PMC7666637_01
Physical findings of the patient's wrist joint: (a) swelling of the volar side of the patient's left wrist joint and (b) swelling of the dorsal side of the patient's left wrist joint and metacarpophalangeal joints of the left middle and little fingers.
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She demonstrated swelling on the volar and dorsal sides of her left wrist and on the dorsal side of the MP joints of her left middle and little fingers (Figures 1(a) and 1(b)). She reported experiencing numbness over the area supplied by the left median nerve.
Anterior-posterior plain radiographs showing bone atrophy around the wrist and the metacarpophalangeal joints.
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Anterior-posterior plain radiographs of the hands showed bone atrophy around the wrist and MP joint (Figure 2).
Surgical findings of the volar side: (a) massive tenosynovitis around the left wrist flexors; (b) surgical findings after transverse carpal ligament release, tenosynovectomy, and neurolysis of the median nerve; (c) amount of the volar side resected synovium.
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Surgical examination of the volar side revealed massive tenosynovitis around the flexors and compression and adhesion of the median nerve owing to tenosynovitis (Figure 3).
Surgical findings of the dorsal side: (a) massive tenosynovitis around the left wrist extensors; (b) surgical findings after tenosynovectomy and synovectomy of the left metacarpophalangeal joints of the middle and little fingers; (c) amount of the dorsal side resected synovium.
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Surgical examination of the dorsal side revealed thinning of the extensor retinaculum and massive tenosynovitis around the extensors (Figure 4).
Immunohistological analyses of the tenosynovial tissue biopsy specimens. Abnormal lymphocytes with CD3(+), CD4(+), CD8(-), CD20(-), CD25(+), CD30(-), CCR4(+), and Foxp3(+) profiles are observed. Ki-67 was positively expressed overall. H&E: hematoxylin and eosin; CCR4: CC chemokine receptor 4.
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The lymphohistiocytic infiltration was positive for Ki-67 (Figure 5).