Tendon sheath fibroma
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Tendon sheath fibromas is a rare proliferative mass, with common imaging features of tenosynovial giant cell tumours.
Epidemiology
There is a 3:1 male predominance and arise between the 2nd to 5th decades 2.
Pathology
Tendon sheath fibromas are lobulated, round-to-oval, encapsulated masses consisting of spindle cells and collagen fibres that arise from the synovium of a tendon sheath1,2.
Location
Tendon sheath fibromas can arise around 2,3:
-
small joints
- finger (~50%)
- hand (~25%): most commonly the flexor surface
- wrist (~10%)
- large joints (~5%): knee, shoulder, elbow and ankle
They can be intra-articular or extra-articular 2.
Radiographics features
MRI
-
T1:
isointense to skeletal musclelow-to-iso signal -
T2:
iso-to-hyperintense to skeletal muscleheterogeneous - GRE: absent susceptibility artifact
-
T1C+: no or
littlevariable contrast enhancement
Treatment and prognosis
Treatment is usually surgical excision. There is a very low recurrence rate, and these tumours are not reported to have undergone malignant transformation 3.
Differential diagnosis
- tenosynovial giant cell tumour: will often show susceptibility artifact on GRE 1
- nodular fasciitis2
-<p><strong>Tendon sheath fibromas</strong> is a rare proliferative mass, with common imaging features of tenosynovial giant cell tumours.</p><h4>Pathology</h4><p>Tendon sheath fibromas are round-to-oval encapsulated masses consisting of spindle cells and collagen fibres <sup>1</sup>. </p><h4>Radiographics features</h4><h5>MRI</h5><ul>- +<p><strong>Tendon sheath fibromas</strong> is a rare proliferative mass, with common imaging features of <a href="/articles/tenosynovial-giant-cell-tumour">tenosynovial giant cell tumours</a>.</p><h4>Epidemiology</h4><p>There is a 3:1 male predominance and arise between the 2nd to 5th decades <sup>2</sup>.</p><h4>Pathology</h4><p>Tendon sheath fibromas are lobulated, round-to-oval, encapsulated masses consisting of spindle cells and collagen fibres that arise from the synovium of a <a href="/articles/tendon-sheath">tendon sheath</a> <sup>1,2</sup>. </p><h5>Location</h5><p>Tendon sheath fibromas can arise around <sup>2,3</sup>:</p><ul>
- +<li>small joints<ul>
- +<li>finger (~50%)</li>
- +<li>hand (~25%): most commonly the flexor surface</li>
- +<li>wrist (~10%)</li>
- +</ul>
- +</li>
- +<li>large joints (~5%): knee, shoulder, elbow and ankle</li>
- +</ul><p>They can be intra-articular or extra-articular <sup>2</sup>.</p><h4>Radiographics features</h4><h5>MRI</h5><ul>
-<strong>T1</strong>: isointense to skeletal muscle</li>- +<strong>T1</strong>: low-to-iso signal</li>
-<strong>T2</strong>: iso-to-hyperintense to skeletal muscle</li>- +<strong>T2</strong>: heterogeneous</li>
-<strong>GRE</strong>: absent <a title="Magnetic susceptibility artifact" href="/articles/magnetic-susceptibility-artifact">susceptibility artifact</a>- +<strong>GRE</strong>: absent <a href="/articles/magnetic-susceptibility-artifact">susceptibility artifact</a>
-<strong>T1C+</strong>: no or little contrast enhancement</li>-</ul><p>Differential diagnosis</p><ul><li>-<a title="Tenosynovial giant cell tumour" href="/articles/tenosynovial-giant-cell-tumour">tenosynovial giant cell tumour</a>: will often show susceptibility artifact on GRE <sup>1</sup>-</li></ul>- +<strong>T1C+</strong>: no or variable contrast enhancement</li>
- +</ul><h4>Treatment and prognosis</h4><p>Treatment is usually surgical excision. There is a very low recurrence rate, and these tumours are not reported to have undergone malignant transformation <sup>3</sup>.</p><h4>Differential diagnosis</h4><ul>
- +<li>
- +<a href="/articles/tenosynovial-giant-cell-tumour">tenosynovial giant cell tumour</a>: will often show susceptibility artifact on GRE <sup>1</sup>
- +</li>
- +<li>
- +<a href="/articles/nodular-fasciitis">nodular fasciitis</a> <sup>2</sup>
- +</li>
- +</ul>
References changed:
- 1. Plotkin B, Sampath S, Sampath S, Motamedi K. MR Imaging and US of the Wrist Tendons. Radiographics. 2016;36(6):1688-700. <a href="https://doi.org/10.1148/rg.2016160014">doi:10.1148/rg.2016160014</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27726753">Pubmed</a>
- 2. Suzuki K, Yasuda T, Suzawa S, Watanabe K, Kanamori M, Kimura T. Fibroma of Tendon Sheath Around Large Joints: Clinical Characteristics and Literature Review. BMC Musculoskelet Disord. 2017;18(1):376. <a href="https://doi.org/10.1186/s12891-017-1736-5">doi:10.1186/s12891-017-1736-5</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28854920">Pubmed</a>
- 3. Heckert R, Bear J, Summers T, Frew M, Gwinn D, McKay P. Fibroma of the Tendon Sheath - a Rare Hand Tumor. Pol Przegl Chir. 2012;84(12):651-6. <a href="https://doi.org/10.2478/v10035-012-0107-z">doi:10.2478/v10035-012-0107-z</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23399633">Pubmed</a>
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