Ozcan, RH

Ozkan, A

Topkara, A

The Kaohsiung Journal of Medical Sciences

English

Pamukkale Üniversitesi Açık Erişim Arşivi

Kaohsiung Journal of Medical Sciences (2016) 32, 436e437Available online at www.sciencedirect.com
ScienceDirect
journal homepage: http: / /www.kjms-onl ine.comLETTER TO THE EDITORA rare cause of carpal tunnel syndrome:
Fibroma of the tendon sheathDear Editor,
A fibroma of tendon sheath (FTS) is most commonly found in
the hand. FTSs are usually seen in the fingers after the age
of fifty and are clinically slow-growing well-defined mass.
Here, we report the case of a 26-year-old man who
featured a compression of the median nerve at the carpal
tunnel secondary to a FTS of the flexor digitorum super-
ficialis. Fibromas of a tendon sheath that compress the
median nerve (MN) are rare causes of carpal tunnel syn-
drome (CTS).
The patient was admitted with chief complaints of a
growing bulge, numbness and pain in the left palm for 6
months (Figure 1A). There was a history of wrist fracture
w8 months prior. Upon examination of the left-hypothenar
region, a nonmobile, solid mass was detected, with no
associated edema, erythema, or increased warmth.
Following magnetic resonance imaging (MRI) the diagnosis
of a regular soft-tissue mass under the hypothenar muscle,
which was applying pressure to the carpal tunnel
(Figure 1B) was suspected. Neurological and vascular ex-
aminations were unremarkable, and electrophysiological
studies were not performed. The mass was totally excised
under regional anesthesia. Macroscopically, the tumor was
a smooth, dense, well-circumscribed, multinodular mass
(Figure 1C). Final histological examination showed a cir-
cumscribed and lobulated hypocellular mass containing
dense fibrocollagenous stroma with scattered spindle-
shaped fibroblasts without inflammatory cells. Narrow,
slit-like vascular spaces were also present (Figure 1D).
These histological findings were diagnostic of FTS. There
were no operative or postoperative complications, and
after surgery, the patient’s complaints of pain and numb-
ness passed. Two years later, the patient remained free of
symptoms and showed no recurrence.Conflicts of interest: All authors declare no conflicts of interest.
http://dx.doi.org/10.1016/j.kjms.2016.04.005
1607-551X/Copyright ª 2016, Kaohsiung Medical University. Published
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nThe symptomatic compression of the MN in the carpal
tunnel is the main cause of CTS. Symptoms include pain,
weakness, and a tingling sensation along the MN distribu-
tion in the hand [1]. An FTS is an unusual, benign tumor that
is rarely reported as a cause of CTS [2,3]. Although there
are many causes of CTS, tendon sheath tumor compression
is an uncommon feature.
FTS is often associated with tendons or tendon sheaths,
and a history of trauma is reported in <10% of cases. In our
case, the patient did have a history of trauma to the region.
Macroscopically, an FTS is similar to a giant-cell tumor of
the tendon sheath and is recognized histologically by a lack
of giant cells, foamy histiocytes, and synovial cells. Micro-
scopically, FTSs comprise fibroblast-like spindle cells in a
fibromyxomatous matrix, with dilated, but frequently slit-
like vascular channels [4]. Differential diagnoses would
include fibromatosis, giant-cell tumor, nodular fascitis,
leiomyoma, neurofibroma, and fibrous hystiocytoma [3].
The appearance on MRI of the FTS presented as a well-
described mass with homogeneously low or isointensity on
T1-weighted images and low- or high-intensity on T2-
weighted images [5]. For this reason, no other studies
were performed.
Despite treatment with wide surgical excision, a 24%
recurrence rate was reported [5]. At 2-year follow-up, the
patient in this case remained free of symptoms and showed
no recurrence. FTSs should be surgically excised, because
late tumors can cause a variety of complications due to the
bass effect.
In spite of its rarity, this lesion should be included in
the differential diagnosis of a palmar mass on physical
exam or imaging, especially if it is painful, benign
appearing, and present in a middle-aged male presenting
with CTS.by Elsevier Taiwan LLC. This is an open access article under the
d/4.0/).
Figure 1. Preoperative magnetic resonance and histological views of the mass. (A) Preoperative view of the mass; (B) magnetic
resonance image of the mass; (C) intraoperative appearance of the excised tumor; and (D) hematoxylin and eosin stains (200).
Tumor cells appear to be spindle shaped and surrounded by an abundant collagenic matrix.
Letter to the Editor 437References
[1] Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel
syndrome: a review of the recent literature. Open Orthop J
2012;6:69e76.
[2] Tiong WH, Ismael TS, Regan PJ. Fibroma of tendon sheath: a rare
causeof carpal tunnel syndrome. JHand Surg Br 2006;31:579e80.
[3] Garrido A, Lam WL, Stanley PR. Fibroma of a tendon sheath at
the wrist: a rare cause of compression of the median nerve.
Scand J Plast Reconstr Surg Hand Surg 2004;38:314e6.
[4] Pulitzer DR, Martin PC, Reed RJ. Fibroma of tendon sheath. A
clinicopathologic study of 32 cases. Am J Surg Pathol 1989;13:
472e9.
[5] Nojiri H, Ogawa S, Takayanagi N, Watanabe A, Kaneko K,
Kurosawa H. Fibroma of the tendon sheath that expanded intothe radiocarpal joint with bony involvement. Scand J Plast
Reconstr Surg Hand Surg 2006;40:357e61.
Adem O¨zkan*
Adem Topkara
Ramazan Hakan O¨zcan
Department of Plastic, Reconstructive and Aesthetic
Surgery, Pamukkale University Hospital, Denizli, Turkey
*Corresponding author. Pamukkale University Hospital,
Department of Plastic, Reconstructive and Aesthetic
Surgery, Kinikli Kampusu, 20070 Denizli, Turkey.
E-mail address: ademo@pau.edu.tr (A. O¨zkan)


A rare cause of carpal tunnel syndrome: Fibroma of the tendon sheath

http://acikerisim.pau.edu.tr:8080/xmlui/bitstream/11499/23049/1/-zkan_et_al-2016-The_Kaohsiung_Journal_of_Medical_Sciences.pdf

A rare cause of carpal tunnel syndrome: Fibroma of the tendon sheath

Abstract

Similar works

Full text

Available Versions

Pamukkale Üniversitesi Açık Erişim Arşivi