. FIBROMA OF TENDON SHEATH. PORTNotes. In: OrthopaedicsOne - The Orthopaedic Knowledge Network. Created Feb 16, 2009 16:36. Last modified Dec 31, 2009 16:13 ver.3. Retrieved 2014-10-01, from http://www.orthopaedicsone.com/x/1AAjAQ.
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
- 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
- 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
- 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
- Non-invasive soft tissue mass
- Rarely > 2cm
- Firm, grey to white, and rubbery
- May be attached to a tendon sheath
- 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
- Localized nodular tenosynovitis
DISEASE COURSE AND TREATMENT
- 0-24% recurrence reported (reexcision is treatment), usually between 1-4 months following surgery
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