Question

A patient presents with a slow-growing soft tissue swelling over the hand and wrist. The clinical image shows a subcutaneous nodule and the X-ray of the wrist is shown. What is the diagnosis?

• A. GCT (Giant Cell Tumour of tendon sheath)
• B. Osteochondroma
• C. Osteoid Osteoma
• D. Ewing Sarcoma

Hint:

Think of the most common benign soft tissue tumour arising from the tendon sheath in the hand.

Answer 1

The Correct Option is A

Step 1: Analyse the clinical presentation.
The patient has a slow-growing, subcutaneous soft tissue swelling over the hand/wrist region. The clinical image shows a localised nodular swelling attached to the tendon sheath, which is characteristic of a tenosynovial Giant Cell Tumour (GCT).

Step 2: Recall the features of tenosynovial GCT.
Tenosynovial GCTs are the second most common soft tissue mass of the hand and wrist (after ganglion cysts). They arise from the tendon sheath and are usually benign. They present in the 3rd to 5th decades with a slight female predilection (F:M ratio 1.5-2.1:1). On imaging, they appear as localised, solitary, subcutaneous soft tissue nodules with low T1 and T2 signal on MRI (due to haemosiderin deposition) and moderate enhancement.

Step 3: Eliminate other options.
Osteochondroma arises from bone with a cartilage cap and has a distinct bony exostosis on X-ray. Osteoid Osteoma presents with nocturnal pain relieved by aspirin and shows a nidus on imaging. Ewing Sarcoma is a malignant bone tumour of children/young adults with an onion-skin periosteal reaction on X-ray.

Conclusion: The localised subcutaneous nodule on the hand/wrist attached to tendon sheath is characteristic of GCT of tendon sheath.