up was 44.1 ± 9.65 months. Almost all of the masses located at right hand in 31 cases. The mean pathologic volume of the masses was 2.09 ± 0.89 cm3 (0.08-12), whereas the mean mass pathology volume of the recurrent 5 cases (8.62%) was 2.46 cm3 (0.08-5.15). Only 44.4% of the patients with known preoperative diagnosis were TSGCT. Conclusion: Preoperative preparation of hand localized mass surgery is often sloppy because it is seen as a simple procedure. We suggest that preoperative clinical examination should be supported by radiological examination in order to reduce recurrence rates. Keywords: Giant cell tumour; Soft tissue; Tendon sheath; Surgical treatment; Recurrence

Anahtar Kelimeler:

ELDE KİTLE OLGULARINA YAKLAŞIMDA TENDON KILIFI DEV HÜCRELİ TÜMÖRÜN PREOPERATİF ÖN TANI SIKLIĞI VE NÜKSE ETKİSİ The Effect of Tendon Sheath Giant Cell Tumor on Preoperative Pre-Diagnosis and Recurrence in the Management of Hand Mass

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1. Gibbons CL, Khwaja HA, Cole AS, Cooke PH, Athanasou NA. Giant-cell tumour of the tendon sheath in the foot and ankle. J Bone Joint Surg Br 2002;84(7):1000-3. 2. Budny PG, Regan PJ, Roberts AH. Localized nodular synovitis: a rare cause of ulnar nerve compression in Guyon's canal. J Hand Surg [Am] 1992;17(4):663-4. 3. Agarwal PK, Gupta M, Srivastava A, Agarwal S. Cytomorphology of giant cell tumor of tendon sheath. A report of two cases. Acta Cytol 1997;41(2):587-9. 4. Reilly KE, Stern PJ, Dale JA. Recurrent giant cell tumors of the tendon sheath. J Hand Surg [Am] 1999;24(6):1298-302. 5. Rao AS, Vigorita VJ. Pigmented villonodular synovitis (giant-cell tumor of the tendon sheath and synovial membrane). A review of eighty-one cases. J Bone Joint Surg Am 1984;66(1):76-94. 6. Adams EL, Yoder EM, Kasdan ML. Giant cell tumor of the tendon sheath: experience with 65 cases. Eplasty 2012;12:e50. 7. Dartoy C, Fenoll B, Leroy JP, Dubrana F, Le Nen D, Jehannin B. Giant cell tumor of the tendon sheath of the long extansor muscle of the thumb in a 7-year-old child. Ann Chir Main Memb Super 1994;13(3):198-201. 8. Suresh SS, Zaki H. Giant cell tumor of tendon sheath: case series and review of literature. Journal of hand and microsurgery 2010;2(2):67-71. 9. O'Connell JX. Pathology of the synovium. American journal of clinical pathology 2000;114(5):773-84. 10. Bedir R, Balık MS, Sehitoglu I, Gucer H, Yurdakul C. Giant Cell Tumour of the Tendon Sheath: Analysis of 35 Cases and their Ki-67 Proliferation Indexes. Journal of clinical and diagnostic research JCDR 2014;8(12):12-15.