Hantonius
Department of Orthopaedic & Traumatology, Siloam Hospitals Jember, Indonesia

Antonius Dwi Saputra
Faculty of Medicine, University of Jember, Indonesia

Candra Bumi
Department of Epidemiology, Faculty of Public Health, University of Jember, Indonesia

DOI: https://doi.org/10.19184/ams.v10i2.45329

Abstract

Fibroma of the tendon sheath (FTS) is a rare slow-growing noncancerous fibrous tumor that is usually small, painless and involves the upper extremity tendons in young adult males. FTS of the lower extremity is an unusual and underreported variety that poses a diagnostic preoperative challenge. We report an atypical case of a large fibroma of the vastus lateralis tendon in a 58-year-old female presented with a painful lump in her right thigh within the past six months. Physical examination showed a hard firm mass approximately 6 cm in diameter palpated in the anterior of the lower thigh. The mass was smooth, mobile, solid, and had well-defined borders. There was no adhesion to the skin, redness, or tenderness. MRI showed a 4,2 x 5,8 x 6,2 cm tumor with isointense signals on T1-weighted images (T1WI), heterogeneous hypointense signals on T2-weighted images (T2WI), and hyperintense signals on FatSat images. Biopsy revealed no malignant findings and the tumor had been surgically resected. Imaging studies for FTS have rarely been described, T1WI often show a low signal mass, with slight isointense to hypointense to the muscle. The T2WI’s appearance of FTS is more variable. In spite of rarity, FTS must still be included as a differential diagnosis of a thigh mass especially if the mass is painful and benign-appearing on physical exam and radiology.

Keyword: Fibroma of the Tendon Sheath, Soft-Tissue Tumor, Vastus Lateralis Tendon, Magnetic Resonance Imaging.

REFERENCE

1. Arıcan, M., Turhan, Y., & Gamsızkan, M. (2020). A rare localized giant cell tumor of the tendon sheath originating from the ligamentum mucosum: A case report. Joint Diseases and Related Surgery, 31(1), 149-153. https://doi.org/10.5606/ehc.2020.72323

2. Emori, M., Takashima, H., Iba, K., Sonoda, K., Oda, T., Hasegawa, T., & Yamashita, T. (2021). Differential diagnosis of fibroma of tendon sheath and giant cell tumor of tendon sheath in the finger using signal intensity on T2 magnetic resonance imaging. Acta Radiologica, 62(12), 1632-1638. https://doi.org/10.1177/0284185120976915

3. Finkelstein, D., Foremny, G., Singer, A., Clifford, P., Mazzini, J. P., Kerr, D. A., & Subhawong, T. K. (2021). Differential diagnosis of T2 hypointense masses in musculoskeletal MRI. Skeletal Radiology, 50, 1981–1994. https://doi.org/10.1007/s00256-021-03711-0

4. Fu, Z., Liu, J., Huang, D., Jia, X., Liu, Z., & Liu, B. (2019). Fibroma of tendon sheath embedded in carpal bones mimicking carpal enchondroma. Medicine, 98(16), e15262. https://doi.org/10.1097/MD.0000000000015262

5. Gaafary, S. M. E., Rahim, S. A. A. A., Ali. H. H. S. A. (2021). Evaluation of Role of Magnetic Resonance Imaging in Detection and Characterization of Soft Tissue Masses of the Hand and Wrist. The Medical Journal of Cairo University, 89(June), 661-671. https://doi.org/10.21608/mjcu.2021.167873

6. Ge, Y., Guo, G., You, Y., Li, Y., Xuan, Y., Jin, Z.-W., & Yan, G. (2019). Magnetic resonance imaging features of fibromas and giant cell tumors of the tendon sheath: differential diagnosis. European Radiology, 29(7), 3441–3449. https://doi.org/10.1007/s00330-019-06226-4

7. Huang, C., Li, C., Zhang, X., Zhao, Z., Gan, D., Zhao, B., & Luo, J. (2019). Fibroma of the tendon sheath in the patellar tendon in a Chinese boy. International Journal of Clinical and Experimental Medicine, 12(1), 1066–1070