Saturday, July 3, 2010

Giant cell tumour of the tendon sheath

A giant cell tumours of the tendon sheath (GCTTS) is an uncommon usually benign lesion that arises from the tendon sheath. It is unclear whether these lesions represent neoplasms or simply reactive masses. The are also known as pigmented villonodular tumour of the tendon sheath (PVNTS).

Clinically these masses typically present in the hand (although they are found elsewhere also) with localised swelling with or without pain. They are slow growing.

Typically they present in 3-5th decades and have a slight female predilection with a M:F ratio of 1.5 -2.1:1 .
Distribution of GCTTS
They have been divided macroscopically into localised or diffuse forms, and appear as rubbery multinodular masses that are well circumscribed. They have an enveloping fibrous capsule, and the cut surface is variably coloured depending on the relative proportions of fibrous tissue, haemosidering and pigmented foam cells.

The tumour is histologically identical to pigmented villonodular synovitis (PVNS) and is composed of fibroblasts and multinucleated giant cells, foamy histiocytes and inflammatory cells on a background fibrous matrix.

Radiographic features
Plain film
As these masses arise from tendons, commonly of the hand, they may cause pressure erosions on the underlying bone. This is only seen in 10 - 20 % of cases. More commonly these masses arise from the palmar tendons. The mass itself is of soft tissue density. Calcification is uncommon.
Ultrasound is useful as it allows not only characterization of the lesion but also is able to demonstrate the relationship with the adjacent tendon.

These masses are typically homogeneously hypoechoic, although some heterogeneity my be seen in echo-texture in a minority of cases . Most will have some internal vascularity.
Giant cell tumour of tendon sheath (Modality: Ultrasound)
Not surprisingly, given the histological similarity to PVNS, giant cell tumours of the tendon sheaths also share the same finding on MRI, mainly on account of hemosiderin accumulation.

* T1 :
o low signal
o variable enhancement
* T2 : low signal

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Clay powder and Cabbage leaves as remedies for muscles ache

When you have trained very hard and you get muscular fever, or if you caught a flu and all muscles hurt, you should not hurry taking pain killers. Instead, you may choose to apply clay or other herbs compresses, with a relaxing effect. Clay has anti-inflammatory effect

Clay powder is a well known remedy in arthrosis, with an anti-inflammatory effect. It may also be used is alleviating muscles ache, no matter the cause. All you need is 4-5 tablespoons of powder clay, in which to add warm water and keep stirring until obtaining a homogeneous paste. This paste can then be applied directly on the entire surface of the painful muscle, or only at the ends, near the joints, in a 5 centimeter layer. Leave it on for 20 minutes to 2 hours. This remedy is also very efficient for back aches.

Cabbage leaves, old but efficient remedy
This is a very old remedy, that our grandparents used to apply on joints affected by arthritis. Besides it being very helpful in muscular aches, it is also very easy to use. All you have to do is smash some cabbage leaves and apply those directly on the affected area, leaving them on for about 30 to 40 minutes. You may use as well oak, birch, walnut or willow leaves.

Warm baths, followed by compresses
Warmth enlarges blood vessels and stimulates the bloodstream, therefore helping aching muscles to relax. That is why a warm bath is more than welcomed in cases of muscles ache. To obtain an even more relaxing effect, add to the bath sweet flag (calamus) or willow bark extract. The extract is prepared by boiling a tablespoon of each plant (add only when the water is boiling) in a liter of water, for about 10 to 15 minutes. The liquid is filtered and poured in the bath tub filled with warm water. The bark or plants remained may be applied on the muscles after the bath.
Very useful in cases of muscle fever is also St John’s wort (hypericum perforatum) or lavender soak applied directly on the affected surface. Raw potatoes or powder mint poultice (cataplasm), mixed until obtaining a homogenous paste can be applied on gauze and afterwards on the muscle.
And remember: a simple exercise often helps reducing muscular fever!