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Agulla B, Vizcaíno N, Velarde R, Estruch J, Domínguez E, Pastor J. Adipocytes in synovial fluid cytology: An approach for diagnosing synovial lipomatosis. Vet Clin Pathol 2024; 53:80-84. [PMID: 38320970 DOI: 10.1111/vcp.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024]
Abstract
A 2-year-old neutered male bullmastiff dog was presented with chronic left hind limb lameness. Physical examination revealed left stifle effusion and medial buttress without cranial tibial thrust. Radiographs showed joint effusion and new bone formation at the patella apex. Magnetic resonance imaging showed increased synovial fluid, widening of the joint space, abnormal infrapatellar fat body and thinning of the cranial cruciate ligament. Synoviocentesis and cytologic evaluation of synovial fluid revealed marked mononuclear inflammation with abundant fatty tissue, suggesting synovial lipomatosis in conjunction with the imaging findings. The disease was confirmed histologically after sampling the lesion during arthrotomy. Synovial lipomatosis, characterized by extensive synovial adipose tissue proliferation of the synovial membrane, is a rare "tumor-like" disorder that usually affects the stifle. Although the etiology remains unclear, joint trauma, inflammation, instability, and lipid abnormalities have been proposed as causes. Inflammatory factors may promote synoviocyte and adipocyte hyperplasia that perpetuate the process. Surgical removal may be suggested to eliminate triggers and prevent future recurrences. The report provides the first cytological description of adipocytes in synovial fluid associated with the diagnosis of synovial lipomatosis in dogs. This case report underscores the potential effectiveness of cytologic analysis of synovial fluid smears, in combination with magnetic resonance imaging (MRI), for diagnosing this condition and reducing complications associated with arthrotomy for sampling purposes. Additionally, the case highlights that synovial lipomatosis should be considered as a potential differential diagnosis for synovial masses in dogs. Further cases are needed to validate these observations in veterinary medicine.
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Affiliation(s)
- Beatriz Agulla
- Department Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nùria Vizcaíno
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roser Velarde
- Department Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Estruch
- Department Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Josep Pastor
- Department Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
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Cantarelli Rodrigues T, Serfaty A. MRI Assessment of Benign Tumor And Tumor-Like Synovial Diseases. Semin Roentgenol 2022; 57:191-200. [DOI: 10.1053/j.ro.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/11/2022]
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Mohey N, Hassan TA. Feasibility of MRI in diagnosis and characterization of intra-articular synovial masses and mass-like lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-0138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Classifications of intra-articular masses are infectious granulomatous diseases, non-infectious synovial proliferative processes (synovial chondromatosis, lipoma arborescens, rheumatoid arthritis, pigmented villonodular synovitis [PVNS]), vascular malformations, deposition disorders, neoplastic, and miscellaneous conditions. The aim of this study is to correlate the results of MRI with arthroscopy in characterization of different varieties of intra-articular synovial masses and mass-like lesions. This observational prospective study was conducted between February 2018 and August 2019. We screened 1000 routine musculoskeletal MRI examination during this period, 32 of which showed intra-articular synovial masses/mass-like lesions. The selected 32 patients (20 males and 12 females) have a mean age of 49.20 ± 2.0 years; all presented with joint swelling, pain, or difficulty of movement according to the joint affected. All patients underwent arthroscopy for histopathological correlation.
Results
The final diagnosis was synovial chondromatosis in 14 patients (43.8%), PVNS in ten patients (31.3%), and lipoma arborescens in five patients (15.6%). Synovial chondrosarcoma, synovial hematoma, and synovial ganglion cyst each in one patient (3.1%). The concordance of MRI to arthroscopy was 96.6% accuracy, 91.7% sensitivity, 99% specificity, 52.3% PPV, and 99.9% NPV.
Conclusion
Good correlation was observed between MRI and arthroscopy in diagnosis of intra-articular synovial masses/mass-like lesions.
