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).

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

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.