Nodular tenosynovitis also known as a giant cell tumor of tendon sheath is a localized form of pigmented villondoular synovitis, usually extra articular in location and shows the same pathological changes. Differential diagnoses include synovial sarcoma (usually bright signal on T2 and shows infiltrative edge), hemophilia and fibromatosis. Post excision, the histopathology revealed xanthoma cells and hemosiderin laden macrophages.