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FIBROMA OF TENDON SHEATH

DEFINITON AND PATHOGENESIS

  • A slowly growing dense fibrous nodule attached to a tendon sheath and most often found in the hands and feet
  • May be an end-stage variant of GCTTS

IMPORTANCE

  • May be reactive and not a neoplasm
  • Slow growing dense nodule firmly attached to tendon sheath, found most frequently in hands and feet, rarely > 2cm

CLINICAL FEATURES

  • Adults ages 20-50 (mean age 31)
  • M:F = 1.5-3:1
  • May limit joint motion (usually occur in the hand, limiting digit ROM; 'trigger wrist' has been described in MF FDP tendon)
  • 71% hand/wrist, 7% foot, 6% knee
  • ? locking or catching
  • Associated trauma is seen in up to 10% of cases
  • Bone involvement in<2% of cases
  • MRI
    • Heterogeneous and lobulated mass with low signal intensity on both T1- and T2-weighted images
    • On T2-weighted images, lesion may be mildly heterogeneous, with a signal intensity approximately that of fat

RADIOLOGIC FEATURES

  • Non-invasive soft tissue mass

GROSS PATHOLOGY

  • Rarely > 2cm
  • Firm, grey to white, and rubbery
  • May be attached to a tendon sheath

HISTOLOGIC FEATURES

  • Well defined and distinctly lobulated with cleft-like spaces, scattered fibroblasts, dense collagenous material, hyalinized areas
  • More cellular areas may be at the periphery of the lesion resembling BFH or nodular fasciitis
  • EM: myofibroblasts (with actin-type filaments) and fibroblasts

DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS

  • Nodular fasciitis
  • Benign fibrous histiocytoma
  • Vascular leiomyoma
  • Fibrosarcoma
  • Fibromatosis
  • Localized nodular tenosynovitis

DISEASE COURSE AND TREATMENT

  • 0-24% recurrence reported (reexcision is treatment), usually between 1-4 months following surgery

REFERENCES

Bertolotto M, Rosenberg I, Parodi RC, Perroue R, Gentile S, Rollandi GA, Succi S: Fibroma of tendon sheath in the distal forearm with associated median nerve neuropathy: US, CT, and MR. Clin Radiol :370-2,1996.
Carneiro RS, Velasquez L, Tietzman A: Trigger wrist caused by a tumor of the tendon sheath in a teenager. Am J Orthop :233-4,2001.
Chung EB, Enzinger FM: Fibroma of tendon sheath. Cancer 44:1945-54,1979.
Desai SS, Pearlman HS, Patel MR: Clicking at the wrist due to fibroma in an anomalous lumbrical muscle: a case report and review of the literature. J Hand Surg 11:512-4,1986.
Evangelisti S, Reale VF: Fibroma of tendon sheath as a cause of carpal tunnel syndrome. J Hand Surg 17A:1026-7,1992.
Greene TL, Strickland JW: Fibroma of tendon sheath. J Hand Surg 9A:758-60,1984.
Hashimoto H, Tsuneyoshi M, Daimaru Y, Ushijima M, Enjoji M: Fibroma of tendon sheath: a tumor of myofibroblasts. A clinicopathologic study of 18 cases. Acta Pathol Jpn 35:1099-1107,1985.
Huk J, Damron TA, Vermont AI, Mathum SC: Fibroma of tendon sheath of infrapatellar fat pad. Skeletal Radiol 28:407-10,1999.
Jablokow VR, Kathuria A: Fibroma of tendon Sheath. J Surg Oncol 19:90-2,1982.
Kernohan JG, Benjamin A, Simpson D: Trigger wrist due to anomalous flexor digitorum profundus muscle in association with fibroma of the tendon sheath. Hand 14:59-60,1982.
Mackenzie DH: Fibroma: a dangerous diagnosis: a review of 205 cases of fibrosarcoma of soft tissues. Br J Surg 51:607- ,1964.
McGrory JE, Rock MG: Fibroma of tendon sheath involving the patellar tendon. Am J Orthop 29:465-7,2000.
Maluf HM, DeYoung BR, Swanson PE, Wick MR: Fibroma and giant cell tumor of tendon sheath: a comparative histological and immunohistological study. Modern Pathol 8:155-9,1995.
Millon SJ, Bush DC, Garbes AD: Fibroma of tendon sheath in the hand. J Hand Surg 19A:788-93,1994.
Misawa A, Okada K, Hiraus Y, Sageshima M: Fibroma of tendon sheath arising from the radio-ulnar joint. Pathol Int 49:1089-92,1999.
Pinar H, Ozkan M, Ozaksoy D, Pabuccuoglu U, Akseki D, Karaoglan O: Intraarticular fibroma of the tendon sheath of the knee. Arthroscopy 11:608-11,1995.
Pulitzer DR, Martin PC, Reed RJ: Fibroma of tendon sheath a clinicopathologic study of 32 cases. Am J Surg Pathol 13:472-9,1989.
Rao J, Thoma A, Salama S: Fibroma of tendon sheath as a cause of carpal tunnel syndrome. Can J Plast Surg 5:176-8,1997.
Sarma DP, Weilbaecher TG, Rodriguez FH: Fibroma of tendon sheath. J Surg Oncol 32:230-2,1986.
Satti MB: Tendon sheath tumors: a pathological study of the relationship between giant cell tumor and fibroma of tendon sheath. Histopathology 20:213-20,1992.
Smith PS, Pieterse AS, McClure J: Fibroma of tendon sheath. J Clin Pathol 35:842-8,1982.
Southwick GJ, Karamoskos P: Fibroma of tendon sheath with bone involvement. J Hand Surg 15B:373-5,1990.

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