CASE 100

By: Dr. Aliya Sarhan Al Barwani

HISTORY: 29 years old with swelling of the index finger.

What are the findings?

What are the differential diagnosis?

What is the recurrence rate?

FINDINGS:

A well define lobulated subcutaneous soft tissue mass surrounding the flexor digitorum tendon of the index finger. The flexor tendon is normal in size and signal.

It is hypo intense in T1WI and hyper intense in T2WI with enhancement on post contrast study.

No pressure erosion on the adjacent cortex.

DIFFERENTIAL DIAGNOSIS:

·        Giant cell tumor of tendon sheath.

·        Haemangiom.

·        Desmoid tumor.

DIAGNOSIS:

Giant cell tumor of tendon sheath.

PEARLS AND DISCUSSION:

Pathologically, giant cell tumors are identical to pigmented villonodular synovitis. These tumors are idiopathic proliferative lesions that can cause bone erosions. Clinical findings include soft-tissue swelling and pain. Most giant cell tumors are treated with surgical excision. The reported recurrence rate varies from approximately 10% to 20%.

On imaging, these lesions are demonstrated as localized, solitary, subcutaneous soft tissue nodules commonly seen on the volar aspect of the finger and hand. It shows low signal in T1WI and low to iso intense signal in T2WI with moderate enhancement in post contrast images.

FURTHER READING:

1.      Wan JM and Magarelli N. Imaging of giant cell tumour of the tendon sheath. Radiol Med. (2010)

2.      Jelinek JS and Kransdorf MJ. Giant cell tumor of the tendon sheath: MR findings in nine cases. AJR Am J Roentgenol. (1994)

3.      Murphey MD and Rhee JH. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics. (2008)