Presentation
Right thumb base palmar nodule.
Patient Data
A well-defined lesion on the palmar side of the 1st metacarpal distal end. The lesion abuts the flexor pollicis longus tendon. However, the tendon shows free movement from the lesion. The neurovascular bundles are displaced by the lesion. The lesion size is 16 (length) x 20 (width) x 12 (anteroposterior) mm. It is solid, hypoechoic, and heterogeneous without no calcification/ cystic changes/ compressibility. Acoustic enhancement is present along with a few peripheral flow signals. The flexure tendon is intact with normal echopattern without tenosynovitis. No effusion involving the MCP and interphalangeal joints.
Surgery revealed a solid lesion close to the normal flexor tendon. The lesion was excised.
Case Discussion
The patient presented with a history of painless, slow-growing nodule at the right thenar region. The ultrasound shows a solid lesion close to the flexor pollicis longus tendon which was surgically removed. Histopathology revealed a tenosynovial giant cell tumour.
Intraoperative photos courtesy: operating surgeon Dr. Pinkesh V. Patel.
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