Age / Sex : 47 / F

Age / Sex : 47 /F

Chief complaint : finger mass

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

* Send Application Answers to In Sook Lee, MD (lis@pusan.ac.kr)

Courtesy : Chai Jee Won, SMG-SNU Boramae Medical Center

GCT of tendon sheath

Discussion

Findings:

Plain radiograph :

 Soft tissue mass at dorsal and volar side of 2^nd finger middle phalanx. No destruction in the phalangeal bone and no visible mineralization in the soft tissue mass.

Ultrasound :

 Lobulated well-defined low echoic mass at radial side of 2^nd finger middle phalanx, adjacent to the flexor tendon sheath. Probably the origin of the mass is between the flexor tendon and phalangeal bone, because the mass increases the gap between them.

MR :

 Lobulated T1 intermediate low/ T2 heterogenous intermediate high signal intensity mass showing heterogenous intense enhancement. T2 dark signal intensity rim(+)

Differential Diagnosis:

 Vascular leiomyoma, hemangioma

Diagnosis: GCT of tendon sheath

Discussion:

-       Commonly presents painless finger mass,

-       2^nd most common mass in the hand after ganglion cyst

-       Closely related to pigmented villonodular synovitis

-       USG : lobulated hypoechoic solid mass with increased vascularity, usually contact with the tendon, calcification, posterior acoustic enhancement may present

-       MR : T1 hypo-intermediate signal intensity, T2 low-intermediate signal intensity, hemosiderin(+), enhancement(+), lobulation(+)

References:

 William D.M. et al. Giant Cell Tumors of the Tendon Sheath : Analysis of Sonographic Findings, AJR 2004;183:337-339

 Mark D.M. et al. From the Archives of the AFIP, Pigmented Villonodular Synovitis:Radiologic-Pathologic Correlation, Radiographics 2008;28:1493-1518

 Stoller et al. Diagnostic Imaging - Orthopaedics, 1^st Ed. 2004 Section 3:90-93