PMC6766145_01
Clinical preoperative images of the patient's hand with volar-based mass spanning the second to fourth metacarpal heads.
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A 14-year-old right-hand-dominant Caucasian male presented with a history for several years of a slowly enlarging mass of the left palm centered about the third metacarpal head (Figure 1).
(a, b) Select preoperative T1 axial and T1 sagittal magnetic resonance images of FTS demonstrating relationship to flexor tendon and neurovascular bundle.
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Magnetic resonance imaging (MRI) with intravenous gadolinium demonstrated a 3.6 x 1.6 x 2.4 cm well-defined soft tissue mass centered about the third metacarpophalangeal joint abutting the flexor tendon sheath of the third digit (Figure 2).
Intraoperative image of well-encapsulated, solitary, solid tan-colored mass shown to be FTS.
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It was well-encapsulated without communication to any neurovascular or tendinous structure aside from the A1 pulley of the third flexor sheath (Figures 3 and 4).
Gross image of excised mass.
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It was well-encapsulated without communication to any neurovascular or tendinous structure aside from the A1 pulley of the third flexor sheath (Figures 3 and 4).
(a) Low-power examination demonstrates a mildly lobulated lesion with tumor cells set in a collagenous matrix. The lesion shows an admixture of hypocellular and hypercellular areas (hematoxylin and eosin stain, magnification 10x). (b) High-power examination demonstrates fibroblasts with basophilic nuclei in a focally hypercellular area. No mitotic figures are identified (hematoxylin and eosin stain, magnification 40x).
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Multinucleate giant cells were not seen (Figure 5).
(a, b) Clinical postoperative images of patient 21 months after surgery.
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He is currently at 21-month status postsurgical excision, reports pain-free activity, and exhibits no evidence of local recurrence (Figure 6).