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Moein SA, Fereidooni R, Niakan R, Kousari A. Mycobacterium tuberculosis-induced multiple tenosynovial masses with rice bodies: A case report. Clin Case Rep 2023; 11:e8228. [PMID: 38125627 PMCID: PMC10731109 DOI: 10.1002/ccr3.8228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Key clinical message Tenosynovitis with rice bodies is a rare presentation, diagnosable by MRI. Surgical excision is the preferred treatment for tendon sheath masses containing rice bodies. The etiology was Mycobacterium tuberculosis in our case, highlighting the need to consider extrapulmonary TB in atypical presentations, ensuring effective treatment. Abstract Rice body tenosynovitis is a rare clinical phenomenon with various etiologies. Inflammatory diseases such as rheumatoid arthritis and tuberculosis have been shown to be associated with this condition. Herein we report a 46-year-old male who presented with multiple masses of the dorsal and volar aspects of the left wrist. The masses did not cause significant pain or limitation of motion. Magnetic resonance imaging showed the presence of numerous hypointense bodies in the masses. During the surgical procedure, separate cysts originating from the synovitis of both the extensor and flexor compartments were identified along with white rice bodies within them. Masses were excised and Xpert MTB/RIF assay on the rice bodies was conclusive of M. tuberculosis (TB). The patient was discharged on anti-TB medications with no complication or recurrence after 1 year of follow-up.
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Affiliation(s)
- Seyed Arman Moein
- Bone and Joint Diseases Research CenterShiraz University of Medical SciencesShirazIran
- Research Center for Non‐communicable DiseasesJahrom University of Medical SciencesJahromIran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Reza Niakan
- Bone and Joint Diseases Research CenterShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Aliasghar Kousari
- Bone and Joint Diseases Research CenterShiraz University of Medical SciencesShirazIran
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Pertea M, Grosu OM, Filip A, Moraru DC, Luca S, Fotea MC, Lunca S, Olinici D, Poroch V, Carp C, Veliceasa B. Rare Benign Tumors and Tumor-like Lesions of the Hand without Skin Damage-Clinical, Imagistic and Histopathological Diagnosis, Retrospective Study. Diagnostics (Basel) 2023; 13:diagnostics13061204. [PMID: 36980511 PMCID: PMC10046979 DOI: 10.3390/diagnostics13061204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The broad spectrum of diagnoses and clinical features of hand tumors and the absence of pathognomonic signs often lead to an inaccurate or delayed diagnosis. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study intends to highlight the clinical, imaging and histological characteristics of uncommon hand tumors or tumor-like lesions. METHODS In this retrospective study, we report a series of 80 patients diagnosed with rare hand tumors and tumor-like lesions without skin damage. Age, gender, tumor location, imaging examinations and clinical and laboratory findings were analyzed. The histopathological exam established the final diagnosis. Surgery was indicated and performed in all cases. RESULTS This study included: neurofibroma, glomus tumor, lipoma, schwannoma, epidermal inclusion cyst and idiopathic tenosynovitis with "rice bodies." We have described the clinical, imagistic and histopathological particularities of these tumors. Surgical management included the complete removal of tumors, with no recurrence recorded within two years and overall high patient satisfaction. The most common findings were lipomas and the rarest neurofibromas. CONCLUSIONS To optimize the care of hand tumors and reduce diagnostic and treatment errors, knowledge of hand tumor types and their clinical and laboratory characteristics is necessary for every surgeon.
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Affiliation(s)
- Mihaela Pertea
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Oxana Madalina Grosu
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Alexandru Filip
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Dan Cristian Moraru
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Stefana Luca
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Madalina-Cristina Fotea
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Sorinel Lunca
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Second Surgical Clinic, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Doinita Olinici
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Dermatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Vladimir Poroch
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Palliative Care, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Claudiu Carp
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Bogdan Veliceasa
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
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Tian Y, Zhou HB, Yi K, Wang KJ. Idiopathic tenosynovitis of the wrist with multiple rice bodies: A case report and review of literature. World J Clin Cases 2022; 10:11908-11920. [PMID: 36405290 PMCID: PMC9669876 DOI: 10.12998/wjcc.v10.i32.11908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery, and there are still many uncertainties regarding its diagnosis and treatment.
CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature. A total of 43 articles and 61 cases were included in the literature review. Our case had a usual presentation: it was similar to those in the literature. The affected population was mainly older adults, with an average age of 59.43 (range, 3 to 90) years. The male-to-female ratio was 1.54:1 (37/24).Most of them showed limited swelling and pain, only 23.0% had carpal tunnel symptoms, and the average disease duration was 18.03 (0.5-60) mo. Wrist flexor tendon sheath involvement was the most common (95.1%, 58/61), and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis (34.4%, 21/61), non-tuberculous mycobacteria (24.6%, 15/61), idiopathic tenosynovitis (31.1%, 19/61), and others (9.84%, 6/61). There were 10 patients with recurrences; in 6 of them, were due to non-tuberculous mycobacterial infections.
CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation, and established a clinical management algorithm for wrist tenosynovitis with rice bodies, which can provide some reference for our clinical diagnosis and treatment. The symptoms of rice-body bursitis of the wrist are insidious, nonspecific, and difficult to identify. The aetiology is mainly idiopathic tenosynovitis and mycobacterial (tuberculosis or non-tuberculous) infections; the latter are difficult to treat and require long-duration systemic combination antibiotic therapies. Therefore, before a diagnosis of idiopathic tenosynovitis is made, we must exclude other causes, especially mycobacterial infections.
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Affiliation(s)
- Yong Tian
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Hong-Bin Zhou
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai Yi
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai-Jian Wang
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
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Tiwari P, Kaur H, Bansal N, Jaura SS. Rheumatoid or tubercular: Flexor tenosynovitis of the wrist with rice bodies. J Family Med Prim Care 2022; 11:6518-6522. [PMID: 36618161 PMCID: PMC9810916 DOI: 10.4103/jfmpc.jfmpc_786_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Rice bodies are formed mainly in tenosynovitis and bursitis of rheumatoid or tubercular origin. It rarely presents with compressive ulnar neuropathy. A 35-year-old female presented with painful swelling in the volar aspect of the left wrist and incomplete flexion of the little finger. The laboratory tests revealed ESR 10 mm/1st hr and C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide tests were negative. Thickened and distended ulnar bursa with rice bodies was seen on magnetic resonance imaging (MRI). Thorough drainage, debridement, and synovectomy were done. Epithelioid cell granulomas with multinucleated giant cells on microscopy and the strongly positive Mantoux test prompted us to start anti-tubercular treatment. The wound healed uneventfully with good recovery of range of motion of the little finger at one-year follow up. Rice bodies can be a diagnostic dilemma in the absence of classical signs of their rheumatoid or tubercular origin.
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Affiliation(s)
- Punit Tiwari
- Department of Orthopaedics, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India
| | - Harmeet Kaur
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, Punjab, India,Address for correspondence: Dr. Harmeet Kaur, Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, Punjab, India. E-mail:
| | - Nitish Bansal
- Department of Orthopaedics, Government Medical College, Patiala, Punjab, India
| | - Sandeep Singh Jaura
- Department of Orthopaedics, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India
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