Answer for CoW 03 Dec 2017
GCT OF TENDON SHEATH
Findings
Large heterointense lesion measuring 11 x 3 cm showing heterogenous contrast enhancement noted arising from tibialis posterior tendon, encasing flexor digitorum longus & flexor halusis longus tendons, extending along the fascial planes inferiorly upto the level of talo calcaneo navicular joint, causing minimal erosions in navicular bone. Tibia, Fibula, & metatarsal bones appear normal. Features suggestive of Giant cell tumor arising from tibialis posterior tendon sheath.
Discussion
GCTTS can be classified as localized (L-) or diffuse (D-) type. L-GCTTS primarily occurs in the tendon sheaths of the hand and foot and exhibits clear boundaries, whereas D-GCTTS occurs in large load-bearing joints including knees, hips, ankles, shoulders and elbows GCTTS frequently presents as a firm, slow-growing, multilobular, non-tender mass located adjacent to the tendon sheath synovium. The tumor usually affects individuals aged 30–50 years and females exhibit slight predominance Was previously termed extra-articular pigmented villonodular synovitis (PVNS) as it shares similar histological characteristics with PVNS Given the histological similarity to PVNS, giant cell tumours of the tendon sheaths also share the same finding on MRI, mainly on account of hemosiderin accumulation. Signal characteristics T1 low signal variable enhancement T2: low signal T1 C+ (Gd): often show moderate enhancement GE: low and may demonstrate blooming.
Findings
Large heterointense lesion measuring 11 x 3 cm showing heterogenous contrast enhancement noted arising from tibialis posterior tendon, encasing flexor digitorum longus & flexor halusis longus tendons, extending along the fascial planes inferiorly upto the level of talo calcaneo navicular joint, causing minimal erosions in navicular bone. Tibia, Fibula, & metatarsal bones appear normal. Features suggestive of Giant cell tumor arising from tibialis posterior tendon sheath.
Discussion
GCTTS can be classified as localized (L-) or diffuse (D-) type. L-GCTTS primarily occurs in the tendon sheaths of the hand and foot and exhibits clear boundaries, whereas D-GCTTS occurs in large load-bearing joints including knees, hips, ankles, shoulders and elbows GCTTS frequently presents as a firm, slow-growing, multilobular, non-tender mass located adjacent to the tendon sheath synovium. The tumor usually affects individuals aged 30–50 years and females exhibit slight predominance Was previously termed extra-articular pigmented villonodular synovitis (PVNS) as it shares similar histological characteristics with PVNS Given the histological similarity to PVNS, giant cell tumours of the tendon sheaths also share the same finding on MRI, mainly on account of hemosiderin accumulation. Signal characteristics T1 low signal variable enhancement T2: low signal T1 C+ (Gd): often show moderate enhancement GE: low and may demonstrate blooming.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!