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Giant Cell Tumors of the Tendon Sheath in the Hand of Pediatric Patients: A Case Report and Literature Review
Alyssa Reese, MD
1, Adam Akari, BS
1, Matthew Serrata, BS
1, Raymond Richards, BS
2, Jessica Bigner, MD
1; Yifan Guo, MD
1(1)Eastern Virginia Medical School, Norfolk, VA, (2)University of Buffalo, Buffalo, NY
Introduction: Giant cell tumor of the tendon sheath (GCTTS), or localized tenosynovial giant cell tumor, is a benign, slow-growing lesion originating from the synovial lining of tendon sheaths. While similar to giant cell tumor of the bone, GCTTS has a lower recurrence rate and distinct characteristics. Although relatively common in adult patients, GCTTS is rare in the pediatric population, particularly in children under 10 years of age. This study presents a case of GCTTS of the hand in a child and provides a literature review to better characterize its presentation, diagnosis, and management in this unique demographic.
Methods: A multi-database search involving PubMed and EMBASE was performed with the following search terms: ("giant cell tumor") AND ("pediatric" OR "child" OR "adolescent") AND ("hand" OR "finger" OR "upper extremity" OR "digit"). Articles were included if they were available in the English-language and mentioned at least one case of GCTTS in the hand of a pediatric patient (<18 years). Non-english publications and articles without pediatric case details (i.e. condensed data reflecting a population rather than specific patients) were excluded.
Results: A total of 155 unique articles were reviewed after duplicate screening. 10 articles published from 1994 to 2025 were included. 15 pediatric patients with GCTTS of the hand were identified, aged 5 to 16 years. Of the 14 cases that reported gender, 8 (57.1%) were male and 6 (42.9%) were female. The majority of cases involved the flexor tendon sheath (93.3%), and commonly affected digits were the middle finger (N=6, 40%) and index finger (N=4, 27%), followed by the small finger (N=2, 13%), thumb (N=2, 13%), and ring finger (N=1, 7%). Surgical excision was performed for all cases. Follow-up data ranged from 6 months to 6 years, and there was only 1 case of recurrence identified at 6 months after surgery. A case from our institution involved a 9-year-old male with a right thumb lesion causing pain during sports. The lesion, measuring 1 cm x 1 cm, was excised successfully under general anesthesia, and the patient had a full recovery with no recurrence at his 2-month follow-up.
Conclusion: This study emphasizes the low recurrence rate of GCTTS in the pediatric hand. Given its characteristic presentation, GCTTS should be considered in the differential diagnosis for unknown soft tissue lesions on the volar surface of the hand, particularly those arising from the flexor tendon sheath.
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