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Umetsu A, Eguchi K, Koga T, Araki T, Takatani A, Aramaki T, Terada K, Iwamoto N, Miyahara K, Yonemitsu N, Nakamura H, Kawakami A, Ueki Y. The Evaluation of Lipoma Arborescens with Intermittent Knee Joint Effusion Based on an Analysis of Serum Cytokine Levels and an Immunohistological Examination. Intern Med 2024; 63:1305-1309. [PMID: 37779066 PMCID: PMC11116025 DOI: 10.2169/internalmedicine.2393-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 10/03/2023] Open
Abstract
We herein report a 27-year-old woman who presented with recurrent knee pain. Laboratory findings revealed minimal inflammation. Arthrography revealed structures resembling adipose tissues. Magnetic resonance imaging showed a high signal intensity of these structures, leading to the diagnosis of lipoma arborescens (LA). Synovectomy was performed. Pathology revealed adipocyte proliferation and B-cell clusters but no T-cell infiltration. A serum cytokine analysis revealed low levels of interleukin-6 and tumor necrosis factor-α compared with patients with rheumatoid arthritis. The pathogenesis of LA remains unclear, but immunostaining and serum cytokine levels may provide valuable data for future investigations.
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Affiliation(s)
- Ayaka Umetsu
- Department of Rheumatology, Sasebo Chuo Hospital, Japan
| | | | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takeshi Araki
- Department of Rheumatology, Sasebo Chuo Hospital, Japan
| | | | | | - Kaoru Terada
- Department of Rheumatology, Sasebo Chuo Hospital, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kenji Miyahara
- Department of Orthopedic Surgery, Sasebo Chuo Hospital, Japan
| | | | - Hideki Nakamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yukitaka Ueki
- Department of Rheumatology, Sasebo Chuo Hospital, Japan
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Cheah AL, Brown W, Bonar SF. Pathology of intra-articular tumours and tumour-like lesions: pearls, pitfalls and rarities from a general surgical pathology practice. Skeletal Radiol 2024:10.1007/s00256-024-04615-5. [PMID: 38363417 DOI: 10.1007/s00256-024-04615-5] [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: 12/04/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Intra-articular tumours are uncommonly encountered in routine practice and may present diagnostic challenges to pathologists. Challenges unique to this site include distinction from more common reactive synovial conditions, which are far more common; histologic variability; superimposed reactive changes; and often, lack of provided clinicoradiological context. This article reviews the pathology of the synovial tumours and tumour-like lesions, including diagnostic pearls, pitfalls and rare entities.
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Affiliation(s)
- Alison L Cheah
- Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW, 2113, Australia.
| | - Wendy Brown
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - S Fiona Bonar
- Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW, 2113, Australia
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MR Imaging Knee Synovitis and Synovial Pathology. Magn Reson Imaging Clin N Am 2022; 30:277-291. [