Case report 734. Fibroma of tendon sheath eroding 3rd metatarsal bone

Fibroma of the tendon sheath in the dorsum of the foot: A case report

Fibroma of tendon sheath (FTS) is a rare soft tissue tumor that usually occurs in the upper extremity. Moreover, of the few cases reported in the feet, nearly all occur in the plantar region. We report the case of a large FTS in the dorsum of the left foot that grew quickly into a 4 cm-diameter lesion. The 44-year-old Japanese man noticed the tumor incidentally one year before presentation and could not recall any possible cause. Physical examination showed an elastic hard mass that spread over the third to fifth metatarsal bones. MRI showed iso-intense signals with central hypo-intensity on T1-weighted images and hypo-intense signals on T2-weighted images. Since a biopsy did not reveal any malignant findings, the lesion was excised surgically. The tumor was found to be multilocular, encapsulated, and to arise from the extensor digitorum brevis tendon. Histopathology showed scattered spindle fibroblasts and slit-like vascular structures within the dense collagenous matrix. The tumor was diagnosed on the basis of the clinical, demographic, surgical, and histopathological findings as an FTS arising from the extensor digitorum brevis tendon. A review of the literature revealed seven cases of FTS of the dorsum of the foot, which indicates its rarity. More than one-half of these cases were from Japan. While the cause of FTS remains unclear, trauma has been implicated. We suggest that the cultural background of the patient, which could promote kneeling-induced dorsal foot trauma, may have contributed to the onset/progression of our case. Level of Clinical Evidence: 4.

Arthroscopic Removal of Suprapatellar Fibroma of Tendon Sheath

Intra-articular fibroma of tendon sheath is a rare disease. To our knowledge, less than 20 cases have been reported in the literature, and none of them was a Chinese patient. In this case report, we present a Chinese patient with intra-articular fibroma of tendon sheath of the knee joint which was excised arthroscopically. We also summarized the clinical presentation, diagnosis, and subsequent management of intra-articular fibroma of tendon sheath.

Fibroma of Tendon Sheath of the Hand: Clinical and Pathological Study

Presented are seven cases of the rare tumour known as fibroma of tendon sheath of the hand. Diagnosis was uncertain before surgery. When the lesions were removed, they resembled schwannomas. Immunohistochemistry helped distinguish these tumours from giant cell tumours of the flexor sheath and schwannomas. The authors recommend that fibroma of the tendon sheath be included in the differential diagnosis of soft tissue neoplasms of the hand.

Fibroma of the tendon sheath of the long head of the biceps tendon

Fibroma of the tendon sheath is a benign tumor that is less common than giant cell tumor of the tendon sheath. Both tumors may present as a painless, slowly enlarging mass. Radiological findings may be similar for both tumors. Histologically, fibroma of the tendon sheath lacks the hemosiderin-laden macrophages that are typical for giant cell tumor of the tendon sheath. We report on a 49-year-old woman with fibroma of the tendon sheath of the long head of the biceps tendon. In our case, on MR images, we observed band-like hypointense areas centrally in the tumor, mild patchy contrast enhancement, and most importantly, no decrease of signal intensity on gradient echo images. These characteristics reflected histological findings.

An intraarticular fibroma of the tendon sheath in the knee joint

Fibromas that usually occur in the tendon sheaths of the wrist and hand are extremely rare in intra-articular locations. Only five such cases in the knee joint have been reported so far. This is a case report of an intra-articular fibroma of the tendon sheath of the knee joint arising adjacent to posterior cruciate ligament (PCL). Magnetic resonance imaging (MRI) revealed a well-defined intra-articular lesion in the region of the intercondylar notch of the femur behind the PCL. The mass was excised by arthrotomy. Histopathological study confirmed the diagnosis.

Fibroma of tendon sheath located within the ankle joint capsule

We report a very rare case of fibroma of the tendon sheath arising from the anteromedial ankle joint capsule, with no apparent connection to any tendon in the area, found in a 58-year-old patient complaining of progressive local swelling. This uncommon tumor has its usual localization in tendon sheaths, is extremely rare in joint capsules, and has never been described in this location previously. MRI showed nonuniform low signal intensity in T1- and T2-weighted images and high intensity in STIR images. The mass was completely excised by open surgery. Histopathological analysis later confirmed the diagnosis of a fibroma of the tendon sheath.

Fibroma of the tendon sheath that expanded into the radiocarpal joint with bony involvement

We present a 46-year-old man with a fibroma of the tendon sheath of the left radiocarpal joint and bony involvement of the scaphoid and the radial styloid. Bony involvement of a fibroma of the tendon sheath is rare and has been reported only four times to our knowledge.

Intra-articular fibroma of tendon sheath involving the scapholunate and radiocarpal joints

Fibroma of tendon sheath is an uncommon benign soft tissue tumor with a predilection for the hand. A unique case involving the scapholunate and radiocarpal joints with bone erosion is reported. The patient presented with a transilluminating mass over the volar radial wrist associated with neuropathy in the superficial radial nerve distribution. Magnetic resonance imaging demonstrated a heterogeneous and lobulated mass with nonspecific signal characteristics closely associated with the scapholunate interval and the volar wrist soft tissues. Histologically it represented a fibroma of tendon sheath. The tumor is discussed and the relevant literature is reviewed.

MR imaging of fibroma of the tendon sheath

OBJECTIVE

The purpose of our study was to describe the MR imaging characteristics of fibroma of the tendon sheath.

CONCLUSION

The diagnosis of fibroma of the tendon sheath can be suggested when MR imaging reveals a focal nodular mass adjacent to a tendon sheath with decreased signal on all pulse sequences and little or no enhancement.

Fibroma of a tendon-sheath presenting as toe deformity

We describe a rare manifestation fibroma in a tendon-sheath in an 83-year-old man. The patient complained initially of a slowly progressive spreading, apart of the right second and third toes. A mass was found in the plantar aspect of the foot. It was completely excised at surgery. Histological examination revealed sparse spindle or stellate cells with slit-like vessels in the dense collagenous matrix. There had been no recurrence at follow-up 17 months after surgery.

Tendon Sheath Tumors: A Report of Two Cases

Two cases of tendon sheath tumors are presented. Similar sonographic appearances of a fibroma of the tendon sheath and a giant cell tumors are discussed.

Achilles tendon nodule: inflammation, rupture, or tumor?

When an active patient has a mass on the Achilles tendon, fibroma of the tendon sheath should be in the differential diagnosis along with other tumors and benign conditions like inflammation or rupture. A case report demonstrates how the clinical characteristics of fibromas resemble other common tendon tumors, such as giant cell tumor of the tendon sheath. A histologic exam is needed to distinguish a fibroma of the tendon sheath from other tumors. Plain films should be considered to rule out bony involvement. Surgical excision is required. Patients should know that fibromas recur in 25% of those who have them removed.