Purpose: We report a locally invasive tenosynovial haemangioma infiltrating the flexor digitorum sublimis of the non dominant little finger in a sixteen year old student which was excised with part of the sublimis tendon and the A2 pulley.

Patients and Methods: Haemangiomata developing in the hand in relation to tendon and the tenosynovium (tendon sheath) are very rare. To our knowledge only three cases have been described arising in relation to the tenosynovium of the tendons of the hand only one of which showed infiltration of the underlying tendon. We report the case of a sixteen year old right hand dominant student who presented to her family doctor with a swelling on her left little finger. A magnetic resonance scan was arranged which confirmed a soft tissue lesion between the flexor tendons and the proximal phalanx of the left little finger with appearance similar to giant cell tumour of the tendon sheath. Surgical exploration demonstrated a dark red fleshy tumour that appeared to infiltrate the flexor digitorum ublimes tendon, and extend around either side of the proximal phalanx. For complete excision of the lesion the infiltrated sublimis tendon and a part of the A2 pulley were sacrificed. There was no resultant bowstringing of the profundus tendon.

Histologically the tenosynovium was expanded by a vascular lesion consisting of dilated, thin-walled vascular channels within fibrous tissue The appearances were those of a synovial haemangioma of the tenosynovium of the flexor tendons

Conclusion: Our case illustrates the pitfalls in diagnosis and the invasive potential of a synovial haemangioma which in our case had infiltrated the flexor sublimis tendon and the area around the A2 pulley. A complete surgical excision is critical to prevent recurrence.

Purpose: We present a 12 year follow up of a patient who presented with a multiple plexiform schwannoma of the median nerve with multiple recurrences, where it was possible to salvage the limb.

Patients and Methods: Multiple plexiform Schwannomas are rare nerve sheath tumours. In this case the tumour presented as a soft non-tender swelling in the palm of a child. On exploration the lesion was found to involve the median nerve from the digital nerves to the antecubital fossa. Histology confirmed a plexiform schwannoma.

The tumour was locally very aggressive with multiple recurrences initially in the median nerve and ulnar nerves and later in the nerve grafts used following excision of the primary tumour.

We present a pictorial review of the mode of presentation of the tumour; discuss different modalities used for limb salvage and the differential diagnosis of this rare tumour.

Conclusion: There are very few reports of PS involving main nerve trunks and none describe the long term follow-up. We report a twelve year follow up of a PS involving the main nerve trunks of the upper limb with salvage despite multiple recurrences. The clinical course of the tumour is presented up to the age of sixteen where the growth tumour appears to have regressed.