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Bruns J, Rosenbaum B, Thorns C. Localized pigmented villo-nodular synovitis of trochanteric bursa. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2023; 12:Doc08. [PMID: 38024102 PMCID: PMC10665716 DOI: 10.3205/iprs000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This is the first report on a localized pigmented villo-nodular synovitis (PVNS or TSGCT) occurring in the trochanteric bursa. Bursal involvement in PVNS is extremely rare. Most often PVNS occurs either as a localized or diffuse lesion in a major synovial joint, such as the knee, ankle joint or hip joint. In principle, all synovial structures can be involved. The case reported here is remarkable regarding the long period between the occurrence of the first symptoms and the final diagnosis as well as the age of the female patient (75 yrs). Therapeutically a complete resection was performed in order to avoid recurrence. More then three years later the patient did well and there has been no evidence of recurrence yet.
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Affiliation(s)
- Juergen Bruns
- Dept. of Orthopedic Surgery, Wilhelmsburg Hospital Groß-Sand, Hamburg, Germany
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Porto C, Ayala C, Feler J, Santos-Fontanez S, Poggi J, Kritselis M, Doberstein C. Diffuse-type tenosynovial giant cell tumor between the suboccipital bone and posterior C1 arch: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23288. [PMID: 37728324 PMCID: PMC10555556 DOI: 10.3171/case23288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/10/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Tenosynovial giant cell tumor (TGCT) occurs most commonly in the appendicular skeleton and is only rarely found in the vertebral column. Lesions of the craniocervical junction are particularly rare, with only 4 cases reported in the literature. The authors describe the case of a diffuse-type TGCT at the craniocervical junction. OBSERVATIONS A patient presented with a 1-year history of right-sided neck pain and bilateral neurological symptoms in the distribution of the right occipital nerve. A 20-mm homogeneously contrast-enhancing mass in the suboccipital and posterior C1 region was discovered on magnetic resonance imaging of the cervical spine. The tumor was operated on via a posterior approach, and gross-total resection (GTR) was achieved. Immunohistochemical (IHC) examination revealed a diffuse-type TGCT. The patient had an uneventful recovery. LESSONS TGCT can arise at the craniocervical junction and is easily misdiagnosed because of its rare occurrence. IHC examination of a tumor specimen should be done to confirm the diagnosis. GTR is the objective when treating these tumors, especially when they are the diffuse type, as they have a high recurrence rate. Radiation and small-molecule therapies are viable postoperative therapies if GTR cannot be achieved or in cases of recurrence.
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Yip SWY, Griffith JF. Image-guided synovial biopsy with a focus on neoplastic lesions. Skeletal Radiol 2023; 52:817-829. [PMID: 35869325 DOI: 10.1007/s00256-022-04094-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
Image-guided synovial biopsy is generally a safe, well-tolerated procedure, with a high diagnostic yield. Percutaneous biopsy is indicated for synovial tumours visible on imaging studies where a definitive diagnosis is not possible on imaging grounds alone and/or when a definite diagnosis is necessary prior to initiating long-term treatment. Synovial biopsy for suspected synovial tumour differs from the technique used for joint aspiration, where the most convenient path between the skin and joint is usually chosen and, also, to a lesser degree, to that used for non-tumoural synovial biopsy. During synovial biopsy for tumour, the needle path should be aligned so that it passes along the length of the synovial tumour, including for suspected malignant tumours, the planned resection plane whenever possible. This review outlines the approach to image-guided biopsy of joint synovial tumours.
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Affiliation(s)
- Stefanie W Y Yip
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong.
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Tie K, Wang H, Chen B, Yang X, Chen L. Midterm outcomes of 18 patients with primary intra-articular diffuse tenosynovial giant cell tumor (TGCT) of the knee treated with complete arthroscopic synovectomy and postoperative low-dose radiotherapy at a mean follow-up of 68 months. Arch Orthop Trauma Surg 2023; 143:2121-2127. [PMID: 35562595 DOI: 10.1007/s00402-022-04465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the long-term clinical outcome of the treatment of complete arthroscopic synovectomy combined with low-dose external radiotherapy in the knee affected by primary intra-articular diffuse tenosynovial giant cell tumor (TGCT). METHODS From May 2009 to January 2016, 18 patients with intra-articular diffuse TGCT underwent complete arthroscopic synovectomy and low-dose external-beam radiotherapy in Zhongnan Hospital were enrolled in this retrospective study. The preoperative symptoms of patients, the complications during or after the arthroscopic procedure and the recurrence were collected and recorded. Each patient was evaluated before treatment and at the follow-up visit. Efficacy evaluation criteria were based on Ogilvie-Harris score, and the evaluation of the functional ability of knee was based on the International Knee Documentation Committee (IKDC) Score. RESULTS The mean time from symptom onset to surgery was 9.1 ± 5.8 months (range from 3 to 29 months). The most frequent preoperative symptoms were joint effusion (100%), diffuse non-specific knee pain (66.7%), and a decreased range of motion (83.3%). Mean follow-up time was 68.0 ± 18.1 months (range from 35 to 120 months). The mean evaluation score according to the Ogilvie-Harris criteria before treatment was 3.19 ± 0.74, which corresponded to a rating of "poor". The mean score after treatment was 8.79 ± 1.57, rated as "good". The Ogilvie-Harris score was significantly increased after treatment (P = 0.003). The IKDC score of all patients increased significantly from 37.1 ± 3.8 before treatment to 83.9 ± 11.3 after treatment. The IKDC score was obviously increased after treatment (P = 0.001). No recurrence was noted at final follow-up. There were no complications during or after the arthroscopic procedure. CONCLUSION The outcome of this study proved that complete arthroscopic synovectomy combined with low-dose external radiotherapy was appropriate for treating primary intra-articular diffuse TGCT of the knee joint. It could be safely and reliably used with minimal complications, fast postoperative recovery and satisfactory control of recurrence rates.
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Affiliation(s)
- Kai Tie
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Hua Wang
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Biao Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Xu Yang
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Liaobin Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.
