Giant cell tumor of tendon sheath
Slow growing lump on finger. Non-tender.
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At the ulnar side of the middle phalanx of the 4th digit there is a soft tissue lesion. This extends anteriorly and posteriorly around the phalanx, abutting the periosteum but without cortical or marrow signal change. The lesion intimately abuts the flexor tendons, however there is no intra-synovial or intra-articular involvement.
Signal characteristics of the lesion: isointense to muscle on T1, with heterogenous enhancement.
MACROSCOPIC DESCRIPTION: "R 4th finger trans ROI core Bx": Five linear tissue cores ranging in length between 4mm and 12mm, each 1mm in diameter. A1. (GS)
MICROSCOPIC DESCRIPTION: Thickly keratinized epidermis, dermis and subcutaneous tissue. Within subcutaneous tissue is a cellular lesion incorporating numerous numerous multinucleate giant cells. There is no cellular atypia or necrosis. No mitoses are identified. No bone is identified. The lesion extends to biopsy edges.
DIAGNOSIS: Right 4th finger lesion: Giant cell tumor.