Surgery on aggressive fibroma of the posterior compartment of the knee: A case report

Abstract

HighlightsWe report a rare case of aggressive fibroma at posterior compartment of the knee.The tumor was resected from the posterior compartment with the preservation of neurovascular structures around the tumor.The popliteal space is covered with the heads of gastrocnemius sutured to the hamstring muscles.One year postoperative, the vascularization was good, no recurrence and neurological deficit with MSTS 80%.

The Tendinous Impaction- Fibroma of Tendon Sheath

“…On histological examination, tendon sheath is typically layered with an epithelium in contiguity with extraneous fibrous tendon sheath and inner synovial sheath with embedded blood vessels (4,5). As joint capsule morphologically resembles structure of tendon sheath, particularly where joint capsule is constituted by dual layer of dense, extraneous fibrous connective tissue and inmost synovial layer with ingrained vasculature, it can be surmised that fibroma of tendon sheath can arise from joint capsule, besides originating from the tendon or tendon sheath(4).…”

“…Cellular or nuclear atypia and malignant metamorphoses is absent. Majority of lesions are hypo-cellular although certain neoplasms exhibit peripheral hyper-cellularity, akin to lesions of nodular fasciitis (4,5). The tumefaction is comprised of dense, collagenous tissue demonstrating variable proportion of collagenisation and tumour cellularity.…”

“…Additionally, diverse inflammatory cells and myxoid stroma can be observed in specific instances. Giant cells or foamy cells are exceptional (4,5).…”

“…Typically, fibroma of tendon sheath demonstrates elongated, thin-walled blood vessels or vascular clefts or slit-like vascular spaces. The minimally cellular neoplasm is composed of spindle-shaped cells intermingled within wavy fascicles of collagenous tissue and an admixture of slit-like blood vessels (5).…”

“…The tumefaction is enveloped with synovial membrane. Thus, it is surmised that intra articular fibroma of tendon sheath can originate from synovial membrane (5). Immune Histochemical Elucidation: Fibroma of tendon sheath is immune reactive to vimentin, muscle specific actin (MSA), smooth muscle actin (SMA), factor XIIIa and CD34.…”