CASE 1066 Published on 17.05.2001
0

Giant cell tumor of the tendon sheath of the hand.

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

S. Cakirer (1), K. Demir (2), M. Beser (3), G. M. Galip (1)

Connected authors
Patient

39 years, female

Categories
No Area of Interest ; Imaging Technique MR, MR
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Clinical History
A 39-year-old female patient was referred with a slowly growing soft tissue mass at the right hand, the mass was located at the palmar site of proximal phalanx of the fourth finger.
Imaging Findings
A 39-year-old female patient was referred to our hospital with a slowly growing soft tissue mass at the left hand over a period of approximately 18 months, the mass was located at the palmar site of proximal phalanx of the fourth finger , and it was well circumscribed with lobulations and easily movable over the neighboring bone on physical examination. MRI study of the right hand was performed on a 1.5 T MR scanner, with SE T1, FSE T2, GRE T2, and post-gadolinium SE T1 sequences in three planes.
Discussion
The localized form of a giant-cell tumor of the tendon sheath is uncommon. Giant cell tumor of the tendon (GCTT), also called extraarticular pigmented villonodular sinovitis of the tendon, presents as an extraarticular soft tissue swelling. This highly cellular lesion has a fibrous capsule which also separates the lobules, seen on microscopic and histopathological examination. Cytologic findings on smears obtained by fine-needle aspiration are rather characteristic and include a mixture of oval or polygonal mononuclear cells showing vacuolation and/or pigment deposition along with a population of multinucleated giant cells. The most common location of GCTT is the soft tissue of the hand, however it may be seen occasionally in the lower extremities, even in the spine. Gross morphology consists of a well delineated, lobulated mass lesion, tumor lobules reaching a diameter of several cm. The most characteristic feature is its location along the tendon sheath. The adjacent joint is not involved. The lesion has a low to intermediate signal intensity on T1- and T2- weighted SE images due to the paramagnetic effect of hemosiderin deposition in xanthoma cells and abundant collagenous proliferation. On GRE T2-weighted images signal intensity is increased. After IV injection of Gadolinium, GCTT usually exhibits a strong contrast enhancement which is due to the presence of numerous capillaries in the collagenous stroma.
Differential Diagnosis List
Giant cell tumor of the tendon sheath of the hand
Final Diagnosis
Giant cell tumor of the tendon sheath of the hand
Case information
URL: https://eurorad.org/case/1066
DOI: 10.1594/EURORAD/CASE.1066
ISSN: 1563-4086
Figure 1

Figure 1

Figure 1
Coronal SE T1 MR image shows a well circumscribed hypointense soft tissue mass with a very hypointense fibrous capsule at the level of proximal phalanx of the fourth finger.
Figure 1
1b. Coronal GRE T2 MR image shows the lobulated structure of the mass, hyperintense lobulations are separated from each other by hypointense fibrous capsule and its septations.
Figure 2

Figure 2

Figure 2
Axial post-gadolinium SE T1 MR image shows the multinodular lobulated appearance of the mass, separated by fibrous septations, it shows intense contrast enhancement, and surrounds flexor digitorum tendon.
Figure 2
Sagittal post-gadolinium SE T1 MR image reveals the intense contrast enhancement of the soft tissue mass on the palmar aspect of proximal phalanx.
Figure 2
Coronal post-gadolinium SE T1 MR image reveals the intense contrast enhancement of the soft tissue mass on the palmar aspect of proximal phalanx.