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

Abstract

BackgroundFibroma 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.MethodsThe 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.ResultsThe 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.ConclusionsA 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.

Hip Arthroscopic Resection of an Intra-Articular Fibroma of the Tendon Sheath

“…5 of the patients underwent arthroscopic tumor resection. Cases with tumors larger than 3 cm tended to be resected by open surgery, and there were no recurrences after surgery in either group [ 5 ].…”

“…In certain instances, local bony erosion has been noted [ 4 ]. A recent review of the literature summarized the reported cases of this condition arising in and around larger joints [ 5 ]; however, to the best of our knowledge, it has never been described within the hip joint. In the current case presentation, this benign tumor was found to be the source of severe hip pain.…”

Fibroma of Tendon Sheath

“…Re-excision is usually curative. No metastatic case has been reported in literature (Fischer 2011;Folpe and Inwards 2010;Suzuki et al 2017).…”

“…The main differential diagnoses are with superficial fibromatoses, benign fibrous histiocytoma, nodular fasciitis, giant cell tumor of tendon sheath, and collagenous fibroma/desmoplastic fibroblastoma (Fischer 2011;Folpe and Inwards 2010;Sciot and Dal Cin 2013;Suzuki et al 2017).…”

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“…Fibromas are benign tumors that can arise from the synovium of a tendon sheath, and usually occur around smaller joints such as the fingers or toes. These lesions are well circumscribed and lobulated, and histologically show presence of elongated thin-walled vessels or clefts, called slit-like spaces [5].…”