Tendon Sheath Fibroma in the Thigh

Full article available online at Healio.com/Orthopedics. Search: 20120327-34 Tendon sheath fibromas are rare, benign soft tissue tumors that are predominantly found in the fingers, hands, and wrists of young adult men. This article describes a tendon sheath fibroma that developed in the thigh of a 70-year-old man, the only known tendon sheath fibroma to form in this location. Similar to tendon sheath fibromas that develop elsewhere, our patient’s lesion presented as a painless, slow-growing soft tissue nodule. Physical examination revealed a firm, nontender mass with no other associated signs or symptoms. Although the imaging appearance of tendon sheath fibromas varies, our patient’s lesion appeared dark on T1and bright on T2-weighted magnetic resonance imaging. It was well marginated and enhanced with contrast. Histologically, tendon sheath fibromas are composed of dense fibrocollagenous stromas with scattered spindle-shaped fibroblasts and narrow slit-like vascular spaces. Most tendon sheath fibromas can be successfully removed by marginal excision, although 24% of lesions recur. No lesions have metastasized. Our patient’s tendon sheath fibroma was removed by marginal excision, and the patient remained disease free 35 months postoperatively. Despite its rarity, tendon sheath fibroma should be included in the differential diagnosis of a thigh mass on physical examination or imaging, especially if it is painless, nontender, benign appearing, and present in men. Dr Moretti is from the Department of Orthopaedic Surgery, University of Illinois Hospital & Health Sciences System, Chicago, Illinois; Mr Ashana and Dr Lackman are from the Department of Orthopaedic Surgery, University of Pennsylvania, and Dr de la Cruz is from the Department of Pathology, Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, Pennsylvania. Dr Moretti and Mr Ashana received a research fellowship from Stryker Orthopaedics, Mahwah, New Jersey. Dr Lackman is a consultant for Stryker Orthopaedics. Dr de la Cruz has no relevant financial relationships to disclose. This study was performed at the University of Pennsylvania, Philadelphia, Pennsylvania. Correspondence should be addressed to: Vincent M. Moretti, MD, Department of Orthopaedic Surgery, University of Illinois Hospital & Health Sciences System,, 835 S Wolcott Ave, Room E-270, Chicago, IL 60612 (vincent.moretti@gmail.com). doi: 10.3928/01477447-20120327-34 Tendon Sheath Fibroma in the Thigh Vincent M. Moretti, MD; ADeDAyo o. AshAnA, BA; MichAel De lA cruz, MD; richArD D. lAckMAn, MD e607 Figure: T1-weighted coronal magnetic resonance image revealing a well-defined homogeneously low-signal mass adjacent to the tensor fascia lata (A). Fat-suppressed T1-weighted coronal magnetic resonance image revealing heterogeneous enhancement of the lesion with contrast (B). A