Chronic granulomatous inflammatory process- extensor tendon sheaths

Case contributed by Dennis Odhiambo Agolah

Presentation

Right wrist mass that has been increasing in size. Patient previously had a ganglion cyst drainage at the same region 2 years ago. Now recurrent swelling. ?Giant cell tumor of tendon sheath.

Patient Data

Age: 55 years
Gender: Female

Predominantly mixed echopattern heterogeneous soft tissue thickening interspersed centrally with clear anechoic fluid spaces is noted enveloping the right dorsal wrist extensor tendon sheaths. The lesion is hypovascular but is lobulated in the mid-line and tapered distally and proximally. Small multiple reactive superficial lymph nodes that maintain their central echogenic stromal fat noted ipsilaterally regionally extrinsic to the wrist joint lesion.

Histopathology report:

Specimen: wrist mass.

Final diagnosis: chronic granulomatous inflammatory process.

Gross:
Nine fragmented whitish cores longest 1 cm. All parts processed in one block.

Microscopy:
Sections of the fragmented biopsies show numerous mixed chronic inflammatory cells composed of lymphocytes, plasma cells, histiocytes, and poorly formed granuloma on a fibroid background and multinucleated giant cells. No evidence of central necrosis.

Comment:

? Granulomatous disease.

Case Discussion

Lobulated tumoral structure with clear eccentric fluid space and trabeculae, enveloping the right dorsal wrist tendon sheaths, with attendant small multiple reactive and enlarged regional lymph nodes. Biopsy result would later reveal chronic granulomatous inflammatory process. The extensor tendon fibers are homogeneous and appear preserved.

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