Isolated peroneal tenosynovial lipoma arborescens: multimodality imaging features

Area of Science:

• Orthopedics
• Radiology
• Pathology

Background:

• Synovial lipoma arborescens is a rare benign fatty proliferation of the synovium.
• It most commonly affects the knee's suprapatellar pouch but can involve tendon sheaths.
• Tenosynovial lipoma arborescens in the ankle, particularly the peroneal tendon sheath, is exceptionally rare.

Purpose of the Study:

• To report the third known case of tenosynovial lipoma arborescens isolated to the peroneal tendon sheath.
• To detail the diagnostic approach using a combination of imaging modalities and histological correlation.
• To enhance awareness of this rare entity for accurate interpretation of imaging studies.

Main Methods:

• Radiographic imaging
• Sonographic evaluation
• Magnetic resonance (MR) imaging
• Intraoperative findings
• Histologic examination

Main Results:

• The study presents a unique case of tenosynovial lipoma arborescens exclusively involving the peroneal tendon sheath without ankle joint effusion.
• Integrated analysis of radiographic, sonographic, and MR imaging provided detailed characterization of the lesion.
• Histological confirmation validated the imaging findings, establishing the diagnosis.

Conclusions:

• This case represents the first report of peroneal tenosynovial lipoma arborescens utilizing a comprehensive imaging and histological correlation.
• Radiologists and clinicians should consider tenosynovial lipoma arborescens in the differential diagnosis of peroneal tendon sheath lesions.
• Accurate diagnosis relies on a combination of advanced imaging techniques and pathological confirmation.