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Kawashima K, Terabayashi N, Asano H, Akiyama H. Lipoma Arborescens of the Subdeltoid Bursa Associated With Rotator Cuff Tear: A Case Report. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320917624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lipoma arborescens is a rare synovial lesion characterized by villous proliferation of the synovial membrane and replacement of subsynovial tissue with mature fat cells. The knee joint is the most frequently affected site, particularly in the suprapatellar pouch. However, there have been few reports regarding shoulder involvement, including the glenohumeral joint and subacromial subdeltoid bursa, associated with rotator cuff tear. This article reviews the case of a 67-year-old man who presented with lipoma arborescens of the left shoulder, associated with a rotator cuff tear. Sonography revealed a fluid collection with thickening of the synovial membrane with hyperechoic villous proliferation, located in the subdeltoid bursa. An arthroscopic synovectomy and rotator cuff repair were performed. Arthroscopic findings included yellow frond-like synovial proliferation of the synovium. Postoperatively, the patient was asymptomatic, and the lesion did not recur. Although magnetic resonance imaging is the first-line imaging modality for diagnosis of this lesion, sonography may be used initially for evaluation of chronic joint swelling. In addition, it can be useful for detection of recurrence after synovectomy. This case illustrates the typical sonographic features of lipoma arborescens.
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Affiliation(s)
- Kenji Kawashima
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu City, Gifu, Japan
| | - Nobuo Terabayashi
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu City, Gifu, Japan
| | - Hiromi Asano
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu City, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu City, Gifu, Japan
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Wang CK, Alfayez S, Marwan Y, Martineau PA, Burman M. Knee Arthroscopy for the Treatment of Lipoma Arborescens. JBJS Rev 2019; 7:e8. [DOI: 10.2106/jbjs.rvw.18.00139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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A Case of Prefemoral Fat Pad Impingement Syndrome Caused by Hyperplastic Fat Pad. Case Rep Orthop 2019; 2018:3583049. [PMID: 30675408 PMCID: PMC6323454 DOI: 10.1155/2018/3583049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/30/2018] [Accepted: 12/03/2018] [Indexed: 11/20/2022] Open
Abstract
Case We report a rare case of prefemoral fat pad impingement syndrome that was caused by a hyperplasia of the normal suprapatellar fat pad. Pain and catching were observed in the proximal-lateral patellofemoral joint, and MRI imaging confirmed a hyperplasic mass in the same area. Although conservative treatment showed no signs of improvement, symptoms improved after an arthroscopic excision of the mass. Conclusion Prefemoral fat pad impingement syndrome is related to patellar motion and should be considered as one of the underlying causes of anterior knee pain (AKP). Surgeons should recognize that a small hyperplasia composed of normal adipose tissue can cause AKP.
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Hayashi S, Adachi N, Ikuta Y, Shimizu R, Nakasa T, Ishikawa M, Nakamae A, Deie M, Ochi M. Lipoma arborescens in bilateral knee joints accompany gouty tophi: A case-based review of the literature. J Orthop Sci 2019; 24:184-188. [PMID: 27863888 DOI: 10.1016/j.jos.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/04/2016] [Accepted: 10/08/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Seiju Hayashi
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan.
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Ryo Shimizu
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Atsuo Nakamae
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Masataka Deie
- Department of Orthopedic Surgery, Aichi Medical University, Aichi, Japan
| | - Mitsuo Ochi
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
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Jang E, Danford NC, Levin AS, Tyler WK. Intra-Articular Tumors: Diagnosis and Management of the Most Common Neoplasms Involving Synovial Joints. JBJS Rev 2018; 6:e8. [PMID: 30589749 DOI: 10.2106/jbjs.rvw.17.00210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Eugene Jang
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
| | - Nicholas C Danford
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
| | - Adam S Levin
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Wakenda K Tyler
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
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Medical image analysis of knee joint lipoma arborescens and arthroscopic treatment. Comput Med Imaging Graph 2018; 66:66-72. [PMID: 29567561 DOI: 10.1016/j.compmedimag.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Arthroscopy is a minimally invasive surgical procedure on a joint in which examination and treatment of knee damage is performed using a surgical device known as the arthroscope. Lipoma arborescens (LA), an infrequent intra-articular lesion, originates from mature adipose cells under subsynovial tissue. The synovial membrane is pale yellow with large villous projections. It is caused by various underlying factors. We found many patients with LA and processed them appropriately.The research was implemented to investigate therapeutic effect of semi-automated arthroscopic diagnosis and treatment for knee joint. METHODS We used the Stryker arthroscopic in surgery that is 4 mm in diameter with angle at 30°. Patients were chosen by biomechanical analysis and scanning mode. All of the patients underwent radiographic imaging examination, Magnetic Resonance Imaging (MRI), Lysholm Score and Visual Analogue Scale (VAS). Arthroscopic limited synovectomy was carried out on these patients. RESULTS The wound of all patients healed up. The content of follow-up includes: chief complaints, range of motion of knee joint, Visual Analogue Scale (VAS) and Lysholm score. No swollen nor effusion of the infected knee was found in all patients during the follow-up. The postoperative symptom was markedly alleviated in fourteen patients and partially alleviated in one. All patients were satisfied with the therapeutic effect. CONCLUSION We performed biomechanical analysis based on knee slight flexion and extension. Arthroscopy is an endoscope for the diagnosis and treatment of joint diseases. Semi-automated arthroscopic debridement is good for early and mid-term osteoarthritis with Lipoma arborescens.
