대한근골격영상의학회

Title : Case 95

Age / Sex : 54 / F Age / Sex : 54/F Chief complaint : palpable mass in the right 1^st web foot dorsum area. (Onset: 3 months ago) 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 Ja-Young Choi, MD (drchoi01@gmail.com) * Case number, Answers, Name & Affiliation of Answerer should be included. Courtesy : Sun-Won Park, MD. Inha University Hospital Diagnosis: giant cell tumor of tendon sheath Discussion Findings: MR : There is a intermediate signal intensity lobulated contoured, well demarcated mass in the 2^nd phalanx extensor digitorum tendon on the T1-weighted images. The mass is shown as intermediate signal on the T2 –weighted images. The mass shows moderate well enhancement on the post-contrast enhancement fat suppression T1-weighed MR images. Differential diagnosis : Ganglion cyst, lipomas, hemangiomas, Foreign bodies, synovial sarcoma Diagnosis: Giant Cell Tumor of tendon sheath Discussion: Definition: Non-neoplastic benign tumor of giant cells in vicinity of joints, most commonly the hand, closely related to pigmented villonodular synovitis Abbreviations and synonyms : Extraarticular pigmented villonodular synovitis, GCTTS, histiocytoma, benign synovioma Imaging findings Best diagnostic clue: intermediate signal intensity soft tissue mass on T1 & T2WIs Two-thirds of masses located volar aspect of fingers-index and long finger most common Morphology: Well-circumscribed fibrous mass Fibrous septations-hypointense Sharply defined interface without reactive edema of adjacent subcutaneous tissue Pathology Accepted theory-reactive or regenerative hyperplasia 2^nd most common mass on hand behind ganglion High rate of recurrence Firm, well-circumscribed lobulated mass Clinical Issues Most common signs/symptoms: Painless slow growing mass present for weeks to years May cause limited function of digit due to size of lesion Osseous erosions related to lesion hypervascularity References: 1. Stoller DW, Tirman PFJ, Bredella MA. Diagnostic imaging Orthopaedics. A medial reference publishing company. 2004, 3-90 to 3-93.

Title : Case 95

Age / Sex : 54 / F

Age / Sex : 54/F

Chief complaint : palpable mass in the right 1^st web foot dorsum area.
(Onset: 3 months ago)

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 Ja-Young Choi, MD (drchoi01@gmail.com)
* Case number, Answers, Name & Affiliation of Answerer should be included.

Courtesy : Sun-Won Park, MD. Inha University Hospital

Diagnosis:

giant cell tumor of tendon sheath

Discussion

Findings:
MR : There is a intermediate signal intensity lobulated contoured, well demarcated mass in the 2^nd phalanx extensor digitorum tendon on the T1-weighted images. The mass is shown as intermediate signal on the T2 –weighted images. The mass shows moderate well enhancement on the post-contrast enhancement fat suppression T1-weighed MR images.

Differential diagnosis :
Ganglion cyst, lipomas, hemangiomas, Foreign bodies, synovial sarcoma

Diagnosis: Giant Cell Tumor of tendon sheath

Discussion:

Definition: Non-neoplastic benign tumor of giant cells in vicinity of joints, most commonly the hand, closely related to pigmented villonodular synovitis

Abbreviations and synonyms : Extraarticular pigmented villonodular synovitis, GCTTS, histiocytoma, benign synovioma

Imaging findings

Best diagnostic clue: intermediate signal intensity soft tissue mass on T1 & T2WIs

Two-thirds of masses located volar aspect of fingers-index and long finger most common

Morphology: Well-circumscribed fibrous mass

Fibrous septations-hypointense

Sharply defined interface without reactive edema of adjacent subcutaneous tissue

Pathology

Accepted theory-reactive or regenerative hyperplasia

2^nd most common mass on hand behind ganglion

High rate of recurrence

Firm, well-circumscribed lobulated mass

Clinical Issues

Most common signs/symptoms: Painless slow growing mass present for weeks to years

May cause limited function of digit due to size of lesion

Osseous erosions related to lesion hypervascularity

References:

1. Stoller DW, Tirman PFJ, Bredella MA. Diagnostic imaging Orthopaedics. A medial reference publishing company. 2004, 3-90 to 3-93.

Correct Answer
Name	Institution
Total Applicants (9)

Correct Answer (8)
김권형: 한마음병원
김성준: 영동세브란스병원
김완태: 서울보훈병원
박상현: 순천향대학천안병원(전공의)
박소영: 분당서울대병원
오경진: 충남대학교 병원
이승훈: 서울보훈병원
최희석: 동국대학교 일산 병원(전공의)

Semicorrect Answer(1)
채지원: 서울대병원