Giant cell tumor of the tendon sheath

Case contributed by Maulik S Patel
Diagnosis almost certain


Presented with left wrist / distal most forearm palmar region swelling, tingling in hand for about last one month. No trauma. Normal finger movements.

Patient Data

Age: 25 years
Gender: Female

There is a well-defined lobulated lesion in the region of interest.


  • Cranio-caudal           - 20 mm
  • Axial                           - 16 mm
  • Antero-posterior      - 11 mm


  • Proximal to carpal tunnel
  • Flexure pollocis longus( FPL ) myotendinous junction abutts radial side of the lesion.
  • The median nerve is elevated and mildly laterally displaced by the lesion.
  • Index finger flexure tendon is deep to the lesion.
  • Palmar cutaneous branch of the median nerve is superficial to the lesion.
  • Hyperechoic fat abutts ends of the lesion.


  • Solid
  • Heterogeneous Hypoechoic
  • No calcification / cystic changes.
  • Small lobulations present
  • Posterior acoustic enhancement present
  • Not compressible


  • Few flow signals are present in the peripheral part of the lesion.  

Dynamic scan

  • Tendons show free movement from the lesion.

Median nerve

  • No edema proximal to tunnel
  • No obvious fascicle thickening near the lesion

The lesion is solid. It is in close relation to the deeper flexure tendon.

Case Discussion

A young female presented with a lump in distal forearm/wrist region on the palmar side. Ultrasound shows a well-defined, solid lesion which is free from the tendons. Surgical excision of the tumor was done. Histopathology revealed the lesion being a giant cell tumor of the tendon sheath.

Intraoperative photos courtesy: Operating surgeon Dr. Pinkesh V. Patel & Dr. Vitrag D. Shah.

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