Fibrochondroma of Digital Flexor Tendon Sheath-a Rare Presentation

• DOI: 10.1007/s12593-012-0085-8
• Publication Date: 2012-11-22T17:18:06Z
• Authors: Sherif Abouel-Enin; Rajan Maheshwari; Himanshu Wadhawan; Anju Verghese; Sanjeev Madan
• Keywords: 03 medical and health sciences; 0302 clinical medicine

A 34 year old female typist presented to the orthopaedic outpatients clinic with a painless swelling in her right ring finger for 3 years duration. Examination revealed a mobile, hard lump on the volar aspect of the right ring finger at the level of the proximal interphalangeal (PIP) joint with restricted range of movement at the PIP joint. The swelling was a cause of concern for the patient and was affecting her job as a typist. Plain radiography (Fig. 1) demonstrated a discrete soft tissue ossified swelling adjacent to the PIP joint which appeared separate from the underlying joint, but the exact nature of the swelling could not be identified. An Ultrasound examination performed showed high density echogenic shadow, consistent with cancellous bone formation. The lesion was relatively mobile, lying superficial to the flexor tendon and arising from the flexor sheath without involving the underlying bone. The decision to proceed with surgery was made keeping in mind the benign nature of the swelling. Intraoperatively, the tumor which was found to be originating from the digital flexor sheath was 1×0.5 cm in diameter, grey in color and firm in consistency. Complete excision of the swelling was carried out with preservation of the digital neurovascular bundles. Microscopic examination of the specimen sent for histopathology showed dense fibrous tissue merging into fibrocartilagenous tissue with ossification. This was regarded as a soft tissue fibrochondroma with ossification arising in a tendon sheath. (Figs. 2 & 3). No cellular atypia was identified in the cartilaginous component. The patient was followed up 2 weeks and 6 months after surgery, there was no clinical evidence of recurrence and she had complete functional recovery with painless full range of movement at the proximal and distal interphalangeal joint.