Department of Orthopedics and Traumatology, Department of Mophofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania;
Rom J Morphol Embryol. 2020 Apr-Jun;61(2):457-463. doi: 10.47162/RJME.61.2.15.
Idiopathic tenosynovitis with rice bodies is a rare disease and its non-association with rheumatic diseases, tuberculosis infection or trauma is reported only in few cases in literature.
PATIENTS, MATERIALS AND METHODS: Our study presents a series of five patients diagnosed with tenosynovitis with rice bodies at the flexor tendons of the upper limb. Medical history revealed no associated disease or trauma. Disease duration ranged between two months and four years, two patients presenting symptoms of acute carpal tunnel and three patients tumor mass. In one case, the tumor measured 210 mm in length and a tendon rupture was suspected. Laboratory and imaging investigations could not establish a specific associated pathology and a preoperative diagnosis. Surgical treatment consisting of synovectomy was performed in all patients.
In all five cases, intraoperative appearance could easily determine the presence of rice bodies. Histopathological examination revealed typical aspect for rice bodies and make the diagnosis possible without the need for other more laborious processing (immunohistochemistry). The amount of rice bodies was directly proportional to disease duration. In all cases, the recovery was complete. After a median 30.4-month follow-up, no recurrence was detected. Subsequently performed laboratory investigations and specific tests did not reveal tuberculosis infection, rheumatic disease, or other diseases.
This is the largest series of patients with idiopathic tenosynovitis with rice bodies and the bigger tumor mass reported to date. Synovectomy with removal of all rice bodies represents the optimal treatment. A longer disease course may be associated with a larger number of rice bodies, which may be associated with tendon rupture. The etiopathogenesis remains unclear, further studies being necessary to establish it.
特发性腱鞘炎伴类风湿结节是一种罕见疾病，其与风湿性疾病、结核感染或创伤无关仅在少数文献中报道。
患者、材料和方法：我们的研究报告了 5 例上肢屈肌腱腱鞘炎伴类风湿结节患者。病史无相关疾病或外伤。疾病持续时间在 2 个月至 4 年之间，2 例出现急性腕管综合征症状，3 例出现肿瘤肿块。在 1 例中，肿瘤长 210 毫米，怀疑有肌腱断裂。实验室和影像学检查无法确定特定的相关病理学和术前诊断。所有患者均行滑膜切除术治疗。
在所有 5 例中，术中表现可轻易确定类风湿结节的存在。组织病理学检查显示典型的类风湿结节表现，无需进行其他更繁琐的处理（免疫组化）即可做出诊断。类风湿结节的数量与疾病持续时间直接相关。所有病例均完全恢复。中位随访 30.4 个月后，未发现复发。随后进行的实验室检查和特殊检查未发现结核感染、风湿性疾病或其他疾病。
这是特发性腱鞘炎伴类风湿结节患者中最大的系列病例，也是迄今为止报道的最大肿瘤肿块。滑膜切除术联合切除所有类风湿结节是最佳治疗方法。较长的病程可能与更多的类风湿结节有关，这可能与肌腱断裂有关。其发病机制尚不清楚，需要进一步研究。