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Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Elbow. Case Rep Orthop 2022; 2022:7956167. [PMID: 36277026 PMCID: PMC9584726 DOI: 10.1155/2022/7956167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of synovium that surrounds the joints, tendon sheaths, and bursae. The elbow is rarely affected, making it difficult to establish treatment guidelines. This article relates on a case of a male patient who presented with elbow pain and decreased range of motion. Diagnosis was established with magnetic resonance imaging (MRI) and biopsy, followed by arthroscopic removal and synovectomy. The patient was pain free shortly after surgery and gained free range of motion after six weeks. At the most recent follow-up after six months, he remained clinically well. The most recent MRI did not reveal any recurrence.
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PD-L1 Status in Tenosynovial Giant Cell Tumors. Medicina (B Aires) 2022; 58:medicina58091270. [PMID: 36143947 PMCID: PMC9501118 DOI: 10.3390/medicina58091270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Tenosynovial giant cell tumors (TSGCTs) are benign soft tissue tumors that are divided into localized- and diffuse-type tumors, according to the World Health Organization classification of soft tissue tumours. The diffuse-type TSGCT sometimes behave aggressively and poses treatment challenges especially in patients with neurovascular involvement. Symptomatic patients who are not good candidates for surgery due to high morbidity risk may benefit from medical therapy. Objectives: Drugs that target programmed death ligand 1 (PD-L1) are among a new generation of medical therapy options, which, recently, have been explored and have displayed promising results in various cancer types; therefore, we aimed to investigate the PD-L1 status of TSGCTs as a possible therapeutic target. Materials and Methods: We assessed the PD-L1 status of 20 patients (15 men and 5 women, median age = 39 years) that had been diagnosed with TSGCTs in a single institution, between 2018 and 2020. The patients had localized- (n = 7) and diffuse-type (n = 13) TSGCTs. Formalin-fixed paraffin-embedded (FFPE) blocks were retrospectively retrieved from the pathology department. An immunohistochemical analysis was performed in sections of 3 micron thickness from these blocks. Results: Seventy-five percent of our patients with TSGCTs were immunopositive to PD-L1 staining. Conclusions: Taking into consideration the high positivity rate of PD-L1 staining in TSGCTs, PD-L1 blockage may be used as a valuable medical treatment for TSGCTs; however, further studies are needed.
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Cheok T, Wills K, Berman M, Jennings MP, Poonnoose PM. Open or Arthroscopic Synovectomy Is the Preferred Management Option in Pigmented Villonodular Synovitis of the Hip Joint Without Evidence of Degeneration: A Systematic Review of 20 Studies. Arthrosc Sports Med Rehabil 2022; 4:e1873-e1886. [PMID: 36312712 PMCID: PMC9596911 DOI: 10.1016/j.asmr.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To provide an up-to-date systematic review on the treatment options for pigmented villonodular synovitis (PVNS) of the hip and provide a grade of recommendation using standardized systems. Methods A systematic search of PubMed, Embase, Web of Science, and The Cochrane Library from the date of inception of each database through December 4, 2021, was performed. Studies that described the outcomes of treatment of hip PVNS were identified. These outcomes were discussed and synthesized by three reviewers, and a grade of recommendation was assigned. Results Twenty studies were identified. Seven studies described arthroscopic synovectomy, eight studies described open synovectomy, nine studies described arthroplasty, and one study described osmic acid synoviorthesis. Synovectomy, either open or arthroscopic, had similar rates of disease recurrence. Hip arthroplasty had low rates of disease recurrence compared to synovectomy; however, it was associated with significant risk of aseptic loosening in the longer term. Conclusion Synovectomy, either open or arthroscopic based on surgeon preference, is favored in the treatment of hip PVNS if there is no evidence of joint space narrowing. Arthroplasty should be considered in cases with joint space narrowing or recurrence following joint preservation therapy. There is insufficient evidence to support synoviorthesis either as monotherapy or adjuvant therapy. Level of Evidence IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Tim Cheok
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Department of Orthopaedic Surgery, MidCentral District Health Board Palmerston North Hospital, Roslyn, Palmerston North, New Zealand
- Address correspondence to Dr. Tim Cheok, B.Clin.Sc., M.D., M.S. (Trauma/Ortho), G.Dip.Biostat., G.Stat., MidCentral District Health Board Palmerston North Hospital, 50 Ruahine St., Roslyn, Palmerston North 4442, New Zealand.
| | - Kenneth Wills
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia
| | - Morgan Berman
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Matthew Phillip Jennings
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Pradeep Mathew Poonnoose
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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Song J, Jiang K, Lv Z, Liu B. Surgical Treatment of Sacroiliac Pigment Villous Nodular Synovitis: A Case Report and Literature Review. Front Surg 2022; 9:760704. [PMID: 35574542 PMCID: PMC9095913 DOI: 10.3389/fsurg.2022.760704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Pigmented villonodular synovitis (PNVS) is a rare and disabling disease that is thought to occur mostly in the knee joint. Here, the authors first present a unique case of PNVS occurring at the sacroiliac joint. The patient complained of sacroiliac joint pain with mild swelling. CT and MRI showed that the tumor was ~63 by 91 by 107 mm in size, and was considered to be a fibrous borderline or low-grade malignancy. Intraoperative macroscopic features of the synovitis during operation suggested PNVS, which was confirmed by histopathological examination. The clinical symptoms and signs of the disease, in this case, are not obvious, and radiological investigations, including MRI, suggest high aggressiveness. The author believes that it may be more likely to relapse and metastasis and recommends complete removal of the synovial membrane and regular follow-up, while preoperative or postoperative radiotherapy and molecular targeted therapy are not recommended for the time being.
