Patellar Tendon Fibroma Mimicking Hemangioma: A Report on a Rare Case.

Fibroma of the tendon sheath (FTS) is an uncommon benign soft tissue tumor of the tendon sheath. Clinical and radiological features are not distinctive enough to clinch the diagnosis preoperatively. FTS occurs mostly around small joints such as the fingers, hands, and wrist. However, it rarely arises around a large joint (knee, shoulder, elbow, or ankle). This case report describes a rare presentation of fibroma within the patellar tendon. The patient, a 35-year-old male, presented with progressive pain and swelling in his left knee. Clinical examination, imaging studies, and histopathological analysis mimicked hemangioma but confirmed the diagnosis of a patellar tendon fibroma. A surgical excision was performed, leading to significant improvement in symptoms and functional recovery. This case highlights the importance of considering rare soft tissue pathologies in the differential diagnosis of knee joint disorders.

Benign Fibrous Histiocytoma of Tendon Sheath in the Index Finger of a 70-Year-Old Patient-A Case Report.

Fibrous histiocytoma (FH) within the finger, particularly involving the flexor tendon sheath, is a rare entity. While cutaneous fibrous histiocytomas have been documented in the fingers, their occurrence around the flexor sheath presents a unique diagnostic challenge, often resembling giant cell tumor of the tendon sheath (GCTTS). We report a case of benign fibrous histiocytoma involving the tendon sheath in the index finger of a 70-year-old patient and discuss its clinical presentation, differential diagnoses, histopathological features, and management. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-024-01971-5.

MANEUVER: A Phase III study of pimicotinib to assess efficacy and safety in tenosynovial giant cell tumor patients.

Tenosynovial giant cell tumor (TGCT) is a rare, locally invasive soft tissue tumor arising from the synovium of joints, bursa and tendon sheaths and is associated with the overexpression of the colony-stimulating factor 1 (CSF-1) gene. Pimicotinib is an orally available, highly selective and potent small molecule CSF-1 receptor (CSF-1R) inhibitor with robust efficacy and safety profile in patients with TGCT and is under development in multiple diseases. In an open-label Phase I study in patients with TGCT not amenable to surgery, pimicotinib showed superior efficacy and safety. In this article, we elucidate the rationale and study design of the multi-region Phase III MANEUVER trial (NCT05804045), which is designed to assess the efficacy and safety of pimicotinib in patients with TGCT not amenable to surgical resection in Asia, North America and Europe.

Tenosynovial giant cell tumor (TGCT) is a rare soft tissue tumor which grows in the soft tissues around joints or parts of the body used for movement. It is caused by high levels of a type of protein called CSF-1. Even though surgery is a preferred treatment option, some patients may be unable to have surgery because of where the tumor is, how complicated it is, or the risk of serious problems or illness after the surgery. Therefore, new treatments that are safe, effective and that help people live well are still needed for this disease. Pimicotinib is a medicine which blocks CSF-1, and researches have shown that it is safe and effective for treating TGCT in smaller, early study. To confirm these results, researchers have started a larger study, known as MANEUVER, in some parts of Asia, North America and Europe. This study will confirm if pimicotinib is safe and effective in patients with TGCT who may not be able to have surgery.Clinical Trial Registration: NCT05804045 (ClinicalTrials.gov).

Fetal development and growth of extensor tendons and their sheaths in the dorsal side of the wrist and hand: a histological study.

BACKGROUND: To understand considerable variations in number of adult extensor ten-dons at the dorsal side of the wrist and hand. MATERIALS AND METHODS: We examined histological sections from 30 human fetuses of gestational age 7-39 weeks and crown-rump length 22-323 mm. RESULTS: At the carpal level, earlier or smaller fetuses showed a simpler configuration with fewer tendon slips, whereas later or larger fetuses had a greater number of tendon slips with considerable variations in number and topographical relationships. Tendon slips of the early extensor digitorum to the middle and ring fingers were always 1 or 2, but were seven or more at late term. A tendon of the extensor digitorum to the little fin-ger could not be distinguished from other tendons at the carpal bone level. At the meta-carpal bone level, however, it extended from the ring finger tendon toward two slips of the extensor digiti minimi tendon. At the distal carpal level at midterm and late term, in which the tendon sheath was lost, each of the extensor digitorum tendon slips further divided to provide a mediolateral linear cluster of thin bundles. This large number of tendon components joined and united together to provide a single tight tendon at the level of the metacarpophalangeal joints. The extensor pollicis longs tendon usually lost a membranous septation when it crossed the extensor carpi radialis brevis tendon. CONCLUSIONS: Tendon slips in the fourth and fifth canals of the sheath were most likely to reduce in number after birth depending on the mechanical demand.

