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Giant Cell Tumors of the Tendon Sheath: Analysis of Sonographic Findings

William D. Middleton1, Vikram Patel1, Sharlene A. Teefey1 and Martin I. Boyer2

1 The Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway, St. Louis, MO 63110.
2 Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.



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  		Fig. 1. —27-year-old woman with history of prior resection of giant cell tumor who presented with recurrent mass in distal thumb. Longitudinal sonogram of volar surface of thumb at level of distal interphalangeal joint shows 4.5 x 2.0 mm solid, homogeneous, hypoechoic mass (cursors) adjacent to insertion of flexor pollicis longus tendon (T). Also seen is proximal (P) and distal (D) phalanx.

 


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  		Fig. 2. —68-year-old man with enlarging mass over proximal fourth finger. Longitudinal sonogram of volar surface of affected finger at level of metacarpal phalangeal joint shows solid, homogeneous, hypoechoic mass (cursors) immediately adjacent to flexor tendons (T). Increased through-transmission is seen deep relative to mass.

 


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  		Fig. 3. —21-year-old woman with enlarging mass over proximal phalanx of thumb. Longitudinal sonogram of volar surface of thumb shows solid, homogeneous, hypoechoic mass (cursors) adjacent to superficial and deep surface of flexor pollicis longus tendon (T). Erosion (arrows) is seen along distal aspect of proximal phalanx.

 


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  		Fig. 4A. —20-year-old woman with enlarging mass over proximal aspect of index finger. Transverse sonogram obtained over volar surface of proximal phalanx shows solid, homogeneous, hypoechoic mass (cursors) that completely encases flexor tendons (T).

 


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  		Fig. 4B. —20-year-old woman with enlarging mass over proximal aspect of index finger. Transverse color power Doppler sonogram shows that tumor (cursors) has readily detectable blood flow located peripherally and centrally.

 

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