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Affiliation(s)
- Jiashi Song
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Orthopedics, Rongjun Hospital, Jiaxing, China
| | - Kunpeng Jiang
- Department of Orthopedics, Rongjun Hospital, Jiaxing, China
| | - Zhanhu Lv
- Department of Orthopedics, Fourth Affiliated Hospital, School of Medicine, Shihezi University, Aksu, China
| | - Bing Liu
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bing Liu
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Souza MFS, Borges NC, Bittar IP, Neves CA, Silva WPRD, Franco LG, Silva MAM. Ultrasound assessment of sheep stifle joint undergone lipopolysaccharide-induced synovitis. CIÊNCIA ANIMAL BRASILEIRA 2022. [DOI: 10.1590/1809-6891v22e-70607e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Synovitis can be induced in animals through the application of bacterial wall lipopolysaccharide and has similar signs to naturally-occurring synovitis. Several studies have been using the sheep species as an experimental model to understand osteoarticular diseases of the femorotibiopatellar (FTP) joint in humans. There are echographic studies on the standardization of normality of the femorotibiopatellar joint in sheep. However, there is a gap in the literature for changes such as acute synovitis. The objective was to serially describe the sonographic aspects of the synovitis process induced by intra-articular infiltration of Escherichia coli (E. coli) lipopolysaccharide in the femorotibiopatellar joint of sheep. Twelve healthy crossbred sheep (Santa Inês x Dorper) were used. Induction of synovitis was performed only in the right FTP joints, which were serially evaluated using ultrasound examination at baseline moment (M0) and 12 (M12), 24 (M24), 48 (M48), 72 (M72), and 120 (M120) hours after lipopolysaccharide infiltration for synovitis induction. Intra-articular application of E. coli lipopolysaccharide resulted in one or more echographic signs of synovitis (increased synovial fluid volume, folding of the synovial membrane, and cellularity in the joint cavity), which were identified early, 12 hours after inoculation, and regressed over the evaluated times (p=0.0001) until disappearing after 120 hours of inoculation.
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Souza MFS, Borges NC, Bittar IP, Neves CA, Silva WPRD, Franco LG, Silva MAM. Ultrassonografia da articulação femorotibiopatelar em ovinos submetidos à indução de sinovite por lipopolissacarídeos. CIÊNCIA ANIMAL BRASILEIRA 2022. [DOI: 10.1590/1809-6891v22e-70607p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo A sinovite pode ser induzida em animais por meio da aplicação de lipopolissacarídeo de parede bacteriana, e apresenta sinais semelhantes à sinovite causada de forma natural. Diversos estudos têm sido realizados utilizando a espécie ovina como modelo experimental na compreensão das enfermidades osteoarticulares da articulação femorotibiopatelar (FTP) em humanos. Existem estudos ecográficos quanto a padronização da normalidade da articulação femorotibiopatelar em ovinos. Porém, para as alterações, como a sinovite aguda há lacuna na literatura. Objetivou-se descrever, de forma seriada, os aspectos ultrassonográficos do processo de sinovite induzida por infiltração intra-articular de lipopolissacarídeo de Escherichia coli (E. coli) na articulação femorotibiopatelar de ovinos. Foram utilizados 12 ovinos mestiços (Santa Inês x Dorper), hígidos. A indução da sinovite foi realizada apenas nas articulações FTP direitas, as quais foram avaliadas, por meio do exame ultrassonográfico de forma seriada, nos momentos basal (M0) e às 12 (M12), 24 (M24), 48 (M48), 72 (M72) e 120 (M120) horas após a infiltração com lipopolissacarídeo para a indução de sinovite. A aplicação intra-articular de lipopolissacarídeo de E. coli resultou em um ou mais sinais ecográficos de sinovite (aumento de volume do fluido sinovial, pregueamento da membrana sinovial e celularidade na cavidade articular), os quais foram identificados precocemente, 12 horas após a inoculação, e regrediram ao longo dos tempos avaliados (p=0,0001), até desaparecerem após 120 horas da inoculação.
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Zarate SD, Joyce DM, Belzarena AC. Tenosynovial giant cell tumor of the distal tibiofibular joint. Radiol Case Rep 2021; 16:950-955. [PMID: 33659035 PMCID: PMC7896125 DOI: 10.1016/j.radcr.2021.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/19/2022] Open
Abstract
Tenosynovial giant cell tumors are extremely rare tumors with highly nonspecific symptoms. This benign but aggressive disease has a slow course of progression; however, it can ultimately lead to irreversible damage to a joint. Here we describe a case of a 45-year-old female with a diagnosis of tenosynovial giant cell tumors of the distal tibiofibular joint, the second case described in the literature for such location. Appropriate imaging studies and ultimately histologic studies are necessary for the correct diagnosis. Some locations are particularly unusual for these tumors making a high level of suspicion as well as treatment by an oncology orthopedic surgery specialist at a high-volume center paramount.
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Affiliation(s)
- Stephanie D. Zarate
- Orthopaedic Oncology Department, Miami Cancer Institute, 8900 N Kendall Dr., Miami, FL 33176, USA
| | - David M. Joyce
- Sarcoma Department, Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL 33612, USA
| | - Ana C. Belzarena
- Orthopaedic Oncology Department, Miami Cancer Institute, 8900 N Kendall Dr., Miami, FL 33176, USA
- Corresponding author.
