Mineralized fibroma of the tendon sheath presenting as a bursitis

Ultrasonography of fibroma of the tendon sheath in the hand and wrist

BACKGROUND

The purpose of our study was to explore the sonographic characteristics of fibromas of the tendon sheath of the hand and wrist and to evaluate the value of high frequency ultrasound in the diagnosis of FTS.

METHODS

We retrospectively reviewed the sonography of 42 patients with surgically proven FTS, including one with a relapsing tumor (43 lesions in total). The location, size, distribution, relationship with the surrounding tissue, two-dimensional gray-scale sonographic appearance and internal color blood flow of all lesions were analysed.

RESULTS

The maximum diameter ranged from 0.4 to 2.8 cm, with an average of 1.5 ± 0.6 cm. Twenty-eight lesions (65%) were associated with an adjacent tendon, while the other 15 lesions (35%) were next to the joint. Spindle or oval lesions were common, followed by irregular shape. The nodules with clear boundaries were hypoechoic and had posterior echo enhancement. Thirty-seven lesions (86%) were homogeneous, while 6 lesions (14%) had cystic components with no echo inside. Seventeen lesions (40%) had a large amount of blood flow. Nine lesions (20%) had a small amount of blood flow. The other 17 lesions (40%) had no significant blood flow.

CONCLUSIONS

The diagnosis of fibroma of the tendon sheath can be considered when ultrasound examination reveals a focal nodular mass adjacent to a tendon sheath with homogeneous hypoechogenicity and no or small or large amounts of blood flow.

Arthroscopic treatment for intra-articular fibroma of the tendon sheath in a teenager

An adolescent female patient presented with atraumatic left knee pain and limited flexion. MRI demonstrated evidence of a soft tissue lesion abutting the posterior cruciate ligament. Differential diagnosis included pigmented villonodular synovitis (PVNS) and fibroma of the tendon sheath (FTS). Following arthroscopic biopsy, histopathological evaluation confirmed FTS. The tumour was then excised via an arthroscopic approach. This case report provides a unique example of FTS abutting the cruciate ligaments in an uncommonly young female patient. It highlights the importance of including benign processes, such as FTS, in the differential with more aggressive-type diagnoses like PVNS. Furthermore, this case exemplifies an appropriate surgical indication for FTS. Finally, it emphasises the importance of communication and collaboration among orthopaedic subspecialists in providing safe and effective arthroscopic treatment of this unique tumour presentation.

Surgery on aggressive fibroma of the posterior compartment of the knee: A case report

INTRODUCTION

Fibroma is a benign tumor. More than 99% fibroma arises from tendon sheaths or tendons. Aggressive Fibroma at posterior compartment knee is a rare case. This report presents one case of fibroma at posterior compartment of the knee with the treatment.

CASE REPORT

A boy with 4-year history of knee discomfort and lump at posterior knee joint, no history of infection and trauma. Physical examination revealed a mass (10 × 9 × 7 cm) with limited Range of Motion extension 30°, flexion 70°. MRI revealed a soft tissue mass at posterior knee compartment. Histologic examination showed a circumscribed and lobulated hypo cellular mass containing spindle cells diagnosed as aggressive fibroma. The patient underwent popliteal resection. An ellipse incision was made 2 cm margin of skin around the biopsy site. Fasciocutaneous flaps were created and retracted to expose the posterior compartment. The tumor had a partial well-defined capsule, popliteal artery and vein embedded and pressing the sciatic nerve. The tumor and enveloping muscles were elevated from the base of the compartment. The sciatic nerve was preserved with epineurotomy. The popliteal artery was reconstructed with saphenous veins graft. After the tumor was resected, the heads of gastrocnemius were sutured to each other and to the hamstring muscles to cover popliteal space. After one year postoperative, there was a good vascularization, no recurrence and neurological deficit with Musculoskeletal Tumour Society Scoring System 80%.

CONCLUSION

One year postoperative with popliteal resection surgery yields a good result. A follow-up is needed for risk of recurrence and malignancy.

Fibroma of the patellar tendon sheath-a rare case in a young boy

Fibroma of the tendon sheath is a rare benign fibrocollagenous soft tissue tumor, arising predominantly from the synovium of tendon sheath. Fibromas occur most commonly in relation to the tendons of the fingers, hand, and the wrist. Fibromas related to large joints are rather rare and though amongst the large joints, the knee is a common site. Fibromas of the patellar tendon sheath, specifically, are very rare. To the best of our knowledge, only three cases of fibromas arising from the patellar tendon sheath have been reported in the relevant English medical literature. Herein we describe the fourth biopsy-proven case of fibroma of patellar tendon sheath in a 6-year-old boy.

Fibroma of tendon sheath around large joints: clinical characteristics and literature review

Background

Fibroma of tendon sheath (FTS) is a benign tumor arising from the synovium of the tendon sheath that occurs mostly around small joints such as the fingers, hands, and wrist. However, FTS rarely arises around a large joint (knee, shoulder, elbow, and ankle) with intra-articular or extra-articular involvement. The clinical characteristics of FTS arising around a large joint are unclear. An additional 3 cases of FTS arising around a large joint are presented. Furthermore, the published cases and the present cases are reviewed with respect to their clinical characteristics and imaging and histopathology findings.

Methods

The 43 reported cases including the present 3 patients were summarized, and the patients’ profiles, symptoms, sites and locations in the joint involved by FTS, magnetic resonance imaging (MRI) findings, surgical procedures, clinical courses, and cytogenetic analyses were reviewed.

