Tenosynovitis with rice body formation in a non-tuberculosis patient: a case report

Abstract

In this report, we present a 68-year-old man with rice body formation in the flexor tendon sheath of the fingers without any inflammatory diseases such as tuberculosis or rheumatoid arthritis. The patient visited our institute in March 2004 with a one-month history of swelling and pain of the right distal forearm. Laboratory data were within normal limits, and the rheumatoid factor was negative. He had no history of tuberculosis, and the tuberculin reaction was weakly positive. Magnetic resonance (MR) images showed a mass measuring 6 cm x 4 cm around the flexor tendons of the forearm. Many rice bodies had been erupted from a small hole of the fibrous wall of the mass at the time of incisional biopsy performed in June 2004. Histological diagnosis was synovitis with fibrous loose bodies. In July 2004, spontaneous ruptures of the right fourth and fifth flexor tendons occurred. Open repair was performed in August 2004. The patient regained good function of the operated fingers with no evidence of recurrence at the latest follow-up in March 2009.

Figure 1.

Anteroposterior (A) and lateral (B) radiogram of the right wrist shows the soft tissue mass on the palmar side without calcification.

Figure 2.

A: Axial T1-weighted MR image of the right distal forearm demonstrates a mass with low signal intensity surrounding the flexor tendons. B: Axial T2-weighted MR image showed a mass with high signal intensity mass and many rice bodies with low signal intensity. C: Sagittal T2-weighted MR image of the right distal forearm showed enlarged tendon sheaths and many small bodies with low signal intensity. D: Axial T1-weighted MR images of the right distal forearm after the administration of gadolinium. The mass which surrounded the flexor tendons was moderately enhanced.

Figure 3.

During the surgery, many rice bodies had been erupted from a small hole in the fibrous wall of the mass.

Figure 4.

Photomicrograph of rice bodies from the distal forearm showed collagen fibers around the fibrin-like materials (×200).

Figure 5.

Photograph during an open repair surgery showed the granulation tissue around the flexor tendons on the volar side of the right forearm.

Figure 6.

Photomicrograph of granulation tissue from the right distal forearm showed chronic synovitis with lymphoid cell infiltration. No acid-fast bacilli were found (×200).