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cIAP2 expression and clinical significance in pigmented villonodular synovitis. J Mol Histol 2021; 52:397-406. [PMID: 33599891 DOI: 10.1007/s10735-021-09961-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/02/2021] [Indexed: 02/08/2023]
Abstract
Pigmented villonodular synovitis (PVNS) is a rare hyperplasia disease of the synovium with a predilection for the knee in either a localized (LPVNS) or a diffuse form (DPVNS). But the exact cause is not clear. The aim of this study was to explore the relationship between the expression of cellular inhibitor of apoptosis 2 (cIAP2) and proliferation, apoptosis, invasive growth and postoperative recurrence in PVNS. Clinical significance of cIAP2 expression in synovium from 63 patients' knee joints with PVNS (40 DPVNS; 23 LPVNS) were investigated with 20 normal subjects acting as controls. The cIAP2 gene was screened by Human Cancer Pathway Finder PCR Array and real-time polymerase chain reaction (RT-PCR). We also used immunohistochemistry to detect cIAP2 and proliferating cell nuclear antigen (PCNA) protein expression and analyzed their relationship with PVNS type, invasive growth, and postoperative recurrence. The expression of cIAP2, PCNA, caspase-8, caspase-9 and caspase-3 protein was tested in Western blot. Screening results of Human Cancer Pathway Finder PCR array and RT-PCR showed significantly more cIAP2 mRNA in DPVNS synovium than in normal or LPVNS synovium (P < 0.05). Immunohistochemistry and western blot showed that the cIAP2 protein expression level in DPVNS was significantly higher than in LPVNS tissue (P < 0.01). As cIAP2 expression increased, the expression of PCNA increased (P < 0.05) and expression of cleaved caspase-3, -8, -9 decreased (P < 0.01). cIAP2 and PCNA overexpression were found to be related to ligament and bone erosion in PVNS and to disease recurrence (P < 0.05). This study suggested that cIAP2 overexpression plays an important role in the anti-apoptotic, proliferative and invasive growth of PVNS, which may account for the recurrence and poor prognosis of DPVNS.
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Heo S, Park SY, Seo J, Koh SH, Lee IJ. Diffuse-Type Tenosynovial Giant Cell Tumor of the Tendon Sheath in Both Wrists. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:250-254. [PMID: 36237452 PMCID: PMC9432412 DOI: 10.3348/jksr.2020.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 11/15/2022]
Abstract
Diffuse-type tenosynovial giant cell tumor (D-TSGCT), previously known as pigmented villonodular synovitis, is a locally aggressive neoplasm that may arise from the synovium, bursa, or tendon sheath. D-TSGCT is usually monoarticular and can be classified into intra- and extra-articular forms, the latter of which is rarer. Here, we report a case of D-TSGCT in a 64-year-old female that involved the entire flexor and extensor tendon sheaths of both wrists. We describe the ultrasonography and MRI findings, as well as review the relevant literature.
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Affiliation(s)
- Sunah Heo
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sun-Young Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jinwon Seo
- Department of Patholgy, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung Hye Koh
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - In Jae Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Hsieh SF, Wu SY, Hung YC, Wang GS. Concurrence of Pigmented Villonodular Synovitis with Calcium Pyrophosphate Deposition in a Postacute Stroke Patient. J Med Ultrasound 2020; 28:188-191. [PMID: 33282666 PMCID: PMC7709534 DOI: 10.4103/jmu.jmu_107_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/15/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a rare synovial proliferative disease featuring hemosiderin deposits. Calcium pyrophosphate deposition (CPPD) is a crystal-induced inflammatory arthritis common in the elderly. We reported the case of a 78-year-old male who was under stroke rehabilitation when acute inflammatory and hemorrhagic knee arthritis of his paretic lower limb occurred. CPPD was proven by synovial analysis. Ultrasonography showed widespread synovial nodular lesions in the affected knee and helped guiding difficult arthrocentesis. These led to a rapid diagnosis of PVNS with magnetic resonance imaging. In elderly stroke patients, knee pain, being a common complaint, warrants a careful diagnosis including adequate imaging. This case demonstrates that ultrasonography is an accessible and useful diagnostic tool.
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Affiliation(s)
- Shiau-Fu Hsieh
- Department of Physical and Rehabilitation Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shu-Yih Wu
- Department of Physical and Rehabilitation Medicine, Asia University Hospital, Taichung, Taiwan
| | - Yu-Chung Hung
- Department of Radiology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Guo-Shou Wang
- Department of Orthopaedics Surgery, MacKay Memorial Hospital, Taipei, Taiwan
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Zhao Q, Lu H. Giant cell tumor of tendon sheath in the wrist that damaged the extensor indicis proprius tendon: a case report and literature review. BMC Cancer 2019; 19:1057. [PMID: 31694605 PMCID: PMC6836650 DOI: 10.1186/s12885-019-6293-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Giant cell tumor of the tendon sheath (GCTTS) is a benign soft tissue (synovial membrane) tumor that rarely involves the hands or wrists. And Tendon impairment caused by GCTTS is extremely rare. CASE PRESENTATION Here, we reported a case of a 60-year-old female with a 10-year history of gradually increasing mass in her left dorsal wrist. The EIP tendon was partially impaired by the mass.The patient was treated with surgical excision of the mass and reconstruction of the EIP tendon. The histopathological examination suggested the presence of GCTTS. After surgery, the patient had adequate functional recovery and no tumor recurrence after 2 years' follow-up. CONCLUSION GCTTS in hands and wrists rarely damages the tendon. Early diagnosis and proactive interventions may likely contribute to good prognostic outcomes.
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Affiliation(s)
- Qingfang Zhao
- Department of Plastic Surgery, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003 People’s Republic of China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003 People’s Republic of China
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Galbiatti JA, Milhomens GRDS, Silva LFHFE, Santiago DDS, Silva Neto JCD, Belluci SDOB. Retrospective Study of the Results of Surgical Treatment of 31 Giant Cell Tumors of the Tendon Sheath in the Hand. Rev Bras Ortop 2019; 54:26-32. [PMID: 31363239 PMCID: PMC6424816 DOI: 10.1016/j.rbo.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/23/2017] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the results of the treatment of 31 giant-cell tumors of the tendon sheath of the hand cared for between 2006 and 2015. Methods A group of patients for the present retrospective evaluation was defined, covering the period between February 2006 and November 2015, in which 31 records of patients who underwent surgery due to cell tumor of the tendon sheath of the fingers were studied and evaluated. The recommended treatment was complete excision of the tumor with preservation of the adjacent structures. The diagnosis was confirmed by pathological examination. The progress of the treatment after surgery was evaluated, especially regarding the rate of tumor recurrence. Results Taking all 31 patients into consideration, there was a predominance of the female gender and white ethnicity. Most of these patients were aged between 30 and 50 years. The most affected side was the left one, and most tumors were in the flexor face. There was a predominance of the radial fingers, along with their distal end. A total of 27 patients are being followed up at regular intervals at an outpatient clinic, and three cases of tumor recurrence have been identified. Conclusion An appropriate surgical technique is essential in order to prevent GCTTS recurrences. The results obtained in this research are in agreement with the literature.
