Tenosynovial giant cell tumor - biceps brachii

Case contributed by Domenico Nicoletti
Diagnosis almost certain

Presentation

Swelling right elbow, anterior surface.

Patient Data

Age: 60 years
Gender: Female

In contact with the distal portion of the biceps muscle tendon, close to the supinator muscle is appreciable lesion hypoechoic oval, regular margins, devoid of flow signals, cleavable from surrounding structures.

Adjacent to the distal portion of the biceps muscle tendon is appreciable slightly hyperintense lesion in T1 with discrete enhancement; in GE T2 sequences it is characterized by blooming artifacts from hemosiderin deposits (short arrow in coronal plane; head arrow in axial plane).

Annotated image

Adjacent to the distal portion of the biceps muscle tendon is appreciable slightly hyperintense lesion in T1 with discrete enhancement; in GE T2 sequences it is characterized by blooming artifacts from hemosiderin deposits (short arrow in coronal plane; head arrow in axial plane).

Case Discussion

Tenosynovial giant cell tumor is a benign tumor of mesenchymal origin that originates from synovial cells lining the joints and tendon sheaths; typically with hemosiderin deposits. There are two distinct forms: localized and widespread. The localized (or nodular) form of tenosynovitis presents itself as the only well-circumscribed nodule independent of a tendon sheath. The disseminated form with multiple nodules extends to the entire articular synovium, which appears hyperplastic and transforms into folds and fingerlike projections. Due to compression, tenosynovial giant cell tumor can cause bone erosion mimicking other primary bone tumors. The high incidence of recurrence requires a careful follow-up postoperatively.

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