Age / Sex : 59 / M

Chief complaint: A palpable mass on the volar aspect of right hand

What is your impression?

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

(Please submit only one answer)

Courtesy: Yun Sun Choi, Eulji Hospital, Eulji University

Palmar fibromatosis

Discussion

Findings:

Axial T1-weighted and T2-weighted fat-suppressed MR images show an oval mass of low to intermediate signal intensity. Sagittal T1-weighted MR image depicts a lesion along the palmar aponeurosis. Sagittal T2-weighted MR image reveals the parallel orientation to the flexor tendon to which it is attached at the level of the second metacarpal head.

Differential Diagnosis:

1.     Calcifying aponeurotic fibroma

2.     Fibroma of tendon sheath

3.     GCTTS

Diagnosis: Palmar fibromatosis

Discussion:

Fibromatosis arising from the palmar aponeurosis and its extensor is referred to as Dupuytren contracture or Dupuytren disease. Palmar fibromatosis affects 1 % to 2 % of the general population and its incidence significantly increases with age. Bilateral involvement is seen 40% to 60%. Patients typically present with a slowly progressive subcutaneous nodules to cord-like mass in the palm of the hand, at the level of the distal palmar crease (4^th>5^th>3^rd>2^nd rays). Lesions may cause traction on the underlying flexor tendons, resulting in flexion contractures of the digits (Dupuytren contractures).

Palmar fibromatosis is hypervascular, hypoechoic on sonography and low to intermediate signal on all MR imaging pulse sequences. Post-contrast MR imaging often reveals diffuse enhancement of variable degree. Surgical release/resection is the treatment of choice, although early lesions are to be avoided as the local increased recurrence. MR imaging may be helpful for planning the optimal timing of surgical treatment of palmar fibromatosis, given that mature collagenous lesions with relatively low signal intensity on T2-weighted images may be less likely to locally recur than are more cellular lesions with higher signal intensity on T2-weighted images.

References:

1. Kransdorf MJ, Murphey MD. Imaging of soft tissue tumors, 3^rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2014:267-270

2. Murphey MD, Ruble CM, Tyszko SM, Zbojniewicz AM, Potter BK, Miettinen M. From the archives of the AFIP: musculoskeletal fibromatoses: radiologic-pathologic correlation. Radiographics 2009;29(7):2143-2173

3. Robbin MR, Murphey MD, Temple HT, Kransdorf MJ, Choi JJ. Imaging of musculoskeletal fibromatosis. Radiographics 2001;21(3):585-600