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Novikov D, Richardson MW, Ho C, Gould ES, Khan FA. A Rare Incidence of Pigmented Villonodular Synovitis of the Ankle in an Adolescent. J Foot Ankle Surg 2019; 57:1263-1266. [PMID: 30146337 DOI: 10.1053/j.jfas.2018.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Indexed: 02/03/2023]
Abstract
Pigmented villonodular synovitis mostly affects the knee and other large joints such as the hip. Although the disease is most commonly found in adult patients aged 30 to 40 years, rare cases in children and the elderly have been reported. We present the case of an 11-year-old female who was found to have biopsy-proven pigmented villonodular synovitis in her subtalar joint in 2012. Five years after surgical excision, the patient has continued to be involved in competitive dancing and cheerleading without any pain in her ankle. Moreover, follow-up magnetic resonance imaging studies showed no evidence of recurrence. Our case report emphasizes that the disease should not be solely considered in the middle-age population but should be included in the differential diagnosis of the pediatric patient.
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Affiliation(s)
- David Novikov
- Medical Student, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Meghan W Richardson
- Resident, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Corey Ho
- Fellow, Department of Radiology, Stony Brook University Hospital, Stony Brook, NY
| | - Elaine S Gould
- Clinical Professor, Department of Radiology & Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Fazel A Khan
- Assistant Professor, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY.
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Long-Term Outcome of Hip Arthroplasty in the Setting of Pigmented Villonodular Synovitis. J Arthroplasty 2018; 33:1467-1471. [PMID: 29352684 DOI: 10.1016/j.arth.2017.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/07/2017] [Accepted: 12/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare, benign, painful proliferation of the synovium previously treated successfully with total hip arthroplasty (THA). Published results come from small series; therefore, the purpose of this study is to investigate the outcomes of THA in the setting of PVNS. METHODS We identified 25 patients with histologically confirmed, diffuse PVNS who underwent THA between 1971 and 2013. Mean follow-up and age was 10 years and 39 years. Before arthroplasty, 16 patients (64%) had at least 1 surgical procedure (mean, 1; range, 1-3) to treat PVNS. Twenty (80%) patients had "active" disease and underwent synovectomy. No constrained acetabular components were used. RESULTS The 10-year disease free-survival was 100%. Recurrence occurred in 1 patient at 24 years postoperatively. Nineteen patients (76%) sustained a complication (most commonly component loosening (n = 12 [48%]), and 16 required revision surgery. The 10-year revision-free survival was 66% for conventional polyethylene implants and 100% for highly cross-linked polyethylene devices. Mean Harris Hip Score improved significantly from 48 (range, 23-69) preoperatively to 78 (range, 47-96) postoperatively (P < .001). CONCLUSION THA in the setting of PVNS improves patient function with a low rate of local recurrence. Complication and revision rates are high in this series likely owing to the young and active patient population and the use of conventional polyethylene. Modern bearings theoretically reduce the risk of revision.
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Giant cell tumor of tendon sheath: Open surgery or arthroscopic synovectomy? A systematic review of the literature. Orthop Traumatol Surg Res 2017; 103:809-814. [PMID: 28428036 DOI: 10.1016/j.otsr.2017.03.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/09/2017] [Accepted: 03/22/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Giant cell tumor of tendon sheath (GCTTS), formerly known as pigmented villonodular synovitis (PVNS), is a benign, locally aggressive, proliferative disorder of the synovium involving a joint, bursa, or tendon sheath. Treatment of GCTTS involves early surgical resection to limit articular destruction and the risk of recurrence. Synovectomy remains the treatment of choice for GCTTS, but without clear consensus to make an open or arthroscopic synovectomy and no certainty on the responsibility of surgery in the evolution towards the degenerative osteoarthritis. The aim of this study was to evaluate the long-term clinical outcomes and the rate of recurrence of open or arthroscopic excision of GCTTS of the four most frequently involved joints: the shoulder, hip, knee and ankle. METHODS We performed a systematic review of literature in September 2015. The keywords were "villonodular synovitis" AND "surgical treatment". The two authors analyzed 413 articles, according to title and abstract. Forty articles were selected, read entirely and references were analyzed. RESULTS Thirty-three articles were selected. CONCLUSION Our review of literature showed that arthroscopic excision is effective for localized type of GCTTS for all four joints. In diffuse type GCTTS, the efficacy of arthroscopic synovectomy has only been shown for the knee joint. In the other joints, early diagnosis can improve clinical outcomes, but we cannot certify that surgical treatment avoids osteoarthritis degradation. STUDY DESIGN Review of literature, level of evidence IV.
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Gao M, Li H, Liang X, Fu X, Li X. Multifocal pigmented villonodular synovitis coexisting in both the knee joint and the patella: a case report and literature review. BMC Musculoskelet Disord 2017; 18:293. [PMID: 28683727 PMCID: PMC5501528 DOI: 10.1186/s12891-017-1654-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/30/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUD Pigmented villonodular synovitis (PVNS) is an uncommon entity of proliferative lesion of the synovium, presenting with different clinical signs and symptoms. PVNS rarely forms an osteolytic lesion in a bone. Here we report a unique case of PVNS with a nodular lesion in the left patella. CASE PRESENTATION A 37-year-old female was referred to our hospital with complaints of ongoing left knee pain and a painful and palpable mass in her left popliteal fossa. MRI demonstrated a nodular lesion in the left patella, diffuse affected synovial tissue in the left knee and an extra-articular mass in the left popliteal fossa. After a primary diagnosis of PVNS had been established, combined arthroscopic synovectomy and open resection were performed. The postoperative pathological diagnoses of the resected mass from the popliteal fossa, the affected synovial tissue and the lesion in the patella were consistent with PVNS. At 1-year follow-up, no evidence of recurrence was noted. CONCLUSIONS Based on brief literature review of PNVS, we presented a very rare case of PVNS with a nodular lesion in the left patella, diffuse affected synovial tissue in the left knee and an extra-articular mass in the left popliteal fossa.
