An Exceptional Tendinous Fibroma Of The Foot

The authors report a case of exceptional tendinous fibroma of the foot. The tendinous sheath fibroma benign tumours and Recurrence is the most common complication after excision. The complete excision of the tumour permitted to our patient to find a functional foot. INTRODUCTION The fibroma of the sheath of the tendon are rare benign tumours [1], often repeating after excision. We report an exceptional pseudo-tumoral case localized in the foot. CASE REPORT A 29 years old patient was seen for consultation in April 2004 for a painless tumor of the right foot, evolving since more than 6 years. The case story specify that this tumor was a recurrence of local tumor, located on the dorsal side of the foot, whose excision had been made in 1995 and for which no anatomo-pathological examination had not been carried out. With the clinical examination, the tumor was multinodular and interested the areas dorsal and plantar, going up with the anterior face of ankle. It infiltrated and enlarge the first interdigital space. The tumor was firm, adherent in the deep plans, with a healthy skin (fig.1). Figure 1 Figure 1 : Clinical aspects Radiography showed a cortical lysis of the first and second métatarsus (fig. 2). An Exceptional Tendinous Fibroma Of The Foot 2 of 4 Figure 2 Figure 2: radiological aspects A complete and total excision was made under loco-regional anesthesia and without tourniquet. Macroscopically the tumor was multinodular, firm and fibrous consistency (fig. 3). Figure 3 Figure 3 : macroscopic aspect The excision carried the flexor tendons sheathe in the tumor, and the anterior capsule of the articulation of tibia and astragal (fig. 4). Figure 4 Figure 4 : after excision The anatomo-pathological examination showed a tendinous fibroma. In the evolution, we note a cutaneous necrosis of the dorsal and intern side of the foot. At 35 days after excision of the tumour, an ischaemia of the big toe was noted (fig. 5), imposing an amputation of the big toe (fig. 6). The healing of wound was done and unfortunately the patient was lost sight of. Figure 5 Figure 5 : necrosis of big toe An Exceptional Tendinous Fibroma Of The Foot 3 of 4 Figure 6 Figure 6 : after amputation of big toe DISCUSSION Only isolated cases of tendinous fibroma on the level of the foot are found in the literature, we didn’t find a case identical to our. This pathology is more often found on the hand than on the foot [ 2 ] This type of tumor is rare and sits at the extremities in 70% of cases, generally in the hand [ 1 ] Some case of fibroma of the sheath of tendon on the level of the wrist were described [ 3 ]. It should however be distinguished from the tumors with giant cells of the tendinous sheaths, which on the IRM can have the same characteristics, with a weak signal in T1 [ 4 ]. However the histology slices on the diagnosis [ 5 ]. The treatment is surgical with a carcinological excision, with a significant risk of recurrence [1, 2]. In our observation we retained a probable repetition of the tumor, 3 years after the first excision however we don’t know if our patient did not repeat, 7 years after its last excision. CONCLUSION The fibroma of the sheath of the tendon is a rare benign tumor and the diagnosis is histological. References 1. PALAZZO E., CHAZERAIN P., GROSSIN M. Tumeurs et dystrophies de la synoviale Encycl Med Chir, Appareil locomoteur, 14-140-A-10, 1996 2. FADELA M.E., SCHULZB E., LINKERB R., JEROSCHB J., Giant cell tumour of the tendon sheath in the foot J Foot Ankle Surg, 12, 2006,33-37 3. MUSSO M., SCHILTON I., PALLOTTI F. Fibrome de la gaine tendineuse occasionnant un «poignet à ressaut» et un syndrome du canal carpien Chir main, 25 , 2006, 89–91 4. CHEVROT A. Imagerie clinique du pied. Masson, Paris, 1997, 290 5. SATTI M. B. Tendon sheath tumours: a pathological study of the relationship between giant cell tumourand fibroma of tendon sheath Histoputhology 1992, 20, 2 13-220 An Exceptional Tendinous Fibroma Of The Foot 4 of 4 Author Information Abdoulaye Bousso Orthopedic Surgeon, Orthopedic Department, General Hospital of Grand-Yoff El Hadj Souleymane Camara Orthopedic Surgeon, Orthopedic Department, General Hospital of Grand-Yoff Jean Claude Sane Orthopedic Surgeon, Orthopedic Department, General Hospital of Grand-Yoff Amadou Ndiassé Kasse Orthopedic Surgeon, Orthopedic Department, General Hospital of Grand-Yoff Babacar Thiam Orthopedic Surgeon, Orthopedic Department, General Hospital of Grand-Yoff Mouhamadou Habib Sy Professor, Orthopedic Surgeon (Head Of Department), Orthopedic Department, General Hospital of Grand-Yoff