# TGCT of the shoulder – a case series and literature review

## TL;DR

This case series and literature review explores the diagnosis and treatment of rare tenosynovial giant cell tumors in the shoulder, emphasizing the need for individualized treatment and follow-up.

## Contribution

The study provides insights into the management of shoulder TGCT through a case series and comprehensive literature review, highlighting treatment outcomes and recurrence risks.

## Key findings

- All patients except one were recurrence-free after treatment, with a mean follow-up of 39–233 months.
- Diffuse TGCT was more common than nodular TGCT in the literature review, with a reported recurrence rate of 10.6%.
- Arthroscopic and open resections were the primary treatments, with adjuvant therapies used in a minority of cases.

## Abstract

Tenosynovial giant cell tumor (TGCT), also known as pigmented villonodular synovitis (PVNS), involving the shoulder is extremely rare and can present with a challenging clinical course. Due to the complex anatomy of the shoulder, both diagnosis and treatment are demanding. This study aims to evaluate the diagnostic and therapeutic management of shoulder TGCT based on a case series and a review of the literature.

Between 2005 and 2021, four patients (2 females, 2 males) with shoulder TGCT (1 localized, 3 diffuse) underwent surgical treatment at our institution. The minimum follow-up was 39 months (range: 39–233 months). Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), the Oxford Shoulder Score (OSS), and the Short Form 36 Health Survey (SF-36). Additionally, a literature review of 65 studies comprising 108 patients was performed.

Treatments consisted of arthroscopic and open resections, tendon repair, adjuvant radiosynoviorthesis, and radiotherapy, as appropriate. All patients were recurrence-free at the last follow-up, except for one with stable residual disease after radiotherapy. The mean interval from symptom onset to diagnosis was 23.6 ± 28.1 months. In the literature cohort, the mean patient age was 50.3 ± 19.7 years, with a nearly equal gender distribution. Diffuse TGCT was more common (66.1%) than nodular TGCT (33.8%). Treatment was primarily surgery, arthroscopic (53.2%) or open (42.9%), with adjuvant therapies applied in 9.3% of cases. After a mean follow-up of 37.6 ± 36.2 months in 67 cases, diffuse in 44.8%, nodular in 19.4% (no data regarding TGCT-type in 35.8%) the reported recurrence rate was 10.6% and 4.5% remained with residual disease.

TGCT of the shoulder remains a rare and complex condition requiring individualized treatment strategies. Arthroscopic and open resections are the mainstays of therapy, while the role of adjuvant treatments should be carefully considered. Given the risk of recurrence, follow-up is essential. Further studies are needed to establish standardized treatment protocols and evaluate long-term outcomes.

Level IV (Case series with no comparison group).