Talwalkar Sumedh, Hayton Michael, Stilwell John, Temperley David, Freemont Anthony
Wrightington Hospital, Wigan, United Kingdom.
Acta Orthop Belg. 2005 Oct;71(5):618-21.
Haemangiomas developing in the hand in relation to tendon and the tenosynovium (tendon sheath) are very rare. To our knowledge only three cases have been described arising in relation to the tenosynovium of the tendons of the hand, only one of which showed infiltration of the underlying tendon. We report the case of a 16-year-old right hand dominant student who presented to her family doctor with a swelling on her left little finger. An MRI scan was arranged which confirmed a soft tissue lesion between the flexor tendons and the proximal phalanx of the left little finger, with appearance similar to giant cell tumour of the tendon sheath. Surgical exploration demonstrated a dark red fleshy tumour that appeared to infiltrate the flexor digitorum sub-limis tendon, and extend around either side of the proximal phalanx. For complete excision of the lesion the infiltrated sublimis tendon and a part of the A2 pulley were sacrificed. There was no resultant bow-stringing of the profundus tendon. Histologically the tenosynovium was expanded by a vascular lesion consisting of dilated, thin-walled vascular channels within fibrous tissue; the appearances were consistent with those of a synovial haemangioma of the flexor tendons. Our case illustrates the pitfalls in diagnosis and the invasive potential of a synovial haemangioma. A complete surgical excision is critical to prevent recurrence.
手部发生的与肌腱和腱鞘（肌腱鞘）相关的血管瘤非常罕见。据我们所知，仅有3例手部肌腱腱鞘相关的病例被描述，其中仅1例显示有下方肌腱浸润。我们报告1例16岁以右手为主的学生，因左手小指肿胀就诊于家庭医生。安排了MRI扫描，证实左手小指屈肌腱与近节指骨之间有一软组织病变，其表现类似于腱鞘巨细胞瘤。手术探查发现一个暗红色肉质肿瘤，似乎浸润了指浅屈肌腱，并向近节指骨两侧延伸。为完全切除病变，牺牲了浸润的指浅屈肌腱和部分A2滑车。屈指深肌腱未出现弓弦状畸形。组织学检查显示腱鞘被血管病变扩张，该病变由纤维组织内扩张的薄壁血管通道组成；其表现与屈肌腱滑膜血管瘤一致。我们的病例说明了滑膜血管瘤在诊断上的陷阱及其侵袭性。完整的手术切除对于预防复发至关重要。