Results

The average age of 26 cases was 40.9 years (range 13–69 years), and about 60% of the patients were male. About 10% of the patients had a past history of trauma to the knee joint. Of the present 3 cases, one case was extra-articular around the elbow joint, one case was extra-articular around the knee joint, and one case was intra-articular involving the knee joint. The common symptoms were pain (62.5%), swelling or palpable mass (54.2%), and limited range of motion of the involved joint (50%). The most commonly involved joint was the knee, with 32 cases (74.4%), followed by the elbow in 5 cases (11.6%), ankle in 4 (9.3%), and shoulder in 2 (4.7%). The tumor typically exhibited iso to low signal intensity on T1-weighted MRI. T2-weighted images showed various patterns, but mostly low signal intensity relative to muscle. The surgical margin was marginal resection in all cases. There were no recurrences after surgery. On chromosomal analysis, only the present Case 3 showed an abnormality.

Conclusions

A total of 43 FTS cases that occurred around large joints were summarized. The most common site was around the knee joint. In FTS cases around large joints, it is necessary to distinguish between various fibroblastic and/or fibrohistiocytic tumors.

Fibroma of tendon sheath on the medial side of the knee: a case report

Fibroma of tendon sheath, which is a benign soft tissue tumor, primarily affects the finger, hand, or wrist. It rarely involves the knee and only a few cases appear in the literature. Here, we report a case of fibroma of tendon sheath on the medial side of the knee, in a previously hardly reported location, and provide detailed imaging and histological findings. A 54-year-old man presented with his right knee pain and a palpable mass that had developed 3 months earlier. Magnetic resonance imaging showed isointensity in the soft tissue tumor on T1-weighted images, variable intensity on T2-weighted images, and contrast enhancement. The specimen obtained by needle biopsy showed no histological findings of malignancy. Marginal resection was performed and the microscopic diagnosis was fibroma of tendon sheath. Since fibroma of tendon sheath is relatively rare, the radiological feature is not specific, and a rate of local recurrence following excision is high, careful diagnosis, surgical treatment and long-term follow-up are necessary. J. Med. Invest. 64: 173-176, February, 2017.

Fibroma of the tendon sheath of the long head of the biceps tendon

Fibroma of the tendon sheath is a benign tumor that is less common than giant cell tumor of the tendon sheath. Both tumors may present as a painless, slowly enlarging mass. Radiological findings may be similar for both tumors. Histologically, fibroma of the tendon sheath lacks the hemosiderin-laden macrophages that are typical for giant cell tumor of the tendon sheath. We report on a 49-year-old woman with fibroma of the tendon sheath of the long head of the biceps tendon. In our case, on MR images, we observed band-like hypointense areas centrally in the tumor, mild patchy contrast enhancement, and most importantly, no decrease of signal intensity on gradient echo images. These characteristics reflected histological findings.

Intraarticular fibroma of tendon sheath

A 17-year-old male presented to us following a hyperflexion injury to his right knee sustained while playing soccer. Immediately after the traumatic event, he developed a large, tense knee effusion. Physical examination revealed limited range of motion. MRI revealed a lobulated mass in the posteromedial aspect of the knee joint. The mass was excised and sections submitted to pathology. A pathologic, microscopic, and immunohistochemical characteristics revealed the final diagnosis of fibroma of tendon sheath in the knee. At 12 months followup, the patient reported no subjective symptoms, such as pain or limitation of athletic activities and has full range of motion. Additionally, he has demonstrated no signs of recurrence. We report a case of fibroma of the tendon sheath originating from the synovial membrane of the joint capsule of the knee.

Fibroma of tendon sheath in the knee: a report of three cases and literature review

Fibroma of tendon sheath (FTS) is a rare and benign soft-tissue tumor. It is predominantly found in the fingers, hands, and wrists of young, adult males. We describe a series of three cases all presenting in the atypical knee location. We also review the literature on FTS, located both in the knee and elsewhere, looking for common clinical, imaging, and histologic patterns to help differentiate it from similar knee lesions. FTS typically presents as a painless, slow-growing, solid nodule. In the knee though, 71% of lesions present with pain/discomfort and 31% present with a palpable mass. Physical exam for knee FTS commonly reveals painful range of motion (50%), decreased range of motion (42%), and a palpable non-tender mass (33%). MRI of FTS usually reveals a well-defined soft-tissue mass, with low signal on T1, variable signal on T2, and variable enhancement. Histologically, the tumors are composed of a dense fibrocollagenous stroma with scattered spindle-shaped fibroblasts and narrow slit-like vascular spaces. Most FTS are removed by marginal excision, with 24% of lesions subsequently recurring. No lesion has ever metastasized. Despite its rarity, this lesion should be included in the differential diagnosis of a knee mass on physical exam or imaging, especially if it is painful, benign appearing, and present in a middle-aged male.

Fibroma with osseous metaplasia of external auditory canal in a dog

The present report describes a case of fibroma with osseous metaplasia of the external auditory canal in a 7-year-old male Pomeranian dog. Upon otoscopic examination, the right external auditory canal was almost completely obstructed by a well-circumscribed mass adjacent to the eardrum. The mass was surgically excised. Grossly, it was well demarcated, firm when cut, pink, and measured 0.3 cm x 0.2 cm x 0.7 cm. The cut surface of the mass exhibited a central portion of homogeneously white osseous components surrounded by brown to pink soft tissue. Microscopically, the resected external auditory canal mass mainly consisted of fibroblastic spindle cells showing differentiation to metaplastic osteoblast-like cells. Metaplastic osteoblasts and osteoclasts lining the osteoid bony trabeculae were also observed. Bony trabeculae and spicules were separated by abundant collagen and neoplastic fibroblastic cells. Fibromatous components, irregular formation of woven bone spicules, and the presence of osteoblasts lining bony trabeculae led to a diagnosis of fibroma with osseous metaplasia.