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Kostas-Agnantis I, Gkiatas I, Korompilia M, Kosmas D, Motsis E, Pakos E, Korompilias A. Lipoma Arborescens of the Upper Extremity With Anatomic Variation of the Palmaris Longus: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00045. [PMID: 36099386 DOI: 10.2106/jbjs.cc.22.00334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
CASE We present a case of a patient who suffered from wrist swelling and had symptoms of carpal tunnel syndrome. The patient underwent ultrasound and magnetic resonance imaging, in which signs of joint effusion and a fatty synovial lesion were presented. The treatment included open excision of the tumor. In addition, the palmaris longus muscle had an anatomic variation with proximal and distal tendon portions. The histopathological examination disclosed lipoma arborescens of the synovial membranes of the joints. CONCLUSION The recognition of this entity and its characteristics are important not only for correct diagnosis but also for the appropriate treatment.
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Affiliation(s)
- Ioannis Kostas-Agnantis
- Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, Greece
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Abstract
INTRODUCTION Lipoma Arborescens is a rare pathology that mainly affects the knee. Occurrences in the elbow are even more uncommon and mainly involve the bicipitoradial bursa. CASE'S DESCRIPTION We describe the case of a 54-year-old patient known for rheumatoid arthritis, who consulted for chronic elbow pain associated with swelling and limited extension. DIAGNOSIS The diagnosis of a lipoma arborescens of the elbow involving the whole joint was made using magnetic resonance imaging and confirmed during arthroscopy. INTERVENTIONS After a failed nonoperative treatment consisting in intra-articular cortisone injections and physiotherapy, the patient underwent arthroscopic synovectomy and arthrolysis. OUTCOME At 1-year follow-up, he reported no pain, satisfactory range of motion, and major improvements in clinical scores. CONCLUSION This is the first illustrated case report about lipoma arborescens involving the whole elbow joint. Even though it is a rare disease, awareness of its presentation, imaging patterns, and treatment options is therefore important for clinicians, radiologists, and surgeons. In this case, arthroscopic treatment resulted in satisfactory and long-lasting pain relief and functional results. It may be considered as a safe and effective option in case of failed nonoperative measures.
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Affiliation(s)
| | - Gregory Cunningham
- Department of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Switzerland, Rue Gabrielle-Perret-Gentil 4
- Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland
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Nambiar M, Onggo JR, Jacobson A. Lipoma arborescens: a rare cause of clicking in the knee. BMJ Case Rep 2019; 12:12/2/bcr-2018-227949. [PMID: 30737327 DOI: 10.1136/bcr-2018-227949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lipoma arborescens (LA) is a rare condition with synovial membrane lipomatous proliferation. It most commonly affects the knee joint, in the suprapatellar pouch. It can present as a painful knee with an effusion. Diagnosis is via MRI demonstrating a synovial mass with frond-like appearance, and histology showing mature adipose cells, with an overlying synovial membrane. Treatment options include non-operative measures with analgesia, or operative intervention to resect the lesion. We describe a unique case of LA present in the anterolateral knee joint, presenting with persistent painful clicking in the knee. The patient underwent an open total resection of the lesion, with resolution of symptoms.
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Affiliation(s)
- Mithun Nambiar
- Department of Orthopaedic Surgery, Eastern Health, Victoria, Australia.,Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Anthony Jacobson
- Department of Orthopaedic Surgery, Eastern Health, Victoria, Australia
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Mahajan A, Beom S. Multifocal intraarticular lipoma arborescens of the hip and knee: A case report and review of literature. JOURNAL OF ORTHOPAEDICS AND SPINE 2019. [DOI: 10.4103/joas.joas_15_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Introduction: Lipoma arborescens is a rare lesion, benign in nature and was first described in detail in 1957. <200 cases have been reported in the literature by now. It consists of subsynovial villous proliferation of mature fat cells. Since the incidence of the condition is very rare, definite etiology has not established. Arthroscopic or open synovectomy has been the treatment of choice of the lesion. Case Report: We present you a case of lipomatosis arborescens of the right knee in a 28-year-old male. The magnetic resonance imaging images showed high signal intensity villous or nodular foci on both T1- and T2-weighted images which were indicative of fat globules. They were predominantly found in huge number in suprapatellar pouch. The patient underwent arthroscopic synovectomy showing numerous broad- based polypoid or thin papillary villi composed of fatty tissue. Approximately 40 cc of lobulated globules were removed, and some were sent to histopathology which confirmed the presence of benign synovial tissue and fragments of adipose tissue present beneath the synovial surface. On 1-year follow-up, the patient was free of pain and devoid of any mechanical symptoms. Conclusion: Hence, we conclude that this is a rare entity that needs early intervention to prevent progressive joint degeneration and has excellent patient satisfaction with arthroscopic debridement with very low incidence of recurrence.
