PMC7276612_01
Anteroposterior radiograph of index finger showing soft tissue swelling but no bony involvement.
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F1
Plain radiographs were obtained which showed soft tissue swelling but no bony involvement (Fig. 1).
Clockwise from top left - Coronal view of the lesion on magnetic resonance imaging (MRI); sagittal views of lesion on MRI.
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F2
The patient was subsequently seen a couple of months later with increased swelling, and magnetic resonance imaging (MRI) was undertaken (Fig. 2).
Intraoperative images of excision of the lesion with flexor tendon sheath involvement and scalloping of the proximal phalanx.
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F3
A careful and thorough dissection was carried out with the use of magnification loupes, with subsequent flexor pulley reconstruction to allow easier flexor tendon excursion (Fig. 3).
Gross histological specimen measuring 2.1cm x 1.5 cm x 1.5 cm.
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F4
Abundant giant cells, foamy macrophages, and spindle cells in the background of collagen bundle.
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F5
Hemosiderin pigment was identified (Fig. 5).
PMC7276612_02
(a) Sagittal magnetic resonance imaging (MRI) view of the hand. Involving the skin and extending into the subcutaneous fat and reaching up to the flexor tendon sheath of the middle finger at the level of the metacarpophalangeal joint.(b) Axial view MRI showing subcutaneous lesion involving skin extending to the tendon sheath.
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F6
MRI imaging was utilized to further define the lesion, which showed an enhancing lesion involving the skin, extending into the subcutaneous tissue and involving the flexor tendon sheath of the middle finger at the MCP joint(Fig. 6a and b).
Sheets of mononuclear cells mixed with foamy macrophages and focal presence of osteoclastic type multinucleate cells evenly distributed in the fibrotic stroma.
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F7
The appearances were consistent with GCTTS (Fig. 7).