Suzuki Kayo, Yasuda Taketoshi, Suzawa Shun, Watanabe Kenta, Kanamori Masahiko, Kimura Tomoatsu
Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
Department of Human Science 1, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
BMC Musculoskelet Disord. 2017 Aug 30;18(1):376. doi: 10.1186/s12891-017-1736-5.
Fibroma of tendon sheath (FTS) is a benign tumor arising from the synovium of the tendon sheath that occurs mostly around small joints such as the fingers, hands, and wrist. However, FTS rarely arises around a large joint (knee, shoulder, elbow, and ankle) with intra-articular or extra-articular involvement. The clinical characteristics of FTS arising around a large joint are unclear. An additional 3 cases of FTS arising around a large joint are presented. Furthermore, the published cases and the present cases are reviewed with respect to their clinical characteristics and imaging and histopathology findings.
The 43 reported cases including the present 3 patients were summarized, and the patients' profiles, symptoms, sites and locations in the joint involved by FTS, magnetic resonance imaging (MRI) findings, surgical procedures, clinical courses, and cytogenetic analyses were reviewed.
The average age of 26 cases was 40.9 years (range 13-69 years), and about 60% of the patients were male. About 10% of the patients had a past history of trauma to the knee joint. Of the present 3 cases, one case was extra-articular around the elbow joint, one case was extra-articular around the knee joint, and one case was intra-articular involving the knee joint. The common symptoms were pain (62.5%), swelling or palpable mass (54.2%), and limited range of motion of the involved joint (50%). The most commonly involved joint was the knee, with 32 cases (74.4%), followed by the elbow in 5 cases (11.6%), ankle in 4 (9.3%), and shoulder in 2 (4.7%). The tumor typically exhibited iso to low signal intensity on T1-weighted MRI. T2-weighted images showed various patterns, but mostly low signal intensity relative to muscle. The surgical margin was marginal resection in all cases. There were no recurrences after surgery. On chromosomal analysis, only the present Case 3 showed an abnormality.
A total of 43 FTS cases that occurred around large joints were summarized. The most common site was around the knee joint. In FTS cases around large joints, it is necessary to distinguish between various fibroblastic and/or fibrohistiocytic tumors.
腱鞘纤维瘤（FTS）是一种起源于腱鞘滑膜的良性肿瘤，多发生于手指、手部和腕部等小关节周围。然而，FTS很少发生在大关节（膝关节、肩关节、肘关节和踝关节）周围，且可累及关节内或关节外。大关节周围发生的FTS的临床特征尚不清楚。本文报告另外3例发生在大关节周围的FTS病例。此外，对已发表的病例和本文病例的临床特征、影像学及组织病理学表现进行了回顾。
总结包括本文3例患者在内的43例报告病例，回顾患者的资料、症状、FTS累及关节的部位及位置、磁共振成像（MRI）表现、手术方式、临床病程及细胞遗传学分析。
26例患者的平均年龄为40.9岁（范围13 - 69岁），约60%的患者为男性。约10%的患者有膝关节外伤史。在本文3例病例中，1例位于肘关节周围关节外，1例位于膝关节周围关节外，1例位于膝关节内。常见症状为疼痛（62.5%）、肿胀或可触及肿块（54.2%）以及受累关节活动范围受限（50%）。最常受累的关节是膝关节，有32例（74.4%），其次是肘关节5例（11.6%）、踝关节4例（9.3%）和肩关节2例（4.7%）。肿瘤在T1加权MRI上通常表现为等信号至低信号强度。T2加权图像显示多种表现，但相对于肌肉大多为低信号强度。所有病例的手术切缘均为边缘切除。术后无复发。染色体分析显示，仅本文病例3存在异常。
总结了43例发生在大关节周围的FTS病例。最常见的部位是膝关节周围。在大关节周围的FTS病例中，有必要区分各种成纤维细胞性和/或纤维组织细胞性肿瘤。