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Affiliation(s)
| | - Gurunath S Kulkarni
- Department of Orthopaedics, Shraddha Surgical and Accident Hospital, Sangli, Maharashtra. India
| | - Prakash G Kulkarni
- Department of Orthopaedics, Shraddha Surgical and Accident Hospital, Sangli, Maharashtra. India
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A rare cause of chronic knee effusion: Lipoma arborescens. MARMARA MEDICAL JOURNAL 2017. [DOI: 10.5472/marumj.370864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fornaciari P, Schai PA, Kurrer MO, Exner GU. Arthroscopic Synovectomy in Bilateral Lipoma Arborescens. J Orthop Case Rep 2017; 6:7-13. [PMID: 28507957 PMCID: PMC5404169 DOI: 10.13107/jocr.2250-0685.606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Lipoma arborescens (LA) is an uncommon condition that consists of a villous lipomatous proliferation of the synovial membrane. Open synovectomy has been previously selected as a curative treatment option. In recent years, some authors have published good results with arthroscopic interventions. We describe a well-documented case of bilateral LA of the knees treated with staged arthroscopic synovectomy. Case Report: A 48-year-old North American woman without a history of trauma presented with recurrent effusions and mild pain in both knee joints for many years. Magnetic resonance imaging examinations confirmed the diagnosis of bilateral LA with multiple villous lipomatous synovial proliferations pattern. Degenerative changes of the medial meniscus were detected bilaterally. The patient underwent bilateral arthroscopic anterior synovectomy and partial medial meniscectomy of the knee with three portal techniques. Arthroscopic the knee joint contained a large number or finger-shaped synovial proliferations with yellowish good vascularized diffuse villous masses in the suprapatellar bursa and intercondylar fossa. The cartilage showed degenerative changes with Outerbridge Grade II to III, which was particularly severe in the femoropatellar compartment. Histopathological examination of the villous masses demonstrated papillary hypertrophy, slight hyperplasia, vascular hyperplasia with a slight degree of stromal fibrosis, and interstitial lymphoplasmacytic inflammation. The adipose cells were reduced in number in relation to a normal finding but had a normal aspect without any pathological changes. 25 months after the first operation, the patient reported pain relief with the preserved function. Magnetic resonance examination of both knee joints at the last follow-up showed no relapse of the disease. The Knee injury and Osteoarthritis Outcome Score improved on the right knee joint from 39.3 preoperatively to 85.1 at the last follow-up, and on the left knee joint from 54.2 preoperatively to 86.3 at the last follow-up. Conclusion: Arthroscopic anterior synovectomy is an efficient method of achieving good results in LA with multiple villous lipomatous synovial proliferations pattern.
