Fibroma of tendon sheath located within the ankle joint capsule
Riccardo Ciatti Æ Æ Pier Paolo Mariani
Received: 29 July 2008/Accepted: 11 July 2009/Published online: 31 July 2009
? Springer-Verlag 2009
tendon sheath arising from the anteromedial ankle joint
capsule, with no apparent connection to any tendon in the
area, found in a 58-year-old patient complaining of pro-
gressive local swelling. This uncommon tumor has its usual
localization in tendon sheaths, is extremely rare in joint
capsules, and has never been described in this location
previously. MRI showed nonuniform low signal intensity
in T1- and T2-weighted images and high intensity in STIR
images. The mass was completely excised by open surgery.
Histopathological analysis later confirmed the diagnosis of
a fibroma of the tendon sheath.
We report a very rare case of fibroma of the
Tumor ? Tendon sheath ? Fibroma ?
Fibroma of the tendon sheath is a rare tumor described as a
synovium of tendon sheath . It has been reported mainly
in finger and hand tendons as a benign, slowly growing
nodule that arises from a synovial sheath [2, 6, 15, 16, 18].
Involvement as a mass adjoining the synovial membrane of
a joint capsule is extremely rare, and to our knowledge only
seven cases have been described, mainly in the knee joint
(four cases) [7, 8, 10, 12–14, 18]. We wish to emphasize its
unusuallocation inthecase describedhere—in the ankle—a
location for a fibroma of the tendon sheath that has never
been described in the English literature before.
aspect of his right ankle joint, with no recollection of asso-
ciated trauma. The mass was slow-growing up to three
months before coming to our attention, when it began to
grow rapidly. Physical examination revealed an approxi-
mately 5-cm-diameter ovoid mass over the anteromedial
aspect of the right ankle joint; the range of motion for dor-
siflexion was progressively reduced to 10?, and was slightly
painful beyond this range. Some discomfort was elicited at
pressure over the mass. No neurologic or vascular com-
pression symptoms were observed. He had no diffuse joint
effusion nor any other particular findings on other physical
examinations. Routine laboratory data were normal. The
mass was noted to be mobile within its surrounding layers.
Plain X-rays of the right ankle joint were normal, while
an MRI scan of the same region showed a soft tissue mass
5.5 9 3.4 9 2.6 cm in size arising from the anteromedial
joint capsule. The mass had a nonuniform low intensity in
T1- and T2-weighted scans, with focal septated areas
exhibiting more intense signals (Fig. 1a). In STIR scans,
the mass had a more uniform high intensity (Fig. 1b).
The patient underwent an excision of the mass by
anteromedialincision carriedoutunder peripheral
Casa di Cura ‘‘Villa Stuart’’, Via Trionfale 5952,
00135 Rome, Italy
P. P. Mariani
Istituto Universitario di Scienze Motorie,
P.le Lauro de Bosis 15, 00194 Rome, Italy
R. Ciatti (&)
Via Pellegrino Matteucci 134, 00154 Rome, Italy
J Orthopaed Traumatol (2009) 10:147–150