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Abstract
Intraarticular benign tumors are rare lesions in many cases seen as incidental findings. One of the typical lesions is the diffuse or nodular form of pigmented villonodular synovitis, which needs a complete surgical removal. Magnetic Resonance Imaging (MRI) is diagnostic in most of the cases because of the intracellular iron content which shows an at least in some parts dark T2-sequence. Adjuvant therapies as radiosynoviorthesis should be considered in diffuse or recurrent lesions. Synovial Chondromatosis represents a metaplastic disorder of the synovial membrane resulting in the production of loose cartilage bodies. Also in this dissease synovectomy or, in late cases, removal of the loose bodies only, is recommended. Synovial hemangiomas are hamartomas which may lead to pain or restriction of movement. In these cases total or partial resection is justified. Alternative treatment options such as laserablation may be possible. Lipoma arborescens represents a proliferative lipoid lesion of the subsynovial region leading to villonodular synovial proliferation. If clinically symptomatic, resection by arthroscopic or open synovectomy is recommented.
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Affiliation(s)
- H R Dürr
- Schwerpunkt Tumororthopädie, Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - A Klein
- Schwerpunkt Tumororthopädie, Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Gupta P, Potti TA, Wuertzer SD, Lenchik L, Pacholke DA. Spectrum of Fat-containing Soft-Tissue Masses at MR Imaging: The Common, the Uncommon, the Characteristic, and the Sometimes Confusing. Radiographics 2017; 36:753-66. [PMID: 27163592 DOI: 10.1148/rg.2016150133] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Fat-containing tumors are the most common soft-tissue tumors encountered clinically. The vast majority of fat-containing soft-tissue masses are benign. Lipomas are the most common benign fat-containing masses and demonstrate a characteristic appearance at magnetic resonance (MR) imaging. Less common benign soft-tissue masses include lipoblastoma, angiolipoma, spindle cell lipoma/pleomorphic lipoma, myolipoma, chondroid lipoma, lipomatosis of nerve, lipomatosis, hibernoma, and fat necrosis. Well-differentiated liposarcomas (WDLPSs)/atypical lipomatous tumors (ALTs) are locally aggressive soft-tissue masses that do not metastasize. Biologically more aggressive liposarcomas include myxoid, pleomorphic, and dedifferentiated liposarcomas. At MR imaging, lipomas typically resemble subcutaneous fat but may contain a few thin septa. The presence of thick, irregular, enhancing septa and nonfatty soft-tissue mass components suggests liposarcoma rather than lipoma. However, benign lipomatous lesions and WDLPS/ALT often have overlapping MR imaging findings. Distinguishing WDLPS/ALT from a benign lipomatous lesion or from fat necrosis at imaging can be challenging and often requires histologic evaluation. We present the spectrum of fat-containing masses, using the World Health Organization classification of adipocytic tumors, with an emphasis on commonly encountered lesions, characteristic MR imaging findings associated with specific tumors, and overlapping MR imaging findings of certain tumors that may require histologic sampling. We also briefly discuss the role of molecular markers in proper characterization and classification of fat-containing soft-tissue masses. (©)RSNA, 2016.
