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Fibroma of Tendon Sheath : Intro & Clinical

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Introduction: Fibroma of tendon sheath is a common, benign, slow-growing fibrous tumor usually seen in the hands and feet. It shares some morphologic features as well as genetic abnormalities with nodular fasciitis (USP6 gene rearrangements) and desmoplastic fibroma [t(2;11)(q31-32;q12)].

Clinical Features: It is usually seen in adults 30 to 50 years of age with a male predominance (M:F=3:1). Most lesions arise in the extremities (upper > lower). In the upper extremity, the usual sites are fingers (thumb, index finger), hands, and wrists. Forearm, elbow and upper arm are rarely involved. The sites in the lower extremity include knee, foot, ankle, and rarely the toe. Rare cases are intra-articular. It presents as a small, solitary, firm, slow-growing, usually painless subcutaneous mass that is attached to the tendon sheath and moves with the involved tendon. Slight pain or tenderness may be present in one-third of cases. Most lesions are smaller than 2 cm (although the case shown here measured 4 cm in size).

The photograph shows recurrent fibroma of tendon sheath on the dorsum of the right wrist of a 49 y/o male. Note the dimpled scar from the previous resection. Recurrences are seen in about 25% of cases following incomplete excision. They are treated by re-excision. Case courtesy of: Dr. Madhav Khadilkar & Dr. Sanjay D. Deshmukh, Department of Pathology, Smt. Kashibai Navale Medical College, Pune, India.

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