Soft tissue
Fibroblastic / myofibroblastic
Fibroma of tendon sheath
Author: Komal Arora, M.D.
Topic Completed: 1 July 2012
Minor changes: 21 March 2019
Copyright: 2002-2018, PathologyOutlines.com, Inc.
PubMed Search: Fibroma of tendon sheath
Table of Contents
Definition / general | Epidemiology | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Electron microscopy description | Electron microscopy images | Positive stains | Molecular / cytogenetics description | Differential diagnosis | Additional referencesCite this page: Arora K. Fibroma of tendon sheath. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/softtissuefibromatendon.html. Accessed August 8th, 2020.
Definition / general
- Well circumscribed, lobulated fibrous tumor attached to tendon or tendon sheath
- Also called tenosynovial fibroma
- Benign, uncommon
- May overlap with nodular fasciitis (Am J Surg Pathol 1989;13:472) or giant cell tumor of tendon sheath (Mod Pathol 1995;8:155, Histopathology 1992;20:213)
Epidemiology
- 60% men, ages 30 - 50 years old with nodule on fingers, hands or wrist
Case reports
- 35 year old man with swelling and mild discomfort on the volar and ulnar aspect of the left hand (Internet Journal of Hand Surgery 2008;2(1))
- 61 year old man with a history of multiple cutaneous nodules on both palms and soles (Ann Dermatol 2011;23:S45)
- Medial canthus of eye (Ophthal Plast Reconstr Surg 2007;23:341)
Treatment
- Excise to relieve symptoms but preserve function, may be difficult to remove from adherent tendons
- Benign, but up to 24% recur; does not metastasize
Clinical images
Images hosted on other servers:
Multiple non-movable deep seated nodules on palm
Gross description
- Well circumscribed, small fibrous multinodular mass < 3 cm, cut surface is pale, solid and homogeneous
Microscopic (histologic) description
- Well circumscribed nodules of dense fibrous tissue with occasional spindle or stellate mesenchymal cells in S or C shaped patterns
- Cells have scant cytoplasm and elongate nuclei with evenly distributed fine chromatin
- Often dilated or slit-like channels / clefts resembling tenosynovial spaces
- Varies from cellular to paucicellular
- May have bizarre tumor cells, extravasated red blood cells, but no atypical mitotic figures, no necrosis, no hyperchromasia
Microscopic (histologic) images
Images hosted on PathOut servers:
Multinodular proliferation
Transition from collagenous to cellular area
Fibroblasts are bland
(ruling out sarcoma) and
separated by collagen
Cellular area resembles
leiomyosarcoma or
fibrosarcoma, but these tumors
are rare in hands and feet
Extensive collagenization
of nodules produces this typical,
eosinophilic, paucicellular
appearance, incomplete
separation of the nodules
produces cleft-like spaces
Most cases are
paucicellular with scattered
spindled fibroblasts in a
densely collagenized matrix
and scattered small vessels
Electron microscopy description
- Resembles myofibroblasts and fibroblasts
Electron microscopy images
Images hosted on other servers:
Various images
Positive stains
Molecular / cytogenetics description
- May have t(2;11)(q31-32;q12) (Histopathology 1998;32:433)
Differential diagnosis
- Sarcoma: rare in hands and feet, usually large masses with cellularity, marked chromatin abnormalities and abnormal mitotic figures
- Benign fibrous histiocytoma: usually not hands or feet, prominent histiocyte-like cells, foam cells, giant cells and hemosiderin, CD68+
- Giant cell tumor of tendon sheat: more cellular, cells have histiocyte-like nuclei, also prominent giant cells, foam cells, hemosiderin; no slit-like vascular spaces, no extensive hyalinized stroma
Additional references
