Tendon Sheathに発生したSynovial Tumor4例

抄録

The sorts of tumors originated in tendon sheaths are enumerated as follows;
benign
1 Ganglion……frequent
2 Xanthomatous giant cell tumor……not infrequent
3 Lipoma……rare
4 Hemangioma……rare
5 Lymphangioma……rare
6 Fibroma……rare
7 Osteochondroma ……rare malignant
8 Synovial sarcoma……rare
(Charache)
In this table, the tumors which show clinically interesting features and pathologically debatable natures are xanthomatous giant cell tumor and synovial sarcoma. Xanthomatous giant cell tumor so named here is not genuine neoplasm in strict sence but considered as certain inflammatory growth which is in reality identical with pigmented villonodular tenosynovitis (Jaffe Lichtenstein). This condition is clinically divided into two types of localized and diffuse form. The former is undoubtedly not infrequently recognized as localized solid tumors at tendon sheaths of the hand or foot, but clinical cases of the latter have been rarely reported and total removal of this tumor may not finish with usual success.
Accurate diagnosis of synovial sarcoma is commonly difficult by reason of variation in histological details from case to case. The microscopic features of this tumors is characterized by appearance of two cytological phase, i. e. fibrosarcomatous and synovial componnet. The fibrosarcomatous component consisted of the spindle-cellular tissue misleads to such an impression of the fibrosarcoma. The synovial component is the parts that is mainly dominated by distinctive glandlike structure.
The presence, in any case, of the both components in full visualization is so the most valuable finding that it would be obviously different from other tumors.
The Four typical cases of such diseases were encountered as below mentioned.
Case No. 1 pigmented villonodular tenosynovitis
A female, 52 years of age. Since about fifteen years ago, she has felt slight painless swelling around the M. P. joint of the right index finger. It enlarged gradually and developed into a conspicuously inflated tumor.
Removal was made at Feb. 12th, 1965. It has arisen from tendon sheaths of m. ext. dig. comm. (index finger) and m. ext. prop. indicis.
Because it expanded diffusely into the surrounding tissue, this tumorous content could not be completely removed.
Case No. 2 localized nodular tenosynovitis.
A female of 36 years old. At just one year ago, she had experience of slight trauma that an iron failed accidentally on her left instep, afterward a small induration has subsequently remained.
It went by consistently painless but grew into a solid tumor of the thumbtip-size. This growth was removed at July 28th, 1967. It originated in tendon sheaths of m, flex. dig. brev. et long. (the second toe) and its surface was all wrapped by thin membrane of the connective tissue.
Isolating from the circumference could be easily made.
Case No. 3 synovial tumor
A female of 35 years old. Since about seven years ago, she has noticed a subcutaneous small node between the thumb and the index finger.
It enlarged progressively and grew into so big plump tumor that functional disturbance and hypaesthesia of the thumb has occurred. Removal was made at July 8th, 1965. This tumor based originally upon a tendon sheath of m. flex. poll. long and has deeply extended into muscle-bellys of m. adduct. poll. and m. opponeus, but total extirpation was not so difficult because of capsulated tumor formation.
The content was red-brownish colored and was equally elastic soft.
Case No. 4 synovial tumor
A male, 23 years of age. Since about 10 years ago, a small node has appeared at dorsal and radial side of the right wrist, and at that time it was diagnosed as ganglion. He left this tumor as it is because it has been grown not so rapidly and maintained continuously the symptomeless condition ever since.
At Jan. 26t