Presentation
Right index finger nodule for the last few years. No pain.
Patient Data
A well-defined lobulated lesion on the dorsal-radial-palmar side of the proximal phalanx and proximal interphalangeal joint region. It reaches close to the extensor tendon slip and abuts the flexure tendon. The lesion is separate from the tendon/ bone/ joints. The lesion elevates the digital neuro-vascular bundle. The underlying flexor tendon shows free movements. Approximate size - 20 x 17 x 6 mm. The lesion is solid, heterogeneous hypoechoic without calcification/ cystic changes/ vascularity. There is no erosion of the adjacent bone cortex.
Gross Description: Two brown white soft tissue pieces with yellow pigmentations, measuring 2.0x1.5x0.8 cms, weighing 2.2 grams. No areas of hemorrhage/ necrosis. Whole tissue was submitted for evaluation.
Microscopic Description: Sections show a tumor composed of haphazardly arranged plump spindle cells forming short fascicles and whorls at places, displaying mild nuclear pleomorphism and occasional mitoses set in a collagenous stroma. Scattered multinucleated osteoclast type giant cells, inflammatory cells, and foamy & pigmented macrophages are present. Mitotic figures are seen, but atypical mitosis is not present.
Case Discussion
The case shows a slow-growing, painless nodule of the index finger. The ultrasound findings favored a possibility of a giant cell tumor of the tendon sheath, which was confirmed by the histopathology examination.
Histopathology report courtesy: Dr. Bharat Tandel MD (Pathology).
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