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A patient presents with a slow-growing soft tissue swelling over the hand and wrist. The clinical image shows a subcutaneous nodule and the X-ray of the wrist is shown. What is the diagnosis?
A patient presents with a slow-growing soft tissue swelling over the hand and wrist. The clinical image shows a subcutaneous nodule and the X-ray of the wrist is shown. What is the diagnosis?
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Think of the most common benign soft tissue tumour arising from the tendon sheath in the hand.
Updated On: Jun 23, 2026
- GCT (Giant Cell Tumour of tendon sheath)
- Osteochondroma
- Osteoid Osteoma
- Ewing Sarcoma
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The Correct Option is A
Solution and Explanation
Diagnosis: Giant Cell Tumour (GCT) of Tendon Sheath
The clinical scenario describes a slow-growing, painless, subcutaneous nodule over the hand and wrist -- this is the classic presentation of a tenosynovial GCT (also called pigmented villonodular synovitis when diffuse).
Characteristic features of tenosynovial GCT:
- Second most common soft tissue mass of hand and wrist (after ganglion)
- Arises from the synovium of tendon sheaths
- Age: 3rd to 5th decades; slight female predominance
- Imaging: low T1 and T2 MRI signal due to haemosiderin deposits, moderate contrast enhancement
- Benign but locally recurrent after excision
Ruling out alternatives:
- Osteochondroma: bony outgrowth with cartilage cap, seen on X-ray as exostosis
- Osteoid Osteoma: nocturnal pain relieved by NSAIDs, nidus on CT
- Ewing Sarcoma: malignant, aggressive bone tumour with onion-skin periosteal reaction
\[\boxed{\text{GCT of tendon sheath}}\]
The clinical scenario describes a slow-growing, painless, subcutaneous nodule over the hand and wrist -- this is the classic presentation of a tenosynovial GCT (also called pigmented villonodular synovitis when diffuse).
Characteristic features of tenosynovial GCT:
- Second most common soft tissue mass of hand and wrist (after ganglion)
- Arises from the synovium of tendon sheaths
- Age: 3rd to 5th decades; slight female predominance
- Imaging: low T1 and T2 MRI signal due to haemosiderin deposits, moderate contrast enhancement
- Benign but locally recurrent after excision
Ruling out alternatives:
- Osteochondroma: bony outgrowth with cartilage cap, seen on X-ray as exostosis
- Osteoid Osteoma: nocturnal pain relieved by NSAIDs, nidus on CT
- Ewing Sarcoma: malignant, aggressive bone tumour with onion-skin periosteal reaction
\[\boxed{\text{GCT of tendon sheath}}\]
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