Trauma Rounds

At the Montreal General

Hospital:

(Case P27)

Foreign Body in the Hand

colour is often a little greyish but usu is more it yellow and the tumour is more loculated ally than this lesion was. Even though they occur more commonly in the fingers, they may develop elsewhere in the hand. Our patient complained that his finger would swell with active exercise and this is obviously because of the chronic irritation produced by this little tumour moving in and out of the tendon sheath. DR. HRENO: How did you deal with the tumour? By excising a portion of the tendon itself? DR. LABELLE: We simply curetted it off the fibres of the tendon. Had it been giant cell tumour, we would have removed a minimal amount of tendon. DR. ROSMAN: What tumours can be found in these tendons and are any of them malignant?. DR. WOOLHOUSE: The only tumour of the tendon itself is a fibroma. DR. LABELLE: The giant cell tumour I men tioned is not really a tendon tumour, but a synovial
tumour. Their tumour.

DR. LABELLE: Mr. P. is a 20-year-old man who, while at work about eight months ago, sustained a penetrating wound of his hand from a piece of metal which entered proximal to the distal palmar crease adjacent to the middle finger. He pulled the object out and the wound healed primarily but since then he has been having some difficulty working because of pain in the middle finger. We saw him at the outpatient clinic about two months ago and noted crepitus on palpation when we tried to open his fingers. We realized that he probably had developed a type of constricting tenosynovitis. He was admitted and a few days later, at operation, a small incision was made over the middle finger (Fig. 1). A soft, mushy, multi-

drugs.

DR. HILL: Has the question of this being a tuberculous lesion been raised? If it had been, how would you have handled the situation? DR. LABELLE: We would have dealt with it the same way except that in addition we would have had to treat the patient systematically with antituberculous DR. WOOLHOUSE: What was the final diagnosis? DR. LABELLE: Nonspecific chronic synovitis. The histopathology of the tissue showed only a diffuse granulomatous process. DR. HRENO: When you speak of giant cell tumour, is this the same entity as the so-called villonodular synovitis? DR. LABELLE: No, not at all. These are two completely different conditions. The villonodular syno vitis looks like a villous tumour of the bowel. It is brownish and involves chiefly the joint surface. It may invade bone. The joint aspirate is a brown fluid. It responds well to synovectomy, steroids and radia tion. The giant cell tumour is a firm, yellowish or some times greyish, very lobulated tumour and tends to grow from the tendon itself. It is a benign lesion.

wimmm
FIG. 2..Extended incision after removal of tendon sheath.

loculated and greyish mass was encountered just to the tendon sheath. The superficial tendon contained a small tumour, which occupied its entire thickness; it was greyish in colour and slightly locu lated. The incision was extended and the mass and tendon sheath were removed (Fig. 2) and sent to the pathology department. A Mantoux test (1:10,000 I.D.) was negative as was also the rheumatoid arthritis test (tanned cells). The working diagnosis, based on the history of trauma, was foreign body granuloma and this was confirmed in the pathological sections. The differential diagnosis would include giant cell

proximal

Prepared

and edited by EDWARD C. PERCY, M.D., C.M., M.Sc, F.R.C.S.[C], F.A.C.S., Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec
75

Canad. Med. Ass. J., Nov. 29, 1969, vol.

101.680.