A Giant Cell Tumor of the Tendon Sheath of the Foot: A Rare Presentation.

A giant cell tumor of the tendon sheath (GCTTS) is a benign tumor that can occur in the joint synovium, bursae, or tendon sheath. It generally emerges in the tendons/synovium of the bones of the hand. It has unique characteristics, as noted in histopathological, clinical, and published literature. GCTTS has been reported across different age groups, with higher incidence observed in middle-aged adults. We present an unusual occurrence of GCTTS arising from the foot in a 54-year-old female who visited our medical facility with a history of swelling in her right foot for one year. Ultrasonography suggested a well-defined 5 x 4 cm lesion deep to the flexor tendon with possible intertarsal extension, which was managed surgically. This article represents a detailed understanding of GCTTS, emphasizing its benign yet locally aggressive nature and the complexities involved in its diagnosis and management.

Giant Cell Tumor of the Tendon Sheath of the Hand: Analysis of Factors Impacting Recurrence.

Background Giant cell tumors of the tendon sheath (GCTTS) of the hand are considered the second most common benign tumors of the hand after ganglion cysts. Excision biopsy is considered the standard treatment at present. They are notorious for having a very high rate of recurrence as given in many studies. Many factors are said to be associated with recurrence of the tumors. The goal of this study is to evaluate the long-term results of a series of 48 patients operated on at a single institute and to find out if there is any correlation between the proposed risk factors with recurrence. Methods A retrospective analysis was done in cases of GCTTS operated on between 2015 and 2021. The patients were invited for follow-up for a minimum of 2 years, and the patient files were reviewed. Further data were collected at follow-up including recurrence, range of movement, sensation, skin necrosis, scarring, and digital neuropathy. A data analysis was done. The correlation between the proposed risk factors and recurrence was calculated with the Pearson correlation coefficient. A p -value of less than 0.05 was considered statistically significant. Results During the 6 years, 48 patients were operated on. Recurrence was observed in eight patients (16%) at an average of 38.7 months from the time of surgery. Of the risk factors, tumors with satellite nodules and tumor adjacency to joint correlated significantly with recurrence. No complications were observed during follow-up. Conclusion GCTTS of the hand has a high propensity to recur. The presence of satellite nodules and proximity to interphalangeal joints are two important risk factors for recurrence. Magnification during surgery ensures complete excision of the tumor and reduces the chance of recurrence.

Adaptive fuzzy control for tendon-sheath actuated bending-tip system with unknown friction for robotic flexible endoscope.

Introduction: The tendon-sheath actuated bending-tip system (TAB) has been widely applied to long-distance transmission scenes due to its high maneuverability, safety, and compliance, such as in exoskeleton robots, rescue robots, and surgical robots design. Due to the suitability of operation in a narrow or tortuous environment, TAB has demonstrated great application potential in the area of minimally invasive surgery. However, TAB involves highly non-linear behavior due to hysteresis, creepage, and non-linear friction existing on the tendon routing, which is an enormous challenge for accurate control. Methods: Considering the difficulties in the precise modeling of non-linearity friction, this paper proposes a novel fuzzy control scheme for the Euler-Lagrange dynamics model of TAB for achieving tracking performance and providing accurate friction compensation. Finally, the asymptotic stability of the closed-loop system is proved theoretically and the effectiveness of the controller is verified by numerical simulation carried out in MATLAB/Simulink. Results: The desired angle can be reached quickly within 3 s by adopting the proposed controller without overshoot or oscillation in Tracking Experiment, demonstrating the regulation performance of the proposed control scheme. The proposed method still achieves the desired trajectory rapidly and accurately without steady-state errors in Varying-friction Experiment. The angle errors generated by external disturbances are < 1 deg under the proposed controller, which returns to zero in 2 s in Anti-disturbance Experiment. In contrast, comparative controllers take more time to be steady and are accompanied by oscillating and residual errors in all experiments. Discussion: The proposed method is model-free control and has no strict requirement for the dynamics model and friction model. It is proved that advanced tracking performance and real-time response can be guaranteed under the presence of unknown bounded non-linear friction and time-varying non-linear dynamics.

