Tenosynovium

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Tenosynovium is a relatively common ditzel.

General

DDx:

Tenosynovitis

Stenosing tenosynovitis directs here.

General

  • Uncommon pathology specimen.
  • May cause trigger finger.[1]

Microscopic

Features:[2]

DDx:

IHC

Features:

  • CD68 +ve.
  • Beta-catenin -ve.

Note:

  • Immunostains are usually not required for the diagnosis.

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Tenosynovium, Left Wrist, Excision:
- Dense connective tissue (consistent with tendon) with degenerative 
  changes and lymphohistiocytic infiltrate.
- NEGATIVE for apparent giant cells and NEGATIVE for calcification.
- NEGATIVE for malignancy.

Block letters

TENOSYNOVIUM, LEFT MIDDLE FINGER, EXCISION:
- DENSE CONNECTIVE TISSUE (CONSISTENT WITH TENDON) WITH LYMPHOHISTIOCYTIC INFILTRATE.
- NEGATIVE FOR GIANT CELLS. 
- NEGATIVE FOR MALIGNANCY.

Micro

The sections show dense connective tissue (tendon) containing a cluster of cells with indistinct cellular borders, abundant foamy grey cytoplasm, and round/oval pale-staining nuclei with small nucleoli (histiocytes). The cell cluster has a small number of interspersed lymphocytes, and the centre of the cell cluster has acellular hyaline material (degenerative tendon).

No calcification is identified. No giant cells are seen.

No nuclear atypia is apparent and no mitotic activity is appreciated.

Alternate

The sections show dense connective tissue (tendon) containing rare histiocytes and lymphocytes. No calcification is identified. No giant cells are seen. No nuclear atypia is apparent and no mitotic activity is appreciated.

Carpal tunnel syndrome

General

Microscopic

Features:[3]

  • Tenosynovium with edema or fibrosis +/-myxoid degeneration

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Tenosynovium, Excision:
- Benign fibroconnective tissue with focal myxoid changes without 
  significant inflammation.
- NEGATIVE for evidence of malignancy.

See also

References

  1. Vuillemin, V.; Guerini, H.; Bard, H.; Morvan, G. (Feb 2012). "Stenosing tenosynovitis.". J Ultrasound 15 (1): 20-8. doi:10.1016/j.jus.2012.02.002. PMID 23396894.
  2. Shon, W.; Folpe, AL. (Jun 2010). "Tenosynovitis with psammomatous calcification: a poorly recognized pseudotumor related to repetitive tendinous injury.". Am J Surg Pathol 34 (6): 892-5. doi:10.1097/PAS.0b013e3181d95a36. PMID 20442645.
  3. Chell, J.; Stevens, A.; Davis, TR. (Sep 1999). "Work practices and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women.". J Bone Joint Surg Br 81 (5): 868-70. PMID 10530852.