Francisco Ben S, Agarwal Jayant P
School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Eplasty. 2009;9:e8. Epub 2009 Feb 2.
Giant cell tumor of tendon sheath is a rare cause of ulnar tunnel syndrome. We present a case of a 37-year-old woman who presented with decreased sensation and weakness of grip of the right hand. Magnetic resonance imaging indicated the presence of a mass in the hypothenar eminence and showed that the mass was associated with the flexor carpi ulnaris tendon and displacing the ulnar neurovascular bundle. A differential diagnosis included desmoid tumor and sarcoma.
Surgical examination showed a mass that was associated with the flexor carpi ulnaris tendon and flexor retinaculum located in the distal portion of Guyon's canal and intertwined with the ulnar nerve and displacing the ulnar artery. The mass was removed and Guyon's canal was released.
Histological examination indicated a diagnosis of giant cell tumor of tendon sheath (GCTTS). Postoperatively, the patient had fully restored sensory and motor function of the right hand.
Although GCTTS is the most common solid, soft-tissue lesion of the hand, it is rarely diagnosed properly preoperatively. Therefore, it is imperative to always include GCTTS in the differential diagnosis of any mass of the hand.
腱鞘巨细胞瘤是尺管综合征的罕见病因。我们报告一例37岁女性，表现为右手感觉减退和握力减弱。磁共振成像显示小鱼际隆起处有一肿块，且该肿块与尺侧腕屈肌腱相关，并使尺神经血管束移位。鉴别诊断包括硬纤维瘤和肉瘤。
手术检查发现一个与尺侧腕屈肌腱和屈肌支持带相关的肿块，位于Guyon管远端，与尺神经交织并使尺动脉移位。切除肿块并松解Guyon管。
组织学检查诊断为腱鞘巨细胞瘤（GCTTS）。术后，患者右手感觉和运动功能完全恢复。
尽管GCTTS是手部最常见的实体性软组织病变，但术前很少能得到正确诊断。因此，在对手部任何肿块进行鉴别诊断时，务必始终将GCTTS纳入考虑。
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