Recurrent Localized Tenosynovial Giant Cell Tumor of the Left Ring Finger: A Case Report and Literature Review.

Here, we report the case of recurrent swelling and pain in the proximal interphalangeal joint of the left ring finger, which was later diagnosed as a localized tenosynovial giant cell tumor in a young adult female. The first presentation was at the same anatomical site four years prior. Examination at presentation showed a firm skin-colored nodule in the volar aspect of the left ring finger. The swelling was seen to be partly attached to underlying structures and was non-tender. After a careful physical examination and plain radiograph imaging of the hand, the two differential diagnoses considered were tenosynovial giant cell tumor and ganglion cyst. A surgical excision was performed, and histopathologic evaluation showed features consistent with a tenosynovial giant cell tumor, localized type. The resection margins were clear of tumor. The patient had no intraoperative or postoperative complications. Postoperative physiotherapy was recommended. No recurrence was seen after postoperative surgical follow-up for one year. This report highlights the importance of histopathologic evaluation and confirmation of clear surgical margins in the management of tenosynovial giant cell tumors. In recurrent cases, surgical re-excision with clear margins provides good clinical outcomes. Before surgical excision, patients should be informed about the biologic nature of the lesion and the high risk of recurrence. The management modalities to prevent recurrence and the need for long-term follow-up should also be discussed with the patient.

Retained wooden splinter migrated within a digital flexor tendon sheath: Ultrasonographic diagnosis for presurgical planning.

A 29-year-old right-handed woman presented to an outside emergency department with right small finger pain, swelling, and concern for a retained wooden splinter. Diagnosis and treatment were delayed for 2 weeks due to the inability to identify the foreign body clinically or radiographically. Ultimately, ultrasonography by a fellowship-trained specialist was used to localize the wooden splinter. It was embedded within the flexor tendon sheath but had migrated away from its initial point of entry. The patient underwent subsequent surgical extraction, irrigation, and debridement. Two weeks following surgery, she had regained full range of motion through her digit without signs of infection. This case highlights the use of diagnostic ultrasound to identify a radiolucent foreign body, such as a wooden splinter, and to guide subsequent surgical extraction.

Ganglion Cysts in the Hallux: A Report of Two Cases.

We experienced two cases of intractable hallux ganglion. Case 1 was a 70-year-old woman with a recurrent ganglion and severe pain on the plantar aspect of the hallux. The continuity between the mass and the distal flexor hallucis longus (FHL) tendon sheath was confirmed. The ganglion was resected along with part of the tendon sheath, and the tendon sheath was incised as proximally as possible. Case 2 was a 69-year-old woman with a ganglion on the dorsal aspect of the interphalangeal joint that repeatedly ruptured due to thinning of the skin. The ganglion was contiguous with the joint capsule but not with the FHL tendon sheath, and the entire capsule was resected. There was no recurrence one year after surgery in either case. The risk of recurrence of an intractable hallux ganglion can be reduced by blocking the synovial supply route and lowering the pressure inside the joint or tendon sheath.

Exploration of the molecular biological mechanisms and review of postoperative radiotherapy cases in tenosynovial giant cell tumors.

Tendon Sheath Giant Cell Tumor (TGCT) is a benign tumor that primarily grows within joints and bursae. However, it has a high postoperative recurrence rate, ranging from 15% to 45%. Although radiotherapy may reduce this recurrence rate, its applicability as a standard treatment is still controversial. Furthermore, the pathogenic mechanisms of TGCT are not clear, which limits the development of effective treatment methods. The unpredictable growth and high recurrence rate of TGCT adds to the challenges of disease management. Currently, our understanding of TGCT mainly depends on pathological slice analysis due to a lack of stable cell models. In this study, we first reviewed the medical records of two female TGCT patients who had undergone radiotherapy. Then, by combining bioinformatics and machine learning, we interpreted the pathogenesis of TGCT and its associations with other diseases from multiple perspectives. Based on a deep analysis of the case data, we provided empirical support for postoperative radiotherapy in TGCT patients. Additionally, our further analysis revealed the signaling pathways of differentially expressed genes in TGCT, as well as its potential associations with osteoarthritis and synovial sarcomas.

Growing stylohyoideus muscle insertion to the hyoid bone with special reference to its topographical relation to the intermediate tendon of digastricus muscle: A histological study using human fetuses.