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Affiliation(s)
- Mingxuan Gao
- Department of Joint Surgery, Lanzhou General Hospital of PLA, NO. 333 Nanbinhe Road, Qilihe District, Lanzhou, Gansu Province, 730050, China
| | - Hong Li
- Ophthalmology Center, Lanzhou General Hospital of PLA, Gansu, 730050, China
| | - Xiaoyan Liang
- Department of Joint Surgery, Lanzhou General Hospital of PLA, NO. 333 Nanbinhe Road, Qilihe District, Lanzhou, Gansu Province, 730050, China
| | - Xiaoyan Fu
- Ultrasonic Diagnosis Department, Lanzhou General Hospital of PLA, Gansu, 730050, China
| | - Xusheng Li
- Department of Joint Surgery, Lanzhou General Hospital of PLA, NO. 333 Nanbinhe Road, Qilihe District, Lanzhou, Gansu Province, 730050, China.
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Gouin F, Noailles T. Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis). Orthop Traumatol Surg Res 2017; 103:S91-S97. [PMID: 28057477 DOI: 10.1016/j.otsr.2016.11.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 02/02/2023]
Abstract
Tenosynovial giant cell tumor (TSGCT) is a rare benign tumor arising from joint synovia, bursae and tendon sheaths. Their variable clinical presentation is related to variations in site and progression. Localized forms are most frequent in the hands, and diffuse forms in the knee. MRI is necessary and sometimes sufficient for diagnosis. Treatment strategy is guided by progression, symptomatology, location and diathesis. Optimally complete resection is the principle of first-line treatment. Radiation therapy is effective and targeted therapies are promising; both should especially be considered in case of relapse.
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Affiliation(s)
- F Gouin
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, place A.-Ricordeau, 44093 Nantes cedex, France; LPRO, Inserm UI957, Laboratoire de la Résorption Osseuse et des Tumeurs Osseuses Primitives, Faculté de Médecine, Université de Nantes, 44000 Nantes, France.
| | - T Noailles
- CHU de Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, Hôtel-Dieu, place A.-Ricordeau, 44093 Nantes cedex, France
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Arthroscopically-assisted mini open partial synovectomy for the treatment of localized pigmented villonodular synovitis of the knee. A retrospective comparative study with long-term follow up. INTERNATIONAL ORTHOPAEDICS 2016; 41:925-930. [DOI: 10.1007/s00264-016-3348-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/11/2016] [Indexed: 12/29/2022]
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Cattelan M, Bonnomet F, Bierry G, Di Marco A, Brinkert D, Adam P, Ehlinger M. Villonodular synovitis of the ankle. Analysis of the risk of recurrence. Orthop Traumatol Surg Res 2016; 102:639-44. [PMID: 27197681 DOI: 10.1016/j.otsr.2016.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Villonodular synovitis (VNS) is a rare disease with an incidence of 1.8 per 1,000,000 inhabitants. VNS of the ankle has seldom been described and evaluated given its extreme rarity (2.5% of VNS cases). It presents an 11% recurrence rate. We report a continuous retrospective series with the main objective of clinically and radiologically evaluating these ankles searching for any risk factors of recurrence. At revision the study's main endpoint was the existence of local recurrence (radiological and clinical) and the secondary endpoint was the existence of tibiotalar osteoarthritis. The working hypothesis was that recurrence could be subclinical, warranting systematic imaging studies during follow-up. MATERIAL AND METHODS The study was retrospective, conducted on seven patients (six males) whose mean age was 42 years treated over a period of 9 years (two diffuse forms and five localized forms). The initial treatment consisted in synovectomy via the conventional approach. Four patients also received adjuvant isotopic synoviorthesis treatment. The revision was clinical (MMTS, AOFAS, and OMAS scores) and radiological (standard and MRI) to evaluate the joint after-effects and search for recurrence. RESULTS Six patients were seen at a mean 6.5 years of follow-up. One case of early recurrence (4 years) was noted, with a major clinical manifestation because it was associated with joint destruction requiring arthrodesis, and one case of late asymptomatic recurrence (9 years), diagnosed radiologically on the follow-up MRI. The functional results remained good at follow-up (MMTS 77%, AOFAS 71, OMAS 71). Five of the six patients returned to their daily activities. At revision, no sign of osteoarthritis was observed. No risk factor for recurrence was demonstrated. DISCUSSION/CONCLUSION The hypothesis was confirmed with the existence of asymptomatic recurrence at revision, underscoring the value of systematic MRI at follow-up. Other than major joint destruction, the prognosis remains good even in case of recurrence. The literature emphasizes the existence of an initial diffuse form and partial surgical resection as risk factors of recurrence. None of the reports in the literature has proven that adjuvant treatment, whose modalities do not meet with consensus, reduces this risk. LEVEL OF EVIDENCE Retrospective series, level IV.
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Affiliation(s)
- M Cattelan
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - F Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - G Bierry
- Service de Radiologie Ostéoarticulaire, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - A Di Marco
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - D Brinkert
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - P Adam
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - M Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Abstract
INTRODUCTION Pigmented villonodular synovitis (PVNS) is a rare, benign proliferative disorder of the synovial membrane that typically presents in adults and affects a single joint. Multifocal PVNS is very rare, particularly in childhood. We reported a rare case of multifocal PVNS affecting over 20 joints in a child. CLINICAL PROCEDURE A 7-year-old female patient had a 6-month history of multifocal joints swelling with mild pain. She was diagnosed as polyarticular juvenile idiopathic arthritis at a local hospital. Naproxen, methotrexate, infliximab, and pavlin were used to treat the patient for 2 months. However, the treatment had no effect, the joints swelling remained. The patient was then transferred to our hospital. Physical examination revealed multiple joints swelling, especially in the shoulders joints. Puncture fluid from a shoulder joint was bloody. Magnetic resonance imaging (MRI) revealed synovial thickening and hemosiderin deposition. Biopsy of joint synovium found villous nodules, the invasion of foam cells, and hemosiderin deposition. By collecting all of the evidence, the diagnosis of PVNS was confirmed. CONCLUSIONS PVNS was easily misdiagnosed as rheumatoid arthritis and the formal treatment was usually delayed. This case described here is the first case of PVNS involving such a large numbers of joints that has been reported in the literature.
