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

Differential diagnosis of fibroma of tendon sheath and giant cell tumor of tendon sheath in the finger using signal intensity on T2 magnetic resonance imaging

BACKGROUND

The differential diagnosis of fibroma of tendon sheath (FTS) and giant cell tumor of tendon sheath (GCTTS) on the basis of clinical and radiographic characteristics remains difficult.

PURPOSE

To evaluate the quantitative measurement of signal intensity (SI) obtained by magnetic resonance imaging (MRI) for the differential diagnosis of FTS and GCTTS in just the finger.

MATERIAL AND METHODS

We retrospectively identified patients with FTS (n = 6) and GCTTS (n = 22) of the finger who were treated at our hospitals between April 2011 and August 2019. Two researchers independently reviewed the MRIs and measured the regions of interest (ROIs) in the tumor and flexor tendon from the same image. The SI ratio obtained for the tumor and tendon ROIs was measured and compared using receiver-operating characteristic curve analyses. Sensitivity and specificity analyses were performed.

RESULTS

The SI ratios (mean ± SD) of FTS and GCTTS were 1.83 ± 0.64 and 6.34 ± 3.16 for researcher 1 and 1.82 ± 0.60 and 6.10 ± 3.22 for researcher 2, respectively. The areas under the curve were 0.970 and 0.970 for researchers 1 and 2, respectively. The cut-off values of the SI ratio as determined by researchers 1 and 2 for differentiating FTS from GCTTS were 3.00 and 3.00, respectively (sensitivity = 95.5%, specificity = 100%).

CONCLUSIONS

The SI ratio is useful for differentiating FTS from GCTTS independent of a combination of tumor signal and shape.

Is the Recurrence of Fibroma of the Tendon Sheath Underestimated? An Instructive Case Report and a Review of the Literature

We report a case of a 21-year-old healthy woman with a history of a painful growing mass in the palm of the right hand, with a trigger finger phenomenon. The mass was surgically entirely excised, and the histological findings of the tumor were those of a fibroma of the tendon sheath (FTS) starting from the flexor tendons. Although the initial outcome was good, the patient experienced the same symptoms at the same location 4.5 years later. The MRI demonstrated a 50 × 10 × 5 mm mass of low intensity on T1-weighted images and high intensity on T2-weighted images and gadolinium enhancement. A second complete excision of the tumor was performed by the same senior surgeon, and the histology confirmed the recurrence of the FTS. We also reviewed the scientific literature about FTS in the hand. Most recent studies show a low rate or no recurrence at all. We hypothesize that a lot of recurrences are missed because of a short follow-up and that the recurrence rate may be higher than thought.

Fibroma of tendon sheath embedded in carpal bones mimicking carpal enchondroma: A case report

RATIONALE

Fibroma of tendon sheath is a rare entity that is typically attached to the tendon sheath.

PATIENT CONCERNS

A 43-year-old man presented with a painful mass in his right wrist, which was initially misdiagnosed as an enchondroma.

DIAGNOSIS

Fibroma embedded into carpal bones, which exhibited lytic radiographic features similar to those of enchondroma. Excisional biopsy demonstrated spindle-shaped cells and collagen-like stroma.

INTERVENTIONS

The patient underwent lesion resection surgery.

OUTCOMES

The patient recovered well and showed no signs of recurrence at 6-month follow-up.

LESSONS

This case provides valuable insights for hand surgeons. While radiograph is helpful in multiple diseases, histological examination is indispensable for establishment of final diagnosis.

Intra-articular fibroma of tendon sheath arising in the acromioclavicular joint

Fibroma of the tendon sheath, a rare benign soft tissue tumor that most often occurs in the distal upper extremities (hands and wrist), is exceedingly rare to present as an intraarticular mass. Presented here is the first case in the English literature, to our knowledge, of a fibroma of the tendon sheath arising in the acromioclavicular joint. The patient presented with recurrent shoulder pain with activity without antecedent trauma. Radiographs were essentially normal. MR images demonstrated a lobulated, heterogeneous mass with contrast enhancement arising from the acromioclavicular joint. Following surgical resection, histopathology revealed hypocellular collagen matrix with spindle-shaped fibroblasts, confirming the diagnosis of fibroma of tendon sheath. The imaging features of the fibroma of the tendon sheath and a brief review of the literature are presented.

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.

Fibroma of tendon sheath of the hand: a series of 20 patients with 23 tumours

Fibroma of tendon sheath is an uncommon fibrous tumour that has a predilection for the hand. Large series from Histopathological Units report a local recurrence rate of 24% after surgical excision. In the hand/orthopaedic surgery literature, fibroma of tendon sheath was generally reported as isolated case reports with unusual presentations, such as triggering and carpal tunnel syndrome. The current article reports on a series of 23 tumours of the hands of 20 patients. These were all adults (mean age of 36 years) with a male to female ratio of 3:1. The thumb and index were the most common sites. A slow-growing painless mass was the clinical presentation in every case. Total surgical excision was ensured by excision of part of flexor sheath/palmar fascia to which the tumour was attached. Diagnosis was confirmed by the classic histological features of fibroma of tendon sheath. There were no recurrences at final follow-up 2-5 years after surgery.

Indeterminate soft-tissue tumors of the hand and wrist: a review based on a clinical series of 39 cases

Soft-tissue masses located at the hand and wrist are a frequent clinical presentation. The majority of these are ganglia, which have characteristic imaging features. Other common masses in which a diagnosis is suggested by imaging include hemangiomas, lipomas, and focal synovitis. The remainder are rare although a diagnosis may be attempted by considering the patients' age and the location. We reviewed 39 soft-tissue masses at the hand and wrist referred to our institution between September 1998 and January 2006 that had indeterminate imaging features. The majority were benign neoplastic lesions with the most common being a giant cell tumor of the tendon sheath, followed by angioleiomyoma, peripheral nerve sheath tumor, fibromatosis, fibroma of tendon sheath, and solitary fibrous tumor. These lesions tend to occur in young adults at the metacarpal level. However, there are no imaging features that can reliably differentiate between benign and malignant tumors.

Intraarticular fibroma of tendon sheath

A 17-year-old male presented to us following a hyperflexion injury to his right knee sustained while playing soccer. Immediately after the traumatic event, he developed a large, tense knee effusion. Physical examination revealed limited range of motion. MRI revealed a lobulated mass in the posteromedial aspect of the knee joint. The mass was excised and sections submitted to pathology. A pathologic, microscopic, and immunohistochemical characteristics revealed the final diagnosis of fibroma of tendon sheath in the knee. At 12 months followup, the patient reported no subjective symptoms, such as pain or limitation of athletic activities and has full range of motion. Additionally, he has demonstrated no signs of recurrence. We report a case of fibroma of the tendon sheath originating from the synovial membrane of the joint capsule of the knee.