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Pathology

(46) Characterization of Tenosynovial Giant Cell Tumors in the Temporomandibular Joint: A Multidisciplinary Approach to Treatment

Thursday, September 12, 2024
2:30 PM – 4:00 PM EDT
Poster Winner

    Poster Presenter(s)

  • Sydnee Vaughan, DMD (she/her/hers)

    Resident
    Oral & Maxillofacial Surgery Massachusetts General Hospital
    Boston, Massachusetts, United States

    • Co-Author(s)

  • AG

    Andrew Gross, PhD, DMD, MBA

    Fellow
    Department of Oral & Maxillofacial Surgery Massachusetts General Hospital Harvard School of Dental Medicine
    Boston, Massachusetts, United States

  • Joseph P. McCain, DMD, FACS

    Director of Fellowship, Endoscopic Maxillofacial and Minimally Invasive TMJ Surgery
    Massachusetts General Hospital, Harvard School of Dental Medicine
    Boston, Massachusetts, United States

  • Daniel D. Choi, MD, DDS, FACS

    Assistant Director, Temporomandibular Joint and Minimally Invasive Endoscopic Fellowship
    Department of Oral & Maxillofacial Surgery Massachusetts General Hospital Harvard School of Dental Medicine
    Boston, Massachusetts, United States

Disclosure(s):
Sydnee Vaughan, DMD: No financial relationships to disclose
Abstract: Tenosynovial giant cell tumor (TGCT), previously known as pigmented villonodular synovitis, is a benign proliferative lesion of synovial tissue commonly presenting in major long bones and joints. Although relatively uncommon in the temporomandibular joint (TMJ), TGCT’s of the TMJ are often locally aggressive and destructive in nature.

In this retrospective case series, we report 6 cases of TGCT between 2016 and 2024 comparing approaches to diagnosis and treatment. Multidisciplinary efforts to treat these lesions involved oral and maxillofacial surgeons, ENT, and Neurosurgical teams.

Clinical presentation, symptomatology, diagnosis, imaging, and treatment are characterized and compared. The mean age at diagnosis is 53.17 years, with a mean duration of symptoms prior to diagnosis reported as 3.13 years. Prominent symptoms associated with TGCT in the TMJ include facial swelling with severe pain, trismus, otalgia, and malocclusion. Computed tomography (CT) and magnetic resonance imaging (MRI) illustrate poorly defined soft tissue masses with distinct zones of sclerotic bone erosion and enlarged synovium. Genetic testing and immunohistochemical stains illustrate upregulation of CSF1 and CD68, offering insight into the destructive nature of this pathology. Histologically, synovial cell proliferation and hyperplasia, hemosiderin deposition, and the presence of multinucleated giant cells are recognized and compared. TGCT of the TMJ is recognized to involve the anterior tympanic plate, mastoid air cells, condylar head, and glenoid fossa. Progressive lesions often lead to skull base erosion and eventual dura involvement. Surgical treatment involves diagnostic arthroscopy, surgical resection and debridement, adjunctive radiation, and eventual total joint reconstruction.

Due to the aggressive nature and risk of recurrence, diagnostic MRI should be considered in the setting of severe pain, trismus, otalgia and malocclusion to rule out the presence of tenosynovial giant cell tumor. A multidisciplinary approach with long-term follow up involving advanced imaging is key to the diagnosis and treatment of TGCT within the TMJ.

References

Kim IK, Cho HY, Cho HW, Seo JH, Lee DH, Peng W. Pigmented villonodular synovitis of the temporomandibular joint - computed tomography and magnetic resonance findings: a case report. J Korean Assoc Oral Maxillofac Surg. 2014 Jun;40(3):140-6. doi: 10.5125/jkaoms.2014.40.3.140. Epub 2014 Jun 27. PMID: 25045642; PMCID: PMC4095812.

Herman, C. R., Swift, J. Q., & Schiffman, E. L. (2009). Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: a case and literature review. International Journal of Oral and Maxillofacial Surgery, 38(7), 795-801. https://doi.org/10.1016/j.ijom.2009.02.013