PMC4898210_01
38-year-old man with multitendon xanthomatosis. A. Sagittal T1-weighted MRI of the third metacarpophalangeal (MCP) joint. Arrows indicate a lobulated low-intermediate signal lesion, both dorsal and associated with the extensor tendon. B. Axial T1-weighted MRI at the level of the third metacarpal head (MC) showing the lesion (arrows). There is interdigitation of the mass with the underlying extensor tendon (long arrow).
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Magnetic resonance imaging (MRI) of the middle finger (Fig. 1), pretibial area of the knee (Fig. 2), and Achilles tendon (Fig. 3) were performed.
38-year-old man with multiple tendon xanthomatosis. A. Sagittal T1-weighted MRI shows a pretibial lesion (arrow) at the level of the tibial tuberosity at and inferior to the distal insertion of the patellar tendon, with similar signal characteristics to the finger lesion. The patellar tendon appears normal. B. Sagittal T2-weighted fat-suppressed MRI shows the lesion to be low in signal (arrows).
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However, the pretibial lesion (Fig. 2) did not interdigitate within the patellar tendon.
38-year-old man with multitendon xanthomatosis. A. Sagittal T1-weighted MRI of the ankle shows that the Achilles tendon is fusiformly enlarged, with both intratendinous vertical striations and more exophytic nodular masses (arrows). These masses are well visualized, in contrast to the surrounding fatty tissues. B. Sagittal T2-weighted fat-suppressed MRI demonstrates fusiform Achilles-tendon enlargement, with abnormal vertical striations interdigitating within the tendon as well as nodularity and abnormal signal around the tendon. The more exophytic nodular masses noted in Part A are less conspicuous on T2-weighted fat-suppressed images. C. Axial T1-weighted MRI of the Achilles tendon shows fusiform tendon enlargement, with interdigitating vertical striations and abnormal soft tissue around the tendon, predominately dorsomedial.
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Magnetic resonance imaging (MRI) of the middle finger (Fig. 1), pretibial area of the knee (Fig. 2), and Achilles tendon (Fig. 3) were performed.
38-year-old man with multitendon xanthomatosis. Intraoperative photograph with resected specimen from the middle finger-extensor region
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At surgery, extra and intratendinous components were dissected from the dorsal aspect of the middle finger (Fig. 4).
38-year-old man with multitendon xanthomatosis. Photomicrographs of the resected extensor tendon from the middle finger. A., Xanthomatous deposits with foam cells are interspersed with fibrous tissue (original magnification 200x; hematoxylin and eosin [H&E] stain). B. Cholesterol clefts (arrowheads) and giant cells are adjacent to normal tendon cells (original magnification 400x; hematoxylin and eosin [H&E] stain).
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Photomicrographs (Fig. 5) of the digital lesion demonstrated the accumulation of cholesterol and lipid foam cells interspersed among the normal tendon bundles.