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Affiliation(s)
- Liang Zhao
- Department of Pediatrics
- Key Laboratory of Ministry of Education for Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kaiyu Zhou
- Department of Pediatrics
- Key Laboratory of Ministry of Education for Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yimin Hua
- Department of Pediatrics
- Key Laboratory of Ministry of Education for Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yifei Li
- Department of Pediatrics
- Key Laboratory of Ministry of Education for Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics
- Key Laboratory of Ministry of Education for Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China
- Correspondence: Dezhi Mu, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China (e-mail: )
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van der Heijden L, Piner SR, van de Sande MAJ. Pigmented villonodular synovitis: a crowdsourcing study of two hundred and seventy two patients. INTERNATIONAL ORTHOPAEDICS 2016; 40:2459-2468. [PMID: 27169531 DOI: 10.1007/s00264-016-3208-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/19/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE We aimed to ascertain the feasibility of crowdsourcing via Facebook for medical research purposes; by investigating surgical, oncological and functional outcome and quality-of-life (QOL) in patients with pigmented villonodular synovitis (PVNS) enrolled in a Facebook community (1112 members). METHODS Patients completed online open surveys on demographics, surgery and clinical outcomes (group 1); and patient-reported outcome measures (PROMs) including knee-injury osteoarthritis outcome score (KOOS), hip-disability osteoarthritis outcome score (HOOS), Toronto extremity salvage score (TESS) and SF-36 (group 2). Mean follow-up was 70 months (12-374). Consistency checks were performed with Cohen's kappa statistic for intra-rater agreement. RESULTS The first survey was completed by 272 patients (group 1) and 72 patients completed the second (group 2). In group 1, recurrence-rate was 58 % (69/118) after arthroscopic, 36 % (35/97) after open and 50 % (5/10) after combined synovectomy (p = 0.003). In group 2, recurrence-rate was 67 % (26/39) after arthroscopic and 51 % (17/33) after open synovectomy (p = 0.19). Recurrence-risk was increased for diffuse disease (OR = 16; 95%CI = 3.2-85; p < 0.001). Mean function and QOL did not differ after arthroscopic or open synovectomy: KOOS 49 vs. 58 (p = 0.24), HOOS 62 vs. 53 (p = 0.56), TESS 78 vs. 82 (p = 0.86), SF-36 61 vs. 66 (p = 0.41). Cohen's kappa statistic for intra-rater agreement was good to outstanding (κ = 0.68-0.95; p < 0.001). CONCLUSION Local recurrence-risk was higher for diffuse-type disease and arthroscopic synovectomy. Functional outcome and QOL were comparable for both types of surgery. Gathering data via crowdsourcing seems a promising and innovative way of evaluating rare diseases including PVNS.
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Affiliation(s)
- Lizz van der Heijden
- Orthopaedic Surgery, Leiden University Medical Centre, Postzone J11-R70, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Sheila R Piner
- Leiden University Medical Centre, Postzone J11-R70, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Lalam RK, Cribb GL, Cassar-Pullicino VN, Cool WP, Singh J, Tyrrell PNM, Tins BJ, Winn N. Radiofrequency thermo-ablation of PVNS in the knee: initial results. Skeletal Radiol 2015; 44:1777-84. [PMID: 26290324 DOI: 10.1007/s00256-015-2233-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/25/2015] [Accepted: 08/03/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pigmented villonodular synovitis (PVNS) is normally treated by arthroscopic or open surgical excision. We present our initial experience with radiofrequency thermo-ablation (RF ablation) of PVNS located in an inaccessible location in the knee. MATERIALS Review of all patients with histologically proven PVNS treated with RF ablation and with at least 2-year follow-up. RESULTS Three patients met inclusion criteria and were treated with RF ablation. Two of the patients were treated successfully by one ablation procedure. One of the three patients had a recurrence which was also treated successfully by repeat RF ablation. There were no complications and all patients returned to their previous occupations following RF ablation. CONCLUSION In this study we demonstrated the feasibility of performing RF ablation to treat PVNS in relatively inaccessible locations with curative intent. We have also discussed various post-ablation imaging appearances which can confound the assessment for residual/recurrent disease.
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Affiliation(s)
- Radhesh K Lalam
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK.
| | - Gillian L Cribb
- Department of Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, USA
| | - Victor N Cassar-Pullicino
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
| | - Wim P Cool
- Department of Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, USA
| | - Jaspreet Singh
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
| | - Prudencia N M Tyrrell
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
| | - Bernhard J Tins
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
| | - Naomi Winn
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, England, SY10 7AG, UK
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Shah SH, Porrino JA, Green JR, Chew FS. Bilateral pigmented villonodular synovitis of the knee. Radiol Case Rep 2015; 10:56-60. [PMID: 26649121 PMCID: PMC4668628 DOI: 10.1016/j.radcr.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/11/2015] [Indexed: 11/24/2022] Open
Abstract
Pigmented villonodular synovitis is a disorder resulting in a villous, nodular, or villonodular proliferation of the synovium, with pigmentation related to the presence of hemosiderin. These lesions are almost exclusively benign with rare reports of malignancy. Pigmented villonodular synovitis can occur in a variety of joints and at any age but most often occurs within the knee in the young adult. Pigmented villonodular synovitis is a rare disease entity, and bilateral synchronous or metachronous involvement of a joint is even more uncommon, with few reports previously described in the literature. We present a case of pigmented villonodular synovitis involving both the right and left knee in the same patient, with radiographic imaging, magnetic resonance imaging, photograph and video intraoperative imaging, and pathologic correlation.
