Tendon sheath fibroma

Last revised by Henry Knipe on 8 May 2023

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

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

Tendon sheath fibromas are lobulated, round-to-oval, encapsulated masses consisting of spindle cells and collagen fibers that arise from the synovium of a tendon sheath 1,2

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.

  • T1: low-to-iso signal

  • T2: heterogeneous

  • GRE: absent susceptibility artifact

  • T1 C+ (Gd): no or variable contrast enhancement

Treatment is usually surgical excision. There is a very low recurrence rate and these tumors are not reported to have undergone malignant transformation 3.

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Cases and figures

  • Figure 1: macroscopic pathology
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  • Case 1
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  • Case 2: macroscopic pathology
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  • Case 2: fibroma (ankle joint)
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