We report a case of tenosynovial giant cell tumor with severe bone erosion in the right fifth finger of a 46-year-old man. Throughout this case review, we describe the imaging findings of tenosynovial giant cell tumor with severe bone erosion and review the literatures regarding osseous lesions caused by tenosynovial giant cell tumor and their significance related to the differential diagnosis and patient treatment.We report a case of tenosynovial giant cell tumor with severe bone erosion in the right fifth finger of a 46-year-old man. Throughout this case review, we describe the imaging findings of tenosynovial giant cell tumor with severe bone erosion and review the literatures regarding osseous lesions caused by tenosynovial giant cell tumor and their significance related to the differential diagnosis and patient treatment.