Moretti Vincent M, de la Cruz Michael, Lackman Richard D, Fox Edward J
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States.
Knee. 2010 Aug;17(4):306-9. doi: 10.1016/j.knee.2010.02.014. Epub 2010 Mar 26.
Fibroma of tendon sheath (FTS) is a rare and benign soft-tissue tumor. It is predominantly found in the fingers, hands, and wrists of young, adult males. We describe a series of three cases all presenting in the atypical knee location. We also review the literature on FTS, located both in the knee and elsewhere, looking for common clinical, imaging, and histologic patterns to help differentiate it from similar knee lesions. FTS typically presents as a painless, slow-growing, solid nodule. In the knee though, 71% of lesions present with pain/discomfort and 31% present with a palpable mass. Physical exam for knee FTS commonly reveals painful range of motion (50%), decreased range of motion (42%), and a palpable non-tender mass (33%). MRI of FTS usually reveals a well-defined soft-tissue mass, with low signal on T1, variable signal on T2, and variable enhancement. Histologically, the tumors are composed of a dense fibrocollagenous stroma with scattered spindle-shaped fibroblasts and narrow slit-like vascular spaces. Most FTS are removed by marginal excision, with 24% of lesions subsequently recurring. No lesion has ever metastasized. Despite its rarity, this lesion should be included in the differential diagnosis of a knee mass on physical exam or imaging, especially if it is painful, benign appearing, and present in a middle-aged male.
腱鞘纤维瘤(FTS)是一种罕见的良性软组织肿瘤。它主要见于年轻成年男性的手指、手部和腕部。我们描述了3例均出现在非典型膝关节部位的病例。我们还回顾了关于膝关节及其他部位FTS的文献,寻找常见的临床、影像学和组织学特征,以帮助将其与类似的膝关节病变相鉴别。FTS通常表现为无痛、生长缓慢的实性结节。然而,在膝关节处,71%的病变伴有疼痛/不适,31%可触及肿块。膝关节FTS的体格检查通常显示活动范围疼痛(50%)、活动范围减小(42%)以及可触及无压痛肿块(33%)。FTS的MRI通常显示边界清晰的软组织肿块,T1加权像呈低信号,T2加权像信号可变,增强方式也可变。组织学上,肿瘤由致密的纤维胶原基质组成,伴有散在的梭形成纤维细胞和狭窄的裂隙样血管间隙。大多数FTS通过边缘切除进行治疗,24%的病变随后会复发。尚无病变发生转移。尽管这种病变罕见,但在体格检查或影像学检查发现膝关节肿块时,尤其是肿块伴有疼痛、外观良性且发生于中年男性时,应将其纳入鉴别诊断。
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