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Affiliation(s)
- Pushpender Gupta
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
| | - Tommy A Potti
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
| | - Scott D Wuertzer
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
| | - Leon Lenchik
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
| | - David A Pacholke
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
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Lipoma Arborescens of the Knee: Report of Three Cases and Review of the Literature. Case Rep Med 2017; 2017:3569512. [PMID: 28243256 PMCID: PMC5294362 DOI: 10.1155/2017/3569512] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 01/10/2017] [Indexed: 11/30/2022] Open
Abstract
Lipoma arborescens is a chronic, slow-growing, intra-articular lesion of benign nature, which is characterized by villous proliferation of the synovium, with replacement of the subsynovial connective tissue by mature fat cells. It usually involves the suprapatellar pouch of the knee joint. It is not a neoplasm but is rather considered a nonspecific reactive response to chronic synovial irritation, due to either mechanical or inflammatory insults. We report three cases of lipoma arborescens affecting the knee, the first in a young male without previous history of arthritis or trauma, the second in a 58-year-old male associated with osteoarthritis, and the final in a 44-year-old male diagnosed with psoriatic arthritis, which cover the entire pathologic spectrum of this unusual entity. We highlight the clinical findings and imaging features, by emphasizing especially the role of MRI, in the differential diagnosis of other, more complex intra-articular masses.
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Dash KK, Gavai PV, Wade R, Rajani A. It's not what it looks like: challenges in diagnosis of synovial lesions of the knee joint. J Exp Orthop 2016; 3:5. [PMID: 26915005 PMCID: PMC4731382 DOI: 10.1186/s40634-016-0039-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the advent of MRI (Magnetic Resonance Imaging), Synovial lesions around knee are being more and more easily detected. Synovial lesions of knee present with boggy swelling, effusion, pain, and restriction of motion. Differential diagnoses of such lesions include pigmented villonodular synovitis, synovial lipoma, synovial chondromatosis, rheumatoid arthritis, synovial hemangioma, amyloid arthropathy, xanthomata and lipoma arborescens. CT and MRI often help in diagnosis of such lesions. MRI of Lipoma Arborescens has been regarded to have characteristic diagnostic appearance - it includes a synovial mass with frond-like architecture and fat signal intensity on all pulse sequences. Sometimes Lipoma Arborescens can present in conjunction with inflammatory arthritis. Synovectomy is often curative for such conditions. FINDINGS We report two cases where lesions diagnosed as Lipoma Arborescens on MRI subsequently revealed to be chronic inflammatory synovitis, characterized by absence of fat infiltration in histopathological examination - refuting the original diagnosis. There was infiltration of lymphocytes and neutrophils in the synovium, suggestive of chronic inflammatory arthritis. Both of these patients required management from rheumatologist, and had relief of symptoms after use of methotrexate and hydroxychloroquine. We also report a third case, where a loose body appearing as chondral fragment on arthroscopy was subsequently diagnosed as an organized hematoma on histopathological examination. CONCLUSION Diagnostic pitfalls after MRI of the knee is not uncommon. For example - normal variant of meniscomeniscal ligaments have been reported as meniscal tears; motion artifacts have been falsely reported as meniscal injuries; and meniscofemoral ligament can appear as free osteochondral fragment. In most of these cases, a routine arthroscopy is enough to clear the confusion. However, as evident in the three cases described here - in some synovial lesions of knee joint, even after MRI and arthroscopic examination, histopathological confirmation may still be prudent. In spite of availability of advanced imaging technologies and high definition arthroscopy equipment, an arthroscopy surgeon still must not forget the value of histopathological examination in establishing the true nature of synovial lesions of the knee joint.
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Affiliation(s)
- Kumar Kaushik Dash
- Department of Orthopaedics, Grant Government Medical College & Sir J.J. Group of Hospitals, Byculla, Mumbai, India.
| | - Piyush Vishwas Gavai
- Department of Orthopaedics, Grant Government Medical College & Sir J.J. Group of Hospitals, Byculla, Mumbai, India.
| | - Roshan Wade
- Department of Orthopaedics, Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, India.
| | - Amyn Rajani
- Department of Orthopaedics, Grant Government Medical College & Sir J.J. Group of Hospitals, Byculla, Mumbai, India.
- Breachcandy Hospital & Saifee Hospital, Mumbai, India.
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Re. Am J Phys Med Rehabil 2016; 95:e90. [DOI: 10.1097/phm.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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