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Affiliation(s)
- Paolo Fornaciari
- Department of Orthopaedics, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, CH-1708 Fribourg. Switzerland
| | - Pascal A Schai
- Department of Orthopaedics, Wolhusen Cantonal Hospital (LUKS), CH-6110 Wolhusen, Switzerland
| | - Michael O Kurrer
- Department of Surgical Pathology, University Hospital Zurich, CH-8091 Zürich, Switzerland
| | - G Ulrich Exner
- Department of Orthopaedics, Orthopedic Center Zürich (OZZ), Seestrasse 259, CH-8038 Zürich, Switzerland
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Synovial Lipomatosis of the Glenohumeral Joint. Case Rep Orthop 2016; 2016:4170923. [PMID: 27563476 PMCID: PMC4983660 DOI: 10.1155/2016/4170923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/29/2016] [Indexed: 11/21/2022] Open
Abstract
Synovial lipomatosis (also known as lipoma arborescens) is a rare and benign lesion affecting synovium-lined cavities. It is characterized by hyperplasia of mature fat tissue in the subsynovial layer. Although the most commonly affected site is the knee joint, rarely additional locations such as tendon sheath and other joints are involved. We present a case of synovial lipomatosis of the glenohumeral joint in a 44-year-old man. The clinical data radiological studies and histopathologic results are described, as well as a review of the current literature.
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Lipoma Arborescens: Review of an Uncommon Cause for Swelling of the Knee. Case Rep Orthop 2016; 2016:9538075. [PMID: 27293937 PMCID: PMC4884798 DOI: 10.1155/2016/9538075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/04/2016] [Indexed: 11/22/2022] Open
Abstract
Lipoma arborescens is a rare cause of chronic monoarticular arthritis, with only a few cases reported in the literature. It is most commonly seen in the knee, but cases in other joints such as the wrist, shoulder, and elbow have also been described. It is a benign condition, in which the subsynovial tissue is replaced diffusely by mature fat cells. We describe a case involving the knee and discuss the symptoms, diagnosis, and treatment.
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Johandi F, Chua Z, Malhotra R, Wang W. Knee pain: a cautionary tale of lipoma arborescens. BMJ Case Rep 2016; 2016:bcr-2015-214049. [PMID: 27298286 DOI: 10.1136/bcr-2015-214049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 51-year-old man, presenting with non-specific symptoms of unilateral knee pain and swelling, who had experienced a 1-year period of multiple misdiagnoses. He was finally diagnosed with lipoma arborescens only after a MRI of the knee was performed, with postoperative histological confirmation after treatment with joint replacement surgery. The possible pathophysiology, diagnostic modalities and treatment of lipoma arborescens are discussed. The authors hope that our experience with this rare condition can be of learning value to fellow clinicians who frequently encounter patients with arthritis, as an accurate diagnosis and management of lipoma arborescens can give rise to a better clinical outcome for the patient.
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Affiliation(s)
- Faisal Johandi
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Zackary Chua
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Rishi Malhotra
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Wilson Wang
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
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Benegas E, Neto AAF, Teodoro DS, da Silva MVM, de Oliveira AM, Filippi RZ, de Santis Prada F. LIPOMA ARBORESCENS: RARE CASE OF ROTATOR CUFF TEAR ASSOCIATED WITH THE PRESENCE OF LIPOMA ARBORESCENS IN THE SUBACROMIAL-SUBDELTOID AND GLENOHUMERAL BURSA. Rev Bras Ortop 2015; 47:517-20. [PMID: 27047861 PMCID: PMC4799465 DOI: 10.1016/s2255-4971(15)30139-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 07/26/2011] [Indexed: 11/25/2022] Open
Abstract
Lipoma arborescens is a rare intra-articular disease that is usually monoarticular and is characterized by extensive proliferation of the synovial villi and hyperplasia of the subsynovial fat. The synovial tissue is progressively replaced by mature fat cells in the synovial membrane. The present study reports a case of a rare condition of lipoma arborescens that was simultaneously intra-articular (glenohumeral joint) and in the subacromial-subdeltoid bursa, in association with a torn supraspinatus tendon. The clinical, histological and radiographic presentations and treatment are discussed here. The description of this case includes radiographic and magnetic resonance evaluations and pathological examination. Although lipoma arborescens is a rare condition, it should be taken into consideration in cases presenting synovial hyperproliferation and synovial fat replacement.
