Journal of Surgical Oncology 32:230-232 (1986)

Fibroma of Tendon Sheath

DEBA P. SARMA, MD, THOMAS G. WEILBAECHER, MD, AND FRED H. RODRIGUEZ, Jr., MD

From the Department of Pathology, Veterans Administration Medical Center, and the Louisiana State University Medical School, New Orleans

This report describes a 60-year-old woman with a fibroma of tendon sheath of left hand. Ultrastructural study of the tumor reveals the nature of the tumor cells as fibroblasts, thus distinguishing it from the more common giant cell tumor of tendon sheath believed to be derived from synovial cells.
KEY WORDS:

tendon sheath tumor, ultrastructure of fibroma of tendon sheath

INTRODUCTION Chung and Enzinger [1] in 1979 described fibroma of tendon sheath as a distinct clinicopathologic lesion different from giant cell tumor of tendon sheath. Light microscopic features of the lesion have been adequately described [1-4]; however, reports of ultrastructural study of such cases are not readily available. Recently, we had an opportunity to study such a case with electron microscopy.

CASE REPORT A 60-year-old white woman presented with a 3-month history of numbness and decreased sensation in the left hand. Physical examination revealed atrophic thenar musculature with marked loss of strength of the thumb. There was complete loss of sensation along the median nerve distribution as well as partial block of flexion of the long finger. Radical pulse was normal. All hematologic and chemical tests yielded normal values. The patient had undergone surgical procedure one year previously for repair of a lacerated flexor tendon of the left thumb. COMMENT At operation for carpal tunnnel release, a 4 x 3 x 2cm firm, encapsulated tumor mass was noted to be atUltrastructurally, the cells of giant cell tumor of tendon tached to the flexor profundus tendon of the long finger. sheath show features of synovial cells, osteoblastic mesThe tumor was easily separable from the tendon. The enchyme, fibroblasts and histiocytes [5]. They are bemedian nerve was noted to be compressed within the lieved to be arising from synovial cells. carpal runner prior to its release. Postoperative course was uneventful. The excised tumor had smooth, shiny, glistening cut surfaces. Histologically (Fig. 1), the encapsulated mass Accepted for publication March 2, 1985. was composed of spindle-shaped fibroblasts within dense Address reprint requests to D. Sarma, M.D., V.A. Medical Center, collagenous stroma with many slit-like vascular spaces. 1601 Perdido Street, New Orleans, LA 70146.
1986 Alan R. Liss, Inc.

There were areas of hypercellularity where the cells were plump, slightly pleomorphic with vesicular nuclei. No histiocytes or giant cells were noted. Numerous samples from the hypercellular as well as acellular areas of the lesion were examined by electron microscopy (Fig. 2). The predominant cell was fibroblast with an oval or elongate nucleus with a marginated, flocculent chromation pattern and an invaginated nuclear membrane. Occasional cells had small nuclear membrane blebs. The cytoplasm contained a prominent rough endoplasmic reticulum, which was significantly dilated in some cells. Mitochondria were small and uniform. There was a distinct Golgi zone, and many cells contained haphazard aggregates of intermediate filaments. All cells appeared to be morphologic fibroblast variants. No intracellular junctional complexes were noted. The cells were seen singly in an interstitital-type collagen stroma. There were no specific secretory granules. The slit-like spaces proved to be vascular channels lined by plump, swollen endothelial cells that were enclosed by a thin, delicate basal lamina. There were adjacent pericyte-type cells. No macrophage or histiocyte-type cells were noted.

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Fig. 1. Fibroma of tendon sheath showing spindled cells in a dense collagenous stroma with many slit-like spaces (H&E X60).

Fig. 2. Plump fibroblastic cells with indented nuclear membranes and prominent cytoplasmic rough endoplasmic reticulum are present in a stroma of interstitial-type collagen (uranyl acetate and lead citrate, X3.200).

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Our ultrastructural study of a fibroma of tendon sheath REFERENCES clearly shows that the cells of such a lesion are fibro1. Chung EB, Enzinger FM: Fibroma of tendon sheath. Cancer blastic in nature, and they do not show features of syn44:1945-1954, 1979. ovial cells. Though clinically and grossly similar, the 2. Enzinger FM, Weiss SW: "Soft Tissue Tumors." St. Louis: CV Mosby Co., 1983, pp 31-33. giant cell tumor and fibroma of tendon sheath appear to 3. Cooper PH: Fibroma of tendon sheath. J Am Acad Dermatol be histogenetically different. 11:625-628, 1984. ACKNOWLEDGMENTS We thank Ms. Roey Holliday for excellent secretarial assistance.
4. Jablokow VR, Kathuria S: Fibroma of tendon sheath. J. Surg Oncol 19:90-92, 1982. 5. Alguacil-Garcia A, Unni KK, Goellner JR: Giant cell tumor of tendon sheath and pigmented villonodular synovitis: An ultrastruc tural study. Am J Clin Pathol 69:6-17, 1978.

Sarma DP, Weilbaecher TG, Rodriguez FH Jr.(1986): Fibroma of tendon sheath. J Surg Oncol 32(4): 230-232 .PMID: 3736066 [PubMed - indexed for MEDLINE] Sarma DP, Weilbaecher TG, Rodriguez FH Jr.

Abstract
This report describes a 60-year-old woman with a fibroma of tendon sheath of left hand. Ultrastructural study of the tumor reveals the nature of the tumor cells as fibroblasts, thus distinguishing it from the more common giant cell tumor of tendon sheath believed to be derived from synovial cells.
PMID: 3736066 [PubMed - indexed for MEDLINE] Sarma DP, Townsend GH, Rodriguez FH(1987): Fibroma of tendon sheath. J Foot Surg 26(5): 4224.PMID: 3680870 [PubMed - indexed for MEDLINE]