PMC2852770_01
Anteroposterior (A) and lateral (B) radiogram of the right wrist shows the soft tissue mass on the palmar side without calcification.
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Plain radiograms of the right wrist and hand showed degenerative changes and Heberden's nodes in the distal interphalangeal joints, but no apparent calcification was observed in the mass (Figure 1).
A: Axial T1-weighted MR image of the right distal forearm demonstrates a mass with low signal intensity surrounding the flexor tendons. B: Axial T2-weighted MR image showed a mass with high signal intensity mass and many rice bodies with low signal intensity. C: Sagittal T2-weighted MR image of the right distal forearm showed enlarged tendon sheaths and many small bodies with low signal intensity. D: Axial T1-weighted MR images of the right distal forearm after the administration of gadolinium. The mass which surrounded the flexor tendons was moderately enhanced.
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On magnetic resonance (MR) imaging, T1-weighted images showed a low-intensity mass surrounding the flexor tendons (Figure 2A). On T2-weighed images, the mass partially showed high-signal intensity (Figure 2B). T2-weighed images demonstrated an effusion in the sheaths of the flexor tendons and many small low-intensity bodies in the mass (Figure 2C). The mass was moderately enhanced by administration of intravenous gadolinium (Figure 2D), but the small bodies were not enhanced.
During the surgery, many rice bodies had been erupted from a small hole in the fibrous wall of the mass.
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Many rice bodies had erupted from a small hole in the wall of the mass (Figure 3).
Photomicrograph of rice bodies from the distal forearm showed collagen fibers around the fibrin-like materials (x200).
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Histological findings revealed hyperplastic tenosynovitis with fibrinous loose bodies (Figure 4).
Photograph during an open repair surgery showed the granulation tissue around the flexor tendons on the volar side of the right forearm.
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During the surgery, we observed granulation tissues proliferating around the flexor tendons (Figure 5) and a rupture of the flexor tendons of the ring and little fingers.
Photomicrograph of granulation tissue from the right distal forearm showed chronic synovitis with lymphoid cell infiltration. No acid-fast bacilli were found (x200).
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Histologically, the granulation tissues showed chronic synovitis (Figure 6), and acid-fast bacilli were negative.