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Affiliation(s)
- Samir H Shah
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE Box 354755, Seattle, WA, 98105, USA
| | - Jack A Porrino
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE Box 354755, Seattle, WA, 98105, USA
| | - John R Green
- Department of Orthopaedics, University of Washington, Seattle, WA, USA
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE Box 354755, Seattle, WA, 98105, USA
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Psarelis S, Richards BW, Kourounis G, Hatzikosti M. Persistent knee effusion in a young female. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2015; 15:237-9; quiz 239. [PMID: 26032217 PMCID: PMC5133728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Psarelis
- Rheumatology Department – Nicosia General Hospital Cyprus,St George’s University of London Medical School, UK,Corresponding author: Dr. Savvas Psarelis MD, PhD, Honorary Associate Professor St George’s University of London Medical School, UK - Nicosia General Hospital, Cyprus E-mail:
| | | | - G. Kourounis
- St George’s University of London Medical School, UK
| | - M. Hatzikosti
- Radiology Department - Nicosia General Hospital Cyprus
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Gans I, Morrison MJ, Chikwava KR, Wells L. Intra-articular nodular fasciitis of the knee in a pediatric patient. Orthopedics 2014; 37:e313-6. [PMID: 24762162 DOI: 10.3928/01477447-20140225-67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/05/2013] [Indexed: 02/03/2023]
Abstract
The differential diagnosis for an intra-articular lesion in the knee of a pediatric patient is broad. Diagnostic considerations include pigmented villonodular synovitis (PVNS)-the most common intra-articular tumor-and a variety of both benign and malignant tumors, including lipomas, hemangiopericytomas, nodular fasciitis, parosteal osteosarcomas, and fibromyxoid sarcomas. If there is concern over possible malignant lesions, a tumor surgeon should be consulted. Precise pathologic diagnosis is ideal for identifying these enigmatic lesions and for determining the appropriate treatment plan. This article presents the case of a 13-year-old boy who presented with 1-month duration of knee pain and no history of trauma to the extremity. Physical examination revealed pain along the medial and lateral joint lines, pain with range of motion, and limited range of motion of the affected knee. Magnetic resonance imaging revealed a 3×1×3-cm lesion in the posterolateral corner that was believed to be localized PVNS. Arthroscopically, there was no evidence of PVNS, but a posterolateral soft tissue mass was found and removed, which was pathologically diagnosed as a rare, benign, intra-articular nodular fasciitis. When working with intra-articular masses, it is important to assess the likelihood of malignancy and to both consult a tumor surgeon and use the appropriate surgical tumor principles when malignancy is a concern. Additionally, the pathology team should be consulted prior to surgery and be on standby during arthroscopic evaluation of the knee to help with precise diagnosis of the intra-articular mass. Discussing the case with the pathologist with imaging studies present is helpful and often aids in the diagnosis of the lesion.
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Jain JK, Vidyasagar JVS, Sagar R, Patel H, Chetan ML, Bajaj A. Arthroscopic synovectomy in pigmented villonodular synovitis of the knee: clinical series and outcome. INTERNATIONAL ORTHOPAEDICS 2013; 37:2363-9. [PMID: 23860791 DOI: 10.1007/s00264-013-2003-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/22/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the long-term results of arthroscopic excision of pigmented villonodular synovitis (PVNS) of the knee joint. METHODS We retrospectively assessed the results of arthroscopic excision of PVNS done in 40 patients from 1987 to 2012 by the senior author (JVS). No radiotherapy was given to any patient. All patients were followed for a mean of seven years. At follow-up functional assessment was done using the Lysholm score. Recurrence-free survival and recurrence-free survival probability were calculated. RESULTS No recurrence was noted in the localised variety. In the diffuse variety the five year recurrence-free survival probability was 57%. Twelve patients developed recurrences between three months and two years. No recurrence was noted after two years. The mean recurrence interval was 6.25 months. CONCLUSIONS We concluded from this series that arthroscopic excision is an effective treatment for localised as well as diffuse PVNS. Recurrences can also be successfully dealt with by arthroscopic excision with excellent functional outcome.
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Affiliation(s)
- Jitesh K Jain
- Department of Orthopaedics, Aware Global Hospital, Karmanghat, India,
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Ma X, Shi G, Xia C, Liu H, He J, Jin W. Pigmented villonodular synovitis: a retrospective study of seventy five cases (eighty one joints). INTERNATIONAL ORTHOPAEDICS 2013; 37:1165-70. [PMID: 23503697 DOI: 10.1007/s00264-013-1858-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Pigmented villonodular synovitis (PVNS) is a relatively rare, benign proliferation lesion of the synovium of large joints, but there is not much information available about the disease's aetiology, clinical history, differential diagnosis, treatment, and long-term effects. We conducted a study to analyse these aspects of PVNS. METHODS We reviewed all clinical data for 75 patients with PVNS (81 joints) who were treated either by synovectomy alone or synovectomy plus arthroplasty. RESULTS In all cases, the diagnosis of PVNS was confirmed by pathological examination. The ratio of males to females was 27:48, and the average age of patients was 46 years (range, 15-80 years). Lesions were located in the knee, hip, or ankle, and pain and swelling were the main symptoms. Of 75 patients, 42 had a history of trauma to the involved joint. Forty-one patients (43 joints) underwent synovectomy alone, and 34 patients (38 joints) underwent synovectomy and arthroplasty together. Of the 75 patients, 61 had full follow-up data. Twelve patients had recurrent legions detected by pathological examinations; four patients had more than two recurrences. Moreover, five patients developed PVNS after arthroplasty. CONCLUSIONS PVNS occurs most often in middle-aged women and most frequently involves the knee, followed by the hip and ankle. The disease's etiology is varied and unclear. Surgical excision alone or with arthroplasty is an effective treatment, but there is a high rate of recurrence.
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Affiliation(s)
- Xiaomei Ma
- Department of Pathology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China.
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