Multicentric localized giant cell tumor of the tendon sheath

The authors report on a rare case of multicentric giant cell tumor of the tendon sheath in the right index finger of a 76-year-old woman. In the present case, three lesions simultaneously arose at different sites in the same finger. Magnetic resonance imaging and intraoperative findings revealed no contiguity among the three lesions. A multicentric origin of the tumor is unusual. SICOT Online Report E059 Accepted May 24th, 2004 2 Introduction Localized giant cell tumor of the tendon sheath usually forms as a solitary nodule in the subcutis of the finger, hand and toe [3,4]. A multicentric origin of the tumor is extremely rare [2]. The authors describe a case of localized giant cell tumor of the tendon sheath, in which three separate tumors simultaneously developed at different sites in the same finger. Case Report A 76-year-old woman presented with an approximately 5-month history of two, gradually increasing masses in the volar aspect of her right index finger. The patient had no pain in the affected finger. The patient reported no previous trauma to the finger. On physical examination, mild swelling was noted over the volar aspect of the right index finger. A subcutaneous mass, measuring 1x1cm in size, was palpated in the volar aspect of the metacarpophalangeal (MP) joint, and another mass, measuring 2x1.5cm, was palpated in the volar aspect of the proximal interphalangeal (PIP) joint. Both masses were well-defined, soft, smooth-surfaced and non-tender. The overlying skin was normal. Another mass, measuring 0.5x0.5cm was palpated in the volar aspect of the distal interphalangeal (DIP) joint, which the patient had not noticed prior to presentation. The distal mass had similar nature to that of the other two proximal masses. All masses were located in the subcutis. The range of motion of the DIP, PIP and MP joints were mildly restricted in flexion due to the masses. Magnetic resonance (MR) imaging revealed three masses attaching to the flexor tendon sheath. All masses showed low signal intensity on both T1-weighted and T2-weighted images (Fig 1). There was no contiguity among the three lesions on MR imaging. Laboratory data showed no abnormalities. SICOT Online Report E059 Accepted May 24th, 2004