Wrist – Giant cell tumor of the tendon sheath

CASE HISTORY

29-year-old female with complaint of left wrist discomfort for the last four months. No known injury. No pain. Evaluate for mass and flexor tenosynovitis.

TECHNICAL FACTORS

Long- and short-axis fat- and water-weighted images were performed. 1.5T High Field Oval.

KEY IMAGES

This case has no key images.

CASE FINDINGS

• A 2.2cm (CC) x 1cm (ML) X 0.5cm (AP) soft tissue mass with well-defined contours is seen deep to the flexor tendons starting at the level of 3rd metacarpal base and extending distally. The lesion is iso-slightly hyperintense to musculature on T1 slightly hyperintense on T2 and demonstrates ferromagnetic susceptibility artifact on sagittal T2 gradient-echo series. Constellations of these findings are most consistent with giant cell tumor of tendon sheath. Differential considerations may include fibrous tumors. No malignant features are identified. 
• Median nerve signal intensity and contours are preserved. Guyon’s canal is normal. Flexor and extensor tendons are intact. 
• No macrofracture or bony contusion. 
• No substantive arthropathic change in the wrist or carpometacarpal joints. Capsulosynovial cyst formation arising from the pisotriquetral joint is noted. 
• Triangular fibrocartilage demonstrates pinhole defect in the central zone. Mild distention of the distal radioulnar joint. 
• Scapholunate lunatotriquetral ulnolunate and radiolunate ligaments are intact. Mild volar and dorsal capsulitis of the carpal bones is present. 
• Musculature is normal.

CASE CONCLUSION

• A 2.2cm (CC) x 1cm (ML) X 0.5cm (AP) soft tissue mass deep to the flexor tendons starting at the level of 3rd metacarpal base and extending distally most likely a giant cell tumor of tendon sheath. Differential considerations may include fibrous tumors. No malignant features are identified. 
• Triangular fibrocartilage demonstrates pinhole defect in the central zone. Mild distention of the distal radioulnar joint.