Fibroma of Tendon Sheath in the Hand-Experience of 12 Cases at Kaohsiung Veterans General Hospital

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Background:Fibroma of tendon sheath is a rare benign tumor and tends to involve upper extremities, especially in the hand. To our knowledge, treatment with marginal excision biopsy was always thought to be curative with low tumor recurrent rate. More specially, large tumor size fibroma of tendon sheath in the hand was especially rare and seen in case reports only.Aim and Objectives:We try to find out the characteristic of fibroma of tendon sheath in the hand at Kaohsiung Veterans General Hospital (KSVGH) and shared a rare case presented with large tumor size in our series (case 1).Materials and Methods:From January 1991 to March 2007, 12 cases with fibroma of tendon sheath in the hand at KSVGH were collected with a retrospective method. The data of patients collected included gender, age, symptoms, trauma history, outpatient or admission division treatment, location of tumor, preoperative image study, treatment modalities, gross appearance, tumor size, follow-up period, and recurrence.Results:Among these 12 cases, 11 cases underwent marginal excision biopsy at our outpatient division and only 1 case admitted for marginal excision biopsy due to large tumor size with possibility of malignancy. 5 cases received pre-operative image study and the other 7 cases didn’t receive any pre-operative image study. No patient was found to have tumor recurrence or surgical complication during postoperative follow-up. The ratio of male to female is 2 to 1 with male predominant tendency. The average age is 45 years old (M: 46 and F: 44). The tumor distributed over digit in 6 cases, palm in 3 cases, wrist in 2 cases, interdigital web in 1 case. No predilection of right or left hand was found. The average tumor size was 1.5 cm in greatest dimension. One case with large tumor size: 5.4 x 3.8 x 2.6 cm was noted.Conclusion:We found that in most cases (91.7%) presented with small tumor size and the marginal excision biopsy can be completed at outpatient division. In one rare case (8.3%), due to large tumor size and possibility of malignancy, admission surgery may be needed. No tumor recurrence was found in our 9 available follow-up cases. The tumor is characterized with male predominant and digit is the most popular site. Fibroma of tendon sheath was rarely associated with bone erosion, which was common in giant cell tumor of tendon sheath. Preoperative image study is highly suggested, especially in those with large tumor, not only to differentiate fibroma of tendon sheath (FTS) with giant cell tumor of tendon sheath (GCTTS) but also to prevent intraoperative neurovascular and adjacent structures damages. (J Taiwan Soc of Plast Surg 2011; 20: 274∼287)