Tendon Sheath Fibroma (FTS) arising from foot

Anirudh Bansal; Vikramjit Singh; Kailash Sethi; Ajay Mandloi

doi:10.4103/2347-6486.240226

CASE REPORT

Year : 2017 | Volume : 5 | Issue : 1 | Page : 48-50

Tendon Sheath Fibroma (FTS) arising from foot

Anirudh Bansal¹, Vikramjit Singh¹, Kailash Sethi², Ajay Mandloi³
¹ Resident, Department of Orthopedics, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
² Professor, Department of Orthopedics, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat, India
³ Dhiraj Hospital, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat, India

Date of Web Publication

30-Aug-2018

Correspondence Address:
Kailash Sethi
Professor, Department of Orthopedics, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, Gujarat
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-6486.240226

Abstract

Introduction: Tendon Sheath Fibroma (FTS) is a benign but rare condition. Tumor arises from the sheath of the tendon.
Case report: Middle aged female having mildly painful swelling on the dorsum of right foot with clinical and histopathological diagnosis of FTS is presented here.
Discussion: It is mostly found in the palm and on right side. FTS of foot region is rare. Conclusion: Patient can be successfully treated with surgical excision.

Keywords: Tendon sheath fibroma, FTS

How to cite this article:
Bansal A, Singh V, Sethi K, Mandloi A. Tendon Sheath Fibroma (FTS) arising from foot. J Integr Health Sci 2017;5:48-50

How to cite this URL:
Bansal A, Singh V, Sethi K, Mandloi A. Tendon Sheath Fibroma (FTS) arising from foot. J Integr Health Sci [serial online] 2017 [cited 2023 Mar 22];5:48-50. Available from: https://www.jihs.in/text.asp?2017/5/1/48/240226

Introduction

The Tendon sheath fibroma (FTS) was initially described in 1936 by Gechickter and Copeland as benign, firm tumor in palm more so in thumb, which is a slow growing least painful rare entity arising from sheath of a tendon.^[1],[2] FTS arising from planter aspect is comparatively rare entity.^[2] It is seen predominantly in males. They usually occur between 20 to 40 years of age, but can occur at any age.^[3] Histologically, it is a well- demarcated nodule. It shows of haphazardly- arranged, fibroblast-like spindle cells in a dense collagenous matrix.^[4]

Very few cases of FTS have been described in the literature1-7. Here, we report on the unusual presentation of FTS arising from a flexor tendon of foot.

Case Report

A 45 year female patient came to OPD with three- year long history of gradually increasing mildly painful swelling on dorsum of right forefoot. Pain increased on walking. No other constitutional symptoms were present. The swelling increased in size over last six months. Occasionally she experienced stiffness and numbness on her feet. There was no history of trauma. In past about one year ago she had excision of swelling but no details were available.

Differential Diagnosis

Tenosynovial giant cell tumor
Inclusion body fibromatosis
Nodular fasciitis
Desmoplasticfibroblastoma
Palmar / plantar fibromatosis
Knuckle pads
Benign fibrous histiocytoma
Fibrosarcoma
Synovial sarcoma
Calcifying fibrous pseudotumor

On local examination there was a linear scar mark on swelling. Swelling was minimally tender, firm in nature, overlying skin was freely mobile. No other signs of inflammation were seen, no regional lymphadenopathy was present and rest of examination was also normal. Past medical history was not significant.

Routine blood tests were in normal limits. Foot X- ray showed no bony changes except soft tissue swelling. Ultra sound showed a soft tissue swelling between 2nd and 3rd metatarsals.

Intra-operative examination revealed a whitish swelling with multiple nodules located between 2nd and 3rd metatarsal neck, measuring approximately 2cm x1.5 cm [Figure 1]. This was attached to planter tendon of 3rd toe. Surrounding tendons and bones were normal. No restrictions of foot or toe movements were observed. The excised mass was sent for histopathological examination.

Figure 1: Clinicalphotographs

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The histopathological report described as under –

A 4x2.5x2cm nodular mass of well-circumscribed with extensively collagenized tissue, spindle and stellite cells that are very few and far apart which appears paucicellular. Over all features suggestive of FTS.

On history, examination, clinical and histological findings, she was a case of FTS. She was followed up for 6 months. She lost all symptoms without recurrence of swelling.

Figure 2: Histopathology Report.

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Discussion

FTS is a neoplasm or a reactive fibrosis is not clear, but the presence of clonal chromosomal abnormality (Dal Cinet al12) favors it as a neoplasm and not a reactive fibrosis. Statistically it has been found that FTS is more common in palm and more so in right side and is rare in foot 1. About 31% FTS of cases present with pain and tenderness, which may be due to compression of nerves underlying 1. [13]

Conclusion

Tendon sheath fibroma in foot is a rare benign neoplasm. Excision of mass is the treatment of choice.

References

1.	Chung EB, Enzinger FM. Fibroma of tendon sheath. Cancer. 1979 Nov 1;44(5):1945-54.
2.	Lu H, Chen Q, Shen H, Shen XQ, Wu SC. Fibroma of tendon sheath in planta. SpringerPlus. 2016 Dec 1;5(1):575.
3.	Pulitzer DR, Martin PC, Reed RJ. Fibroma of tendon sheath: a clinicopathologic study of 32 cases. The American journal of surgical 1;44(4):515-7.
4.	Kim BS, Park SY, You DO, Park SD. A case of fibroma of the tendon sheath on the elbow. Korean Journal of Dermatology. 2009 Aug 1;47(8):964-6.
5.	Choi HJ, Yun WJ, Chang SE, Lee MW, Choi JH, Moon KC, Koh JK. Two cases of fibroma of tendon sheath. Korean Journal of Dermatology. 2005 May 1;43(5):685-7.
6.	Chung EB, Enzinger FM. Fibroma of tendon sheath. Cancer. 1979 Nov 1;44(5):1945-54.
7.	Boms S, Gambichler T, Stücker M, Brockmeyer NH. Unusual presentation of fibroma of tendon sheath. Dermatology. 2007;214(4):336-7.
8.	Ciatti R, Mariani PP. Fibroma of tendon sheath located within the ankle joint capsule. Journal of Orthopaedics and Traumatology. pathology. 1989 Jun 1;13(6):472-9.
9.	Lee KH, Cho YK, Han YW, Kim J, Kim HM, Park CJ. A case of fibroma of tendon sheath on the big toe. Korean Journal of Dermatology. 2006 Apr 1;44(4):483-5.
10.	Moon KW, Kim SY, Choi YW, Myung KB, Kim SH. A case of fibroma of tendon sheath. Korean Journal of Dermatology. 2006 Apr 2009 Sep 1;10(3):147-50.
11.	Arnett FC, Edworthy SM, Bloch DA, Mcshane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger TA. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis & Rheumatology. 1988 Mar 1;31(3):315-24.
12.	Lindqvist E, Jonsson K, Saxne T, Eberhardt K. Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis. Annals of the rheumatic diseases. 2003 Jul 1;62(7):611-6.
13.	Dal Cin P, Soot R, De Smet L, Van Den Berghe H. Translocation 2; 11 in a fibroma of tendon sheath. HISTOPATHOLOGY-OXFORD-. 1998 May 1;32:433-5.