BACKGROUND: In adults, the intermediate tendon of digastricus muscle usually runs along the medial or lateral side of the stylohyoideus muscle insertion. To provide a better understanding of the variations, we examined the topographical anatomy of the muscle and tendon in fetuses. METHODS: We examined histological sections from six early-term, 26 mid-term and six near-term fetuses (approximately 8-9, 12-18 weeks and 25-33 weeks). RESULTS: At early-term, an initial sheath of intermediate tendon of digastricus muscle received the stylohyoideus muscle at the superior aspect. The muscle and tendon was distant from the hyoid. At mid-term, near the insertion to the hyoid greater horn, the stylohyoideus muscle consistently surrounded more than 2/3 of the intermediate tendon circumference. In contrast, we found no near-term specimen in which the stylohyoideus muscle surrounded the intermediate tendon. The multilayered tendon sheath was fully developed until near-term and connected to the body of hyoid by an intermuscular septum between the thyrohyoideus muscle and one or two of suprahyoid muscles. Therefore, the hyoid insertion of the styloglossus muscle was a transient morphology at mid-term. CONCLUSION: The stylohyoideus muscle insertion was appeared to move from the tendon sheath to the hyoid greater horn and, until near-term, return to the tendon sheath. A fascia connecting the tendon sheath to the body of hyoid was strengthened by the suprahyoid and infrahyoid muscles. The latter muscles seemed to regulate fixation/relaxation of the intermediate tendon to the hyoid. The stylohyoideus muscle slips sandwiching the intermediate tendon might be a rare morphology.

The effect of surgical factors on recurrence of tendon sheath giant cell tumours.

In this retrospective study, we evaluated the impact of tumour-related and surgical factors on the recurrence of giant cell tumours of tendon sheath. A total of 95 patients were treated at our institution between February 2012 and March 2021. We identified the factors most likely to be associated with recurrence from evaluation of classification, neurovascular invasion, bone erosion and joint invasion. Based on these criteria, we identified 49 patients with a high risk of recurrence. Of the 95 patients, recurrence was observed in 17. Among the 49 patients classified as high-risk, 13 were found to have recurrence. This study demonstrates that recurrence is more common in the high-risk patient group.Level of evidence: IV.

Sonographic features of diffuse giant cell tumor of the tendon sheath in the shoulder: A case report.

A middle-aged woman presented to our hospital with a chief complaint of a mass on the left shoulder for 1 year. The initial lump was small with no pain or tenderness, and the patient had not sought medical attention for numbness in the left shoulder. Clinical examination showed a mass on the left shoulder measuring 11 × 8 × 3 cm approximately with no apparent skin damage or ecchymosis. No limitations in left shoulder joint movements were observed, and the patient exhibited normal movement of the left elbow joint, wrist joint, and metacarpophalangeal joint. Moreover, the left radial artery was palpable.

Giant Cell Tumor of the Tendon Sheath of the Thumb: A Case Report.

The giant cell tumor of the tendon sheath (GCTTS) is a benign nodular tumor that is found on the tendon sheath of hands and feet. It is the second most common tumor of the hand, next only to ganglion cysts. Several hypotheses were formulated about the etiological factors of these tumors, but still, there is not a common opinion on etiology, prognostic factors, and recurrence rate. We report a case of GCTTS in a young male where a lesion was identified in his left thumb. Although marginal excision is the treatment of choice, it is often difficult to perform due to the location and the strict adherence of the tumor to the tendon or neurovascular bundles. The primary issue with the treatment lies in its elevated recurrence rates. Apart from cases of incomplete excision, there is a lack of consensus regarding the impact of other risk factors on the likelihood of recurrence.

Fibroma of the Patellar Tendon Sheath: A New Paradigm.

The authors present a case of fibroma of the tendon sheath with intra-articular location in the knee, more specifically in the infrapatellar fat; with this specific location, this is the fourth case described of an entity that rarely affects large joints. Clinical and epidemiological aspects, but especially the imaging findings on magnetic resonance imaging scans, are essential for the differential and definitive diagnosis, which was nevertheless established only after a histological study of the excised mass by miniarthrotomy.

Does Direct MRI Tenography Improve the Diagnostic Performance of Low-Field MRI to Identify Artificially Created Soft-Tissue Lesions within the Equine Cadaveric Digital Flexor Tendon Sheath?