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Affiliation(s)
- Eduardo Benegas
- Attending Physician in the Shoulder and Elbow Group, Institute of Orthopedics, HC/FMUSP, São Paulo, SP, Brazil
| | - Arnaldo Amado Ferreiro Neto
- Collaborating Professor in the School of Medicine, University of São Paulo, and Head of the Shoulder and Elbow Group, Institute of Orthopedics, HC/FMUSP, São Paulo, SP, Brazil
| | - Daniel Sabatini Teodoro
- Trainee in the Shoulder and Elbow Group, Institute of Orthopedics, HC/FMUSP, São Paulo, SP, Brazil
| | | | | | - Renée Zon Filippi
- Pathologist in the Institute of Orthopedics, HC/FMUSP, São Paulo, SP, Brazil
| | - Flávia de Santis Prada
- Attending Physician in the Shoulder and Elbow Group, Institute of Orthopedics, HC/FMUSP, São Paulo, SP, Brazil
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Kamran F, Kavin K, Vijay S, Shivanand G. Bilateral lipoma arborescens with osteoarthritis knee: Case report and literature review. J Clin Orthop Trauma 2015; 6:131-6. [PMID: 25983521 PMCID: PMC4411376 DOI: 10.1016/j.jcot.2014.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022] Open
Abstract
Lipoma arborescens is villous proliferation of synovium and is often unilateral in the absence of any systemic disease. We report a case of 54 year old male presenting with bilateral lipoma arborescens associated with osteoarthritis. The diagnosis is often difficult due to similar symptomatology of lipoma arborescens and osteoarthritis.
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Affiliation(s)
- Farooque Kamran
- Additional Professor, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Khatri Kavin
- Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,Corresponding author. Room No 311, Doctor's Hostel, JPNATC-AIIMS, Safdarjung Enclave, New Delhi, India. Tel.: +91 (0) 8743878077.
| | - Sharma Vijay
- Additional Professor, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Gamangatti Shivanand
- Additional Professor, Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
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Khalid S, Asif N, Afrose R, Faizan M, Khalid M, Sherwani RK. Lipoma arborescens: is it the cause or effect? EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2015. [DOI: 10.4103/1110-161x.155652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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O'Doherty J, Clauss R, Scuffham J, Khan A, Petitguillaume A, Desbrée A. Three dosimetry models of lipoma arborescens treated by 90Y synovectomy. Med Phys 2014; 41:052501. [PMID: 24784398 DOI: 10.1118/1.4870382] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Lipoma arborescens (LA) is a benign intra-articular lipomatous proliferation of the synovial membrane. This extremely rare condition has previously been treated by intra-articular (90)Y radiosynoviorthesis but dosimetry literature on this form of radionuclide therapy is nonexistent. The authors detail methodology for successful treatment of LA and provide for the first time estimates of radiation dosimetry. The authors also analyze the biodistribution of the radiopharmaceutical over the course of the patient's treatment through sequential imaging. METHODS A patient with bilateral LA underwent intracavity injection of (90)Y citrate colloid to the right and left knee joint spaces (181 and 198 MBq, respectively). SPECT/CT datasets were acquired over 9 days to quantify the biodistribution and kinetics of the radiopharmaceutical. Radiation dosimetry was performed using the MIRD schema (through OLINDA software), a custom voxel-based method, and a direct Monte Carlo calculation (OEDIPE). RESULTS Follow-up MRI showed marked reduction in LA size in both knees. Mean absorbed doses to the LA were 21.2 ± 0.8 and 42.9 ± 2.3 Gy using OLINDA, 8.1 ± 0.3 and 16.7 ± 0.5 Gy using voxel based methodology, and 8.2 ± 0.3 and 15.7 ± 0.5 Gy for OEDIPE in the right and left LA, respectively. Distribution of the radiopharmaceutical within the joint space alters over the imaging period, with less than 1% of the remaining activity having moved posteriorly in the knee cavity. No uptake was detected outside of the joint space after assessment with whole-body scintigraphy. CONCLUSIONS An activity of approximately 185 MBq successfully relieved clinical symptoms of LA. There was good correlation between direct Monte Carlo and voxel based techniques, but OLINDA was shown to overestimate the absorbed dose to the tumor. Accurate dosimetry may help select an activity more tailored to the specific size and location of the LA.
