腱鞘膜之軟骨瘤：一病例報告及文獻回顧

Tendon Sheath Chondromatosis: A Case Report and Review of Literature

一位55成男性網球運動員在最近三年發現在上臂有時痛。放射線學檢查發現在上臂有四顆鈣化病灶。在上臂核磁共振造影發現四顆鈣化性軟骨瘤出現在二頭肌腱鞘。該病灶經外科手術切除後，病理組織學證實是二頭肌鍵鞘膜之軟骨瘤。該病人在術後第8個月追蹤仍無復發跡象。本文回顧文獻發現關節以外之軟骨瘤，大部份出現在手及腳部。在二頭肌鍵鞘，則非常罕見。形成原因主要是從滑膜間質細胞化生而成，再經鈣化後形成之軟骨瘤。增生中的軟骨瘤，細胞非常多，且有不典形細胞外觀。這種病理變化會誤以為是軟骨肉瘤。但回顧文獻發現軟骨瘤並無惡性變化，但卻有復發病例。故必須要完全把相關滑膜切除，以絕後患。

A 55-year-old male tennis player presented with dull pain in the left arm of 3 years. Radiography of the left shoulder showed four calcified lesions in the left mid-humerus. Magnetic resonance imaging of the left shoulder showed four calcified chondral bodies and effusion in the bicipital tendon sheath which was compatible with synovial chondrornatosis. The mass was removed en bloc and was diagnosed as synovial chondrornatosis arising from the bicipital tendon sheath. The patient was symptom-free 8 months after the operation. The literature indicates that extra-articular chondromatosis occur exclusively in the hands and feet and are thought to develop by metaplasia from the mesenchymal cells of the synovial membrane; mineralization and ossification of the tumor are secondary. Extra-articular bicipital tendon sheath chondrornatosis is considered exceptional. The actively growing tumor was celluar and showed atypical cytologic features. Such microscopic characteristics should not be interpreted as evidence of a low-grade chondrosacrorna. A review of the literature failed to disclosed a case with malignant transformation, although there have been cases in which several lesions had recurred, and some recurred more than once. For this reason, complete removal of the involved synovium is of great importance.