Tenosynovitis of the digital flexor tendon sheath (DFTS) is diagnosed using ultrasonography and contrast tenography. Nevertheless, making a precise preoperative diagnosis is challenging. This study aimed to determine and compare the sensitivity and specificity of low-field MRI and MRI tenography (MRIt) to detect artificially created soft-tissue lesions in the DFTS. In 21 DFTSs, 118 lesions were made tenoscopically in the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), manica flexoria (MF) and proximal scutum. MRI and MRI, following intrathecal gadolinium administration (MRIt), were performed. The sensitivity and specificity of MRI and MRIt were calculated and compared. Proximal scutum lesions were less frequently identified by MRI (Sensitivity 38%, specificity 96%) compared to MRIt (Sensitivity: 50%, p = 0.80; specificity: 96%, p = 1). This was similar for SDFT lesions (Sensitivity: 39% versus 54%, p = 0.72; specificity: 93% versus 96%, p = 1). MRI detected DDFT lesions (sensitivity 34%; specificity 100%) better than MRIt (sensitivity 32%, p = 0.77; specificity 98%, p = 1). This was similar for MF lesions (MRI sensitivity 61%; specificity 100% vs. MRIt sensitivity 50%, p = 0.68; specificity 96%, p = 1). Lesion size was significantly associated with MRI or MRIt diagnosis (p = 0.001). The intrathecal administration of gadolinium did not significantly improve the ability of low-field MRI to diagnose artificial DFTS tendon lesions. Small lesion length was a significant discriminating factor for lesion detection. MRI and MRIt specificity were high, thus being helpful in diagnosing an intact structure.

A Giant Lipoma in the Distal Forearm of a Cadaver.

OBJECTIVE: Lipomas are very common tumors which usually prefer the upper limbs and, depending on their size, may cause nerve compression, or may be asymptomatic. The current cadaveric report describes a giant lipoma in the distal forearm area. CASE REPORT: A large mass (5.1 × 3.2 × 1.6 cm) was identified on the palmar surface of the distal forearm, during dissection of a 63-year-old male cadaver. The mass caused anteromedial displacement and flattening of the median nerve (MN). Despite the lack of information about the subject's medical history, MN compression was assumed on the basis of the lipoma's size, its vicinity to neural structures, and the MN displacement and flattening. CONCLUSION: The enlarged distal forearm lipoma, located adjacent to the carpal tunnel, displaced and flattened the MN. The cadaveric finding described is clinically relevant for both differential diagnosis and surgical treatment of carpal tunnel syndrome.

Uncommon Presentation of a Giant Cell Tumor of the Tendon Sheath of the Hand: A Case Report.

A giant cell tumor of the tendon sheath (GCTTS) presents as a rare neoplasm demanding a heightened index of suspicion for precise diagnostic evaluation, especially when manifesting in the digital phalanges, as it is part of a group of neoplasms known as tenosynovial giant cell tumors (TCGTs). An accurate and timely diagnosis is crucial, as it significantly enhances treatment outcomes for this heterogeneous group of lesions. We describe the case of a male patient who presented with multiple nodules in the fourth finger of his left hand and was ultimately diagnosed with a localized form of a GCTTS, an unusual presentation for localized forms of this entity. Our objective is to outline the diagnostic and therapeutic approach, discussing options for differential diagnosis and treatment modalities. To achieve this, we conducted a literature review and compared our findings and the observed evolution in our patient. Early recognition of hand tumors allows for timely diagnosis, facilitating optimal resections during surgical procedures. This, in turn, reduces morbidity and enhances the functionality of the affected extremity, as detailed in the current case.

Unveiling the Enigma: Uncommon Hand Giant Cell Tumor within the Tendon Sheath.

Introduction: Giant cell tumor of tendon sheath (GCTTS), also known as tenosynovial giant cell tumor or pigmented villonodular tenosynovitis, is a rare benign soft-tissue tumor with an unclear cause. It is the second most frequent soft-tissue tumor in the hand after ganglion cyst. Case Report: We described a female patient, age 19, who has had a 3 cm × 2 cm firm swelling on the palmer aspect of the right second metacarpal region for 7 years. The bulge developed spontaneously and moved quite slowly. It is required to do a histological and radiographic evaluation to determine whether or not to pursue additional treatment. Excision surgery was done, and the tumor was entirely removed. According to histopathology, this mass was compatible with GCTTS without being malignant. Conclusion: It is an uncommon instance of GCTTS at the hand, to sum up. The tumor should be entirely excised due to its high risk of recurrence to lower the likelihood of recurrence and restore hand function.