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Affiliation(s)
- Jim O'Doherty
- Department of Medical Physics-Nuclear Medicine, Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom and Division of Imaging Sciences, PET Imaging Centre at St. Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom
| | - Ralf Clauss
- Department of Nuclear Medicine, Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom
| | - James Scuffham
- Department of Medical Physics-Nuclear Medicine, Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom
| | - Aman Khan
- Department of Rheumatology, Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom
| | - Alice Petitguillaume
- Service de Dosimétrie Interne, Institut de Radioprotection et de Sûreté Nucléaire, 92260 Fontenay-aux-Roses, France
| | - Aurélie Desbrée
- Service de Dosimétrie Interne, Institut de Radioprotection et de Sûreté Nucléaire, 92260 Fontenay-aux-Roses, France
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Abstract
Lipoma arborescens (LA) in the knee is a benign intra-articular lipomatous proliferation of the synovial membrane, and data on treatment of LA by radionuclide therapy is sparse. We present a rare case of bilateral LA in the knees successfully treated with injection of Y-citrate colloid. We assessed the biodistribution of the radiopharmaceutical through the use of SPECT/CT imaging. Our images show slight redistribution of the radiocolloid in the knee joint, whereas most of the radioactivity remains localized around the LA. MRI scans confirmed the efficacy of this treatment, with a significant reduction in LA volume after 6 months.
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Progressive bilateral lipoma arborescens of the knee complicated by juvenile spondyloarthropathy: A case report and review of the literature. Semin Arthritis Rheum 2013; 43:259-63. [DOI: 10.1016/j.semarthrit.2012.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/30/2012] [Accepted: 12/07/2012] [Indexed: 11/21/2022]
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Karir T, Sarma HD, Samuel G, Hassan PA, Padmanabhan D, Venkatesh M. Preparation and evaluation of radioiodinated thermoresponsive polymer based on poly(N-isopropyl acrylamide) for radiotherapy. J Appl Polym Sci 2013. [DOI: 10.1002/app.39235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Tarveen Karir
- Quality Control Group; Board of Radiation and Isotope Technology; Department of Atomic Energy; Navi Mumbai 400703 India
| | - Haladhar D. Sarma
- Radiation Biology and Health Sciences Division; Bhabha Atomic Research Centre; Mumbai 400085 India
| | - Grace Samuel
- Quality Control Group; Board of Radiation and Isotope Technology; Department of Atomic Energy; Navi Mumbai 400703 India
| | | | - D. Padmanabhan
- Quality Control Group; Board of Radiation and Isotope Technology; Department of Atomic Energy; Navi Mumbai 400703 India
| | - Meera Venkatesh
- Quality Control Group; Board of Radiation and Isotope Technology; Department of Atomic Energy; Navi Mumbai 400703 India
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Silva L, Terroso G, Sampaio L, Monteiro E, Pimenta S, Pinto F, Pinto JA, Ventura FS. Polyarticular lipoma arborescens--a clinical and aesthetical case. Rheumatol Int 2011; 33:1601-4. [PMID: 21526358 DOI: 10.1007/s00296-011-1941-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 04/13/2011] [Indexed: 11/25/2022]
Abstract
Lipoma arborescens is a benign tumor, but it may be a reactive process to other disorders, and its clinical, analytical, radiological and ultrasound presentation may be redundant to any synovial tumor. Despite the characteristic feature on magnetic resonance imaging (MRI), the correct differential diagnosis in atypical presentation, and the need for timely removal of the lesion to prevent joint damage, forces, ultimately, to invasive procedures. The clinical case reported here, fourth described in English language publications on the polyarticular form, also presented other specificities related to one of the swellings, in the knee. Because of its atypical location in the popliteal fossa, recurrent episodes of joint effusion, personal history of knee trauma, pulmonary tuberculosis, and family history of rheumatoid arthritis required particular attention. This process was hampered by the refusal of knee (and ankle) surgery by the patient. He accepted surgical removal of the swellings of the wrists, for aesthetical reasons, with pathologic confirmation of the diagnosis, and clinical success in that location. MRI of the knee showed the typical image of lipoma arborescens, but also other changes that compromise the prognosis.
