Presentation
Left anterior and lateral ankle swelling for two months which increase in size, become painful with walking.
Patient Data
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There is focal oval bone lucency in the medial tibial epiphysis.
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There is a well-defined lobulated soft tissue mass involving the anterior and posterior recesses of the ankle joint; the bulk of the lesion is seen anteriorly with syndesmotic extension through the anterior tibiofibular ligament and intra-osseous extension to the medial tibial epiphysis.
The mass displays intermediate to low signal on T1 WI, low signal on T2 WI, heterogeneous high signal on STIR, and avid enhancement on the post-contrast study with susceptibility artifact on gradient sequence.
The mass is deep to the ankle extensor tendons and pushes them anteriorly.
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The ultrasound and Doppler study demonstrates heterogeneous predominantly hypoechoic soft tissue lesion with internal vascularity.
Case Discussion
The lesion showed predominantly low signal on both pulse sequences (T1 and T2 WI), marked enhancement with susceptibility artifact on gradient sequences suggesting giant cell tumor of the tendon sheath.
Arthroscopic fresh frozen biopsy was done and showed benign character, and excisional biopsy final report conclusion was in keeping with tenosynovial giant cell tumor (diffuse type).
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