Jump to ContentJump to Main Navigation

Polish Journal of Surgery

The Journal of Foundation of the Polish Journal of Surgery

12 Issues per year

Access brought to you by:

provisional account

Open Access
VolumeIssuePage

Issues

Open Access

Fibroma of the Tendon Sheath – A Rare Hand Tumor

Reed Heckert1 / Jonathan Bear23 / Thomas Summers Jr4 / Michael Frew5 / David Gwinn1 / Patricia McKay2

1Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda

2Naval Medical Center San Diego, San Diego

3Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Bethesda, MD 20814, USA

4Department of Pathology and Laboratory Sciences, Walter Reed National Military Medical Center, Bethesda

5Department of Radiology, Walter Reed National Military Medical Center, Bethesda

This content is open access.

Citation Information: Polish Journal of Surgery. Volume 84, Issue 12, Pages 651–656, ISSN (Online) , ISSN (Print) 0032-373X, DOI: 10.2478/v10035-012-0107-z, February 2013

Publication History

Published Online:
2013-02-09

Abstract

Fibroma of the tendon sheath (FTS) is a rare, benign, soft tissue lesion. Clinically, FTS presents similarly to the more common giant cell tumor of the tendon sheath. It is distinguished histologically by the lack of giant cells, foamy histiocytes and synovial cells.

We presented a case of FTS involving the common tendon sheath surrounding the flexor tendons leading to the third metacarpal. A 63-year-old man presented with a 3-month history of a painless mass in his right palm that had recently tripled in size. Examination demonstrated a 5x4 cm firm, nodular, superficial mass that was adherent to the overlying skin. Radiographs of the hand revealed a soft tissue mass without bony abnormality. Ultrasound demonstrated a solid, heterogeneous and hypoechoic mass and computed tomography demonstrated that the mass centered predominantly at the mid and distal portions of the third metacarpal. The patient underwent excisional biopsy of the lesion and a palmar, longitudinal incision was made from the wrist to the third metacarpal. Submitted histologic sections revealed a well-circumscribed lesion closely resembling hyalinized collagen. Neither vascular proliferations, necrosis, nor mitoses were observed. Similarly, multinucleated giant cells, pigment-laden macrophages, and inflammatory cells were also not identified. A diagnosis of FTS was rendered. We provided an additional rare case to the literature of a FTS and highlight the need to consider this entity in the differential diagnosis for any soft tissue lesion in the hand. Three months post surgery the patient demonstrated full range of motion of the hand

Keywords : fibroma; tendon sheath; FTS; soft tissue tumor; hand lesion

  • 1. Buxton St JD: Tumours of tendon and tendon sheath. Br J Surg 1923; 10: 469-74.

  • 2. Geschickter CF, Copeland MM: Tumors of bone 3rd ed. Philadelphia: Lippincott; 1949.

  • 3. Chung EB, Enzinger FM: Fibroma of tendon sheath. Cancer 1979; 44(5): 1945-54. [CrossRef]

  • 4. Millon SJ, Bush DC, Garbes AD: Fibroma of tendon sheath in the hand. J Hand Surg Am 1994; 19(5): 788-93. [CrossRef] [PubMed]

  • 5. McFarland GB: Soft tissue tumors. In: Green DP, ed. Operative hand surgery. 2nd ed. New York: Churchill Livingstone 1988: 2301-22.

  • 6. Athwal GS, Bueno RA, Bansal M et al.: Intraarticular fibroma of tendon sheath involving the scapholunate and radiocarpal joints. Skeletal Radiol 2006; 35(8): 599-602. [CrossRef]

  • 7. Bertolotto M, Rosenberg I, Parodi RC et al.: Case report: Fibroma of tendon sheath in the distal forearm with associated median nerve neuropathy: US, CT and MR appearances. Clin Radiol 1996; 51(5): 370-72. [CrossRef]

  • 8. Moore JR, Weiland AJ: Gouty tenosynovitis in the hand. J Hand Surg Am 1985; 10(2): 291-95. [PubMed] [CrossRef]

  • 9. Primm DD, Jr., Allen JR: Gouty involvement of a flexor tendon in the hand. J Hand Surg Am 1983; 8(6): 863-65. [CrossRef] [PubMed]

  • 10. Caudle RJ, Heim JM, Stern PJ: Digital flexion contractures secondary to tophaceous gout. A report of three cases. Orthopedics 1989; 12(5): 731-35.

  • 11. Straub LR, Smith JW, Carpenter GKJ, DietzGH: The surgery of gout in the upper extremity JBone Joint Surg 1961; 43: 731-52.

  • 12. Abrahamsson SO: Gouty tenosynovitis simulating an infection. A case report. Acta Orthop Scand 1987; 58(3): 282-83. [CrossRef] [PubMed]

  • 13. Cornelis F, Bardin T, Faller B et al.: Rheumatic syndromes and beta 2-microglobulin amyloidosis in patients receiving long-term peritoneal dialysis. Arthritis Rheum 1989; 32(6): 785-88. [CrossRef]

  • 14. Allieu Y, Benichou M, Clemencet F et al.: Amyloid arthropathy of the hand in patients on chronic hemodialysis. Ann Chir Main Memb Super 1990; 9(4): 282-89.

  • 15. Bardin T, Kuntz D, Zingraff J et al.: Synovial amyloidosis in patients undergoing long-term hemodialysis. Arthritis Rheum 1985; 28(9): 1052-58. [CrossRef]

  • 16. Murase T, Kawai H: Carpal-tunnel syndrome in hemodialysis. Syndrome diagnosed in 8 of 60 patients. Acta Orthop Scand 1993; 64(4): 475-78.

  • 17. Spencer JD: Amyloidosis as a cause of carpal tunnel syndrome in haemodialysis patients. J HandSurg Br 1988; 13(4): 402-05.

  • 18. Jablokow VR, Kathuria S: Fibroma of tendon sheath. J Surg Oncol 1982; 19(2): 90-92. [CrossRef]

  • 19. Lamovec J, Bracko M, Voncina D: Pleomorphic fibroma of tendon sheath. Am J Surg Pathol 1991; 15(12): 1202-05. [CrossRef] [PubMed]

  • 20. Maluf HM, DeYoung BR, Swanson PE, WickMR: Fibroma and giant cell tumor of tendon sheath: a comparative histological and immunohistological study. Mod Pathol 1995; 8(2): 155-59. [PubMed]

  • 21. Hsu CS, Hentz VR, Yao J: Tumours of the hand. Lancet Oncol 2007; 8(2): 157-66. [CrossRef] [Web of Science] [PubMed]

  • 22. Weiss SW, Goldblum JR: Benign Fibroblastic / Myofibroblastic Proliferations. In: Weiss SW, Goldblum JR, eds. Enzinger and Weiss’s Soft Tissue Tumors. 5th ed. China: Mosby Elsevier; 2008: 203-06.

  • 23. Pulitzer DR, Martin PC, Reed RJ: Fibroma of tendon sheath. A clinicopathologic study of 32 cases. Am J Surg Pathol 1989; 13(6): 472-79. [PubMed] [CrossRef]

Comments (0)

Please log in or register to comment.