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Affiliation(s)
- Lígia Silva
- Interna Complementar de Reumatologia, Serviços de Reumatologia do Hospital de São João e da Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal.
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Affiliation(s)
- D Das
- Department of Radiology, Guy's and St. Thomas' Hospitals, London, UK.
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[Treatment resistant chronic monoarticular synovitis: Lipoma arborescens]. An Pediatr (Barc) 2010; 73:154-6. [PMID: 20580624 DOI: 10.1016/j.anpedi.2010.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/24/2010] [Accepted: 05/18/2010] [Indexed: 11/21/2022] Open
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Lipoma arborescence of the knee in a child--a diagnostic dilemma: radiological and arthroscopic evaluation. J Orthop Sci 2010; 15:414-9. [PMID: 20559811 DOI: 10.1007/s00776-009-1424-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 08/06/2009] [Indexed: 10/19/2022]
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Abstract
Lipoma arborescens is a rare clinical condition characterized by mono or biarticular involvement of large joints, such as knees, hips, ankles, elbows, and shoulders. The aim of this case report is to describe an unusual case of lipoma arborescens affecting multiple large joints, mimicking rheumatoid arthritis. The patient, a 29-year-old woman had a history of intermittent arthritis of the wrists, knees, and ankles for at least 12 years. With the diagnosis of rheumatoid arthritis she had been on methotrexate (7.5 mg/wk) for the last 6 months along with different nonsteroidal anti-inflammatory drugs, without benefit. On physical examination a discreet joint swelling of the knees without effusion, gluteal muscle atrophy, and limited hip movements were observed. Laboratory tests presented normal acute phase reactants of inflammation as well as the rheumatoid factor, CK, and negative results for antinuclear, anti-DNA, anti-SSA/Ro, and anti-CCP (ELISA) antibodies. Magnetic resonance imaging of the knees and hips showed articular effusion and synovitis, and a pattern of lipoma arborescens. The histopathologic study confirmed the diagnosis. Knee arthroscopic synovectomy brought some improvement to joint mobility and pain.Although rare, this condition must be remembered in the presence of inflammatory arthropathy, particularly in the absence of response to clinical treatment, and absence of rheumatoid factor and anti-CCP antibodies, since the therapeutic strategy is radically different.
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Hruby M, Kucka J, Lebeda O, Mackova H, Babic M, Konak C, Studenovsky M, Sikora A, Kozempel J, Ulbrich K. New bioerodable thermoresponsive polymers for possible radiotherapeutic applications. J Control Release 2007; 119:25-33. [DOI: 10.1016/j.jconrel.2007.02.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 02/11/2007] [Accepted: 02/15/2007] [Indexed: 10/23/2022]
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Hrubý M, Subr V, Kucka J, Kozempel J, Lebeda O, Sikora A. Thermoresponsive polymers as promising new materials for local radiotherapy. Appl Radiat Isot 2005; 63:423-31. [PMID: 15996473 DOI: 10.1016/j.apradiso.2005.05.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 05/15/2005] [Accepted: 05/18/2005] [Indexed: 11/26/2022]
Abstract
We describe a novel thermoresponsive polymeric drug delivery system based on poly(N-isopropylacrylamide) with isotopically labellable end groups [l-tyrosinamide or diethylenetriaminepentaacetic acid (DTPA)] designed for local radiotherapy. The polymers are readily soluble in isotonic aqueous sodium chloride at room temperature and the phase separation is complete at body temperature as proved by DSC measurements. Sufficent binding capacity for radionuclides and chemical stability are demonstrated on 125I and 90Y-labelled polymers.
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Affiliation(s)
- M Hrubý
- Institute of Macromolecular Chemistry, Academy of Sciences of the Czech Republic, Heyrovského Sq. 2, 162 06 Prague 6, Czech Republic.
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