Tendon sheath fibroma

Changed by Henry Knipe, 8 May 2023
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Disclosures - updated 16 Jan 2023:
  • Integral Diagnostics, Shareholder (ongoing)
  • Micro-X Ltd, Shareholder (ongoing)

Updates to Article Attributes

Body was changed:

Tendon sheath fibromas are rare proliferative lesions with common imaging features of tenosynovial giant cell tumours.

Epidemiology

They are found in adults typically between the age of 20 and 50 with a 3:1 male predominance 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 sheath 1,2. 

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.

Radiographic features

MRI

  • T1: low-to-iso signal

  • T2: heterogeneous

  • GRE: absent susceptibility artifact

  • T1 C+ (Gd): no or variable 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

  • -<li><p><a href="/articles/tenosynovial-giant-cell-tumour">tenosynovial giant cell tumour</a>: will often show susceptibility artifact on GRE <sup>1</sup></p></li>
  • -<li><p><a href="/articles/nodular-fasciitis">nodular fasciitis</a> <sup>2</sup></p></li>
  • +<li><p><a href="/articles/localised-tenosynovial-giant-cell-tumour-1">tenosynovial giant cell tumour</a>: will often show susceptibility artifact on GRE and cortical erosion on plain radiograph <sup>1,4</sup></p></li>
  • +<li><p><a href="/articles/nodular-fasciitis">nodular fasciitis</a>: subcutaneous not peritendinous location <sup>2,4</sup></p></li>

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>
  • 4. Nepal P, Songmen S, Alam S, Gandhi D, Ghimire N, Ojili V. Common Soft Tissue Tumors Involving the Hand with Histopathological Correlation. J Clin Imaging Sci. 2019;9(15):15. <a href="https://doi.org/10.25259/JCIS-6-2019">doi:10.25259/JCIS-6-2019</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31448166">Pubmed</a>
  • 1. Benjamin Plotkin, Srihari C. Sampath, Srinath C. Sampath, Kambiz Motamedi. MR Imaging and US of the Wrist Tendons. (2016) RadioGraphics. 36 (6): 1688-1700. <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> <span class="ref_v4"></span>
  • 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. (2017) BMC musculoskeletal disorders. 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> <span class="ref_v4"></span>
  • 3. Heckert R, Bear J, Summers T, Frew M, Gwinn D, McKay P. Fibroma of the tendon sheath - a rare hand tumor. (2012) Polski przeglad chirurgiczny. 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> <span class="ref_v4"></span>

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