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Fibroma of Tendon Sheath


  • 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)
    • 11-year-old boy with lesion involving peroneus longus tendon sheath reported
  • M:F = 1.5-3:1
  • May limit joint motion (usually occur in the hand, limiting digit ROM
  • May cause neurologic sxs
  • 71% hand/wrist, 7% foot, 6% knee
  • ± locking or catching
  • ± motion limitation
  • ± deformity
    • Toe deformity reported
  • ± skin ulceration
  • Multiplelobules have been reported
    • Case involving both palms and both soles associated with + RF titer reported
  • 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
  • Unusual locations



  • 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 spindle-shaped fibroblasts, dense collagenous material, hyalinized areas
  • More cellular areas may be at the periphery of the lesion resembling BFH or nodular fasciitis
  • Special staining
  • EM: myofibroblasts(with actin-type filaments) and fibroblasts
  • Chromosomal findings
    • t(2;11)(q31-32;q12) has been reported
    • t(9;11)(p24;q13-14) has been reported



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





    • Reported in a flexor tendon causing impairment of tendon excursion
      • Longitudinal tenotomy and tumor excision reported


Al-Qattan MM. Fibroma of tendon sheath of the hand: a series of 20 patients with 23 tumours. J Hand Surg Eur Vol. 2014 Mar;39(3):300-5.

Andrew N, Dodd T, Selva D, Davis G. Tendon sheath fibroma of the medial canthal tendon. Ophthal Plast Reconstr Surg. 2013 Jan-Feb;29(1):e1-2.

Athwal GS, Bueno RA, Bansal M, Mintz Dhanasian EA. Intra-articular fibroma of tendon sheath involving the scapholunate and radiocarpal joints. Skeletal Radiol 2006 Aug;35(8):599-602.

Aynaci O, Kerimoglu S, Ozturk C, Saracoglu M, Yildiz K. Intraarticular fibroma of the tendon sheath arising from the infrapatellar fat pad in the knee joint. Arch Orthop Trauma Surg. 2009 Mar; 129(3):291-4.

Azzopardi JG, Tanda F, Salm R. Tenosynovial fibroma. Diagn Histopthol. 1983 Apr-Jun;6(2):69-76.

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.
Borns S, Gambichler T, Stucker M, Brockmeyer NH. Unusual presentation of fibroma of tendon sheath. Dermatology 2007;214(4):336-7.

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.
Chi H, Oda J. Fibroma of tendon sheath with ulceration. J Dermatol, 1993, 20:703-706.

Chen CH, Wu T, Sun JS, Lin WH, Chen CY. Unusual causes of carpal tunnel syndrome: space occupying lesions. J Hand Surg Eur Vol. 2012 Jan;37(1):14-9.

Chou LB, Ho YY, Malawer MM. Tumors of the foot and ankle: experience with 153 cases. Foot Ankle Int. 2009, 30:836-841.

Chung EB, Enzinger FM: Fibroma of tendon sheath. 1979. Cancer 44:1945-54. PubMed

  • The original article describing 138 cases with their clinical and pathological features presented in 1979. The tumor occurred from 5 months to 70 years of age (median 31 years) with a 3:1 male predominance. It occurred in tendons and tendon sheaths of the fingers (49%), hands (21%), and wrist (12%). Symptoms were present from 1 week to 6 years (median 5 months).10/138 recurred once and 3/138 recurred twice. Local excision was recommended. Typical fibrocollagenous areas transitioned to more celluar areas of the tumor.

Ciatti R, Mariani PP. Fibroma of tendon sheath located within the ankle joint capsule. J Orthop Traumatol 2009;10:147-150.

Coffin CM, Dehner LP. Fibroblastic-myofibroblastic tumors in children and adolescents: a clinicopathologic study of 108 examples in 103 patients. Pediatr Pathol. 1991 Jul-Aug;11(4):569-88.

Cooper PH. Fibroma of tendon sheath. J Am Acad Dermatol. 1984 Oct;11(4 Pt 1):625-8.

Dal Cin P, Sciot R, De Smet L, Van den Berghe H. Translocation 2;11 in a fibroma of tendon sheath. Hetopathology, 1998, 32:433-435.

  • A biopsy of a fibroma of tendon sheath was cultured and characterized by a t(2;11)(q31-32;q12).

Degreef I, Sciot R, De Smet L. Intraarticular fibroma of the tendon sheath in the wrist. J Hand Surg Eur Vol. 2007 Dec;32(6):723.

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.
De Maeseneer M, Van Isacker T, Lenchik L, Van Caillie MA, Shahabpour M. Fibroma of the tendon sheath of the long head of the biceps tendon. Skeletal Radiol. 2014 Mar; 43(3):399-402.

Evangelisti S, Reale VF: Fibroma of tendon sheath as a cause of carpal tunnel syndrome. J Hand Surg 17A:1026-7,1992.
Eyden B. Electron microscopy in the study of myofibroblastic lesions. Semin Diagn Pathol. 2003 Feb;20(1):13-24.

Eyden B. The myofibroblast: a study of normal, reactive and neoplastic tissues, with an emphasis on ultrastructure. Part 2 - tumours and tumour-like lesions. J Submicrosc Cytol Pathol. 2005 Nov;37(3-4):231-96.

Fox MG, Kransdorf MJ, Bancroft LW, Peterson JJ, Flemming DJ. MR imaging of fibroma of the tendon sheath. AJR Am J Roentgenol 2003;180:1449-1453.

Garner HW, Bestic JM. Benign synovial tumors and proliferative processes. Semin Musculoskeletal Radiol. 2013 Apr;17(2):177-8.

Garrido A, Lam WL, Stanley PR. Fibroma of a tendon sheath at the wrist: a rare cause of compression of the median nerve. Scand J Plast Reconstr Surg Hand Surg. 2004;38(5):314-6.

Glover M, Chebib I, Simeone FJ. Intra-articular fibroma of tendo sheath arising in the acromioclavicular joint. Skeletal Radiol 2014;43:681-686.

Greene TL, Strickland JW: Fibroma of tendon sheath. J Hand Surg 9A:758-60,1984.
Griesser MJ, Wakely PE, Mayerson J. Intraarticular fibroma of tendon sheath. Indian J Orthop. 2011 May;45(3):276-9.

Grenga TE. Intratendinous fibroma of flexor tendon. J Hand Surg Am. 1990 Jan;15(1):92-3.

Ha DH, Choi S, Kim SJ, Lih W. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome. Korean J Radiol. 2015 Jan-Feb;16(1):169-74.

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.

Heckert R, Bear J, Summers T, Frew M, Gwinn D, McKay P. Fibroma of the tendon sheath - a rare hand tumor. Pol Przegl Chir. 2012 Dec;84(12):651-6.

Hermann G, Hoch BL, Springfield D, Abdelwahab IF, Klein MJ. Intra-articular fibroma of tendon sheath of the shoulder joint: synovial fibroma. Skeletal Radiol 2006;35:603-607.

High WA, Stewart D, Essary LR, Kageyama NP, Hoang MP, Cockerell CJ. Sclerotic fibroma-like change in various neoplastic and inflammatory skin lesions: is sclerotic fibroma a distinct entity? J Cutan Pathol. 2004 May;31(5):373-8.

Hitora T, Yamamoto T, Akisue T, Marui T, Nagira K, Ohta R, Kurosaka M. Fibroma of tendon sheath originating from the knee joint capsule. Clin Imaging. 2002 Jul-Aug;26(4):280-3.

Huk J, Damron TA, Vermont AI, Mathum SC: Fibroma of tendon sheath of infrapatellar fat pad. Skeletal Radiol 28:407-10,1999.
Humphreys S, McKee PH, Fletcher CD. Fibroma of tendon sheath: a clinicopathologic study. J Cutan Pathol. 1986 Oct;13(5):331-8.

Hur J, Damron TA, Vermont AI, Mathur SC. Fibroma of tendon sheath of the infrapatellar fat pad. Skeletal Radiol. 1999 Jul;28(7):407-10.

Jablokow VR, Kathuria A: Fibroma of tendon sheath. J Surg Oncol 19:90-2,1982.
Jacobs E, Witlox MA, Hermus JP. Fibroma of tendon sheath located within Kager's triangle. J Foot Ankle Surg 20014;53:208-211.

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.
Kim SW, Lee SY, Jung SN, Sohn WI, Kwon H. Fibroma of the flexor hallucis longus tendon sheath. J Foot Ankle Surg. 2012, 51:343-344.

Kohl SK, Persidsky I, Gigantelli JW. Tendon sheath fibroma of the medial canthus. Ophthal Plast Reconstr Surg. 2007 Jul-Aug;23(4):341-2.

Kundangar R, Pandey V, Acharya KK, Rao PS, Rao L. An intraarticular fibroma of the tendon sheath in the knee joint. Knee Surg Sports Traumatol Arthrosc 2011;19:1830-1833.

Kusumi T, Nishikawa S, Tanaka M, Ogawa T, Jin H, Sato F, Toh S, Hasegawa T, Kijima H. Low-grade fibromyxoid sarcoma arising in the big toe. Pathol Int 2005 Dec;55(12):802-6.

Lamovec J, Bracko M, Voncina D. Pleomorphic fibroma of tendon sheath. Am J Surg Pathol. 1991 Dec;15(12):1202-5.

Le Corroller T, Bouvier-Labit C, Sbihi A, Champsaur P. Mineralized fibroma of the tendon sheath presenting as a bursitis. Skeletal Radiol. 2008 Dec;37(12):1141-5.

Lee MH, Kim NR, Ryu JA. Cyst-like solid tumors of the musculoskeletal system: an analysis of ultrasound findings. Skeletal Radiol. 2010 Oct;39(10):981-6.

Li TJ, Kiltano M, Tsuneyoshi M, Sonoda S, Mimura T. Intra-articular fibroma of tendon sheath in the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Oct;84(4):407-10.

Lourie JA, Lwin KY, Woods CG. Case report 734. Fibroma of tendon sheath eroding 3rd metatarsal bone. Skeletal Radiol, 1992. 21:273-275.

Lundgren LG, Kindblom LG. Fibroma of tendon sheath. A light and electron-microscopic study of 6 cases. Acta Pathol Microbiol Immunol Scand A. 1984 Nov;92(6):401-9.

Ma X, Xu J, Wang X, Wang C, Zhang YJ. Toe deformity after pregnancy due to fibroma of tendon sheath: a case report and review of literature. Orthop Surg. 2013 Aug;5(3):225-8.

Mackenzie DH: Fibroma: a dangerous diagnosis: a review of 205 cases of fibrosarcoma of soft tissues. Br J Surg 51:607- ,1964.
Marrouche N, Kurban M, Salman S, Kibbi AB, Abbas O. Asymptomatic solitary nodule over the right hand. Fibroma of tendon sheath (FTS). Int J Dermatol. 2012 Nov;51(11):1277-8.

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.
Moretti VM, Ashana AO, de la Cruz M, Lackman RD. Tendon sheath fibroma in the thigh. Orthopedics. 2012 Apr;35(4):e607-9.

Moretti VM, de la Cruz M, Lackman RD, Fox EJ. Fibroma of tendon sheath in the knee: a report of three cases and literature review. Knee 2010;17:306-309.

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.

Moretti VM, de la Cruz M, Lackman RD, Fox EJ. Fibroma of tendon sheath in the knee: a report of three cases and literature review. Knee. 2010 Aug;17(4):306-9.

Nakanishi S, Hizawa K. Enzyme histochemical observation of fibrohistiocytic tumors. Acta Pathol Jpn. 1984 Sep;34(5):1003-16.

Nason GJ, Baker JF, O'Toole P, Walsh A, Lui DF, O'Neill F, O'Sullivan M, Kelly PM. Fibroma of the peroneus longus tendon sheath in a child: a case report. J Orthop Surg (Hong Kong). 2013 Dec;21(3):387-90.

Netscher DT, Baumholtz MA, Popek E, Schneider AM. Non-malignant fibrosing tumors in the pediatric hand: a clinicopathologic case review. Hand (NY). 2009 Mar;4(1):2-11.

Nishio J. Updates on the cytogenetics and molecular cytogenetics of benign and intermediate soft tissue tumors. Oncol Lett. 2013 Jan;5(1):12-18.

Nishio J, Iwasaki H, Nagatomo M, Naito M. Fibroma of tendon sheath with 11q rearrangements. Anticancer Res. 2014 Sep;34(9):5159-62.

Nokiri H, Ogawa S, Takayanagi N, Watanabe A, Kaneko K, Kurosawa H. Fibroma of the tendon sheath that expanded into the radiocarpal joint with bony involvement. Scand J Plast Reconstr Surg Hand Surg 2006;40(6):357-61.

Okada J, Shinozaki T, Hirato J, Yanagawa T, Takagishi K. Fibroma of tendon sheath of the infrapatellar fat pad in the knee. Clin Imaging. 2009 Sep-Oct;33(5):406-8.

Oni OO. A tendon sheath tumour presenting as trigger finger. J Hand Surg Br. 1984 Oct;9(3):340.

Park SY, Jin SP, Yeom B, Kim SW, Cho SY, Lee JH. Multiple fibromas of tendon sheath: unusual presentation. Ann Dermatol. 2011 Sep;23 Suppl 1:S45-7.

Parker WL, Beckenbaugh RR, Amrami KK. Cacifying aponeurotic fibroma of the hand: radiologic differentiation from giant cell tumors of the tendon sheath. J Hand Surg Am 2006 Jul-Aug 31(6):1024-8.

Patel S, Colaco HB, Taylor EJ. Impingement of a fibroma of the extensor tendon sheath on the extensor retinaculum. J Hand Microsurg. 2010 Jun;2(1):31-2.

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.

  • Ten years after the original description, this article reports on 32 cases and adds that the tumors are heterogeneous and must be distinguished from tenosynovial counterparts of nodular fasciitis.

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.
Roberts CC, Liu PT, Chew FS. Imaging evaluation of tendon sheath disease: self-assessment module. AJR Am J Roentgenol 2007 Mar;188(3 Suppl):S10-12.

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.
Sookur PA, Saifuddin A. Indeterminate soft-tissue tumors of the hand and wrist: a review based on a clinical series of 39 cases. Skeletal Radiol. 2011 Aug;40(8):977-89.

Southwick GJ, Karamoskos P: Fibroma of tendon sheath with bone involvement. J Hand Surg 15B:373-5,1990.

Takakubo Y, Fukushima S, Asano T, Yamakawa M. Case reports: intraarticular fibroma of the tendon sheath in the knee. Clini Orthop Relat Res 2005 Oct;439:280-5.

Tiong WH, Ismael TS, Regan PJ. Fibroma of tendon sheath: a rare cause of carpal tunnel syndrome. J Hand Surg Br. 2006 Oct;31(5):579-80.

Walker EA, Fenton ME, Salesky JS, Murphey MD. Magnetic resonance imaging of benign soft tissue neoplasms in adults. Radiol Clin North Am. 2011 Nov;49(6):1197-217.

Watanabe T, Sasaki T, Ogata F, Okochi H, Furue M. Sclerotic fibroma of tendon sheath. Dermatology 1997;195(3):563-5.

Yamamoto T, Marui T, Mizuno K. Fibroma of a tendon-sheath presenting as toe deformity. Foot Ankle Int, 2001, 22:59-61.

Yousaf M. Fibroma of the tendon sheath–a rare hand tumor following repetitive trauma to the palm. J Ayub Med Coll Abbottabad. 2014 Apr-Jun;26(2):252-4.

Zelger B. Connective tissue tumors. Recent Results Cancer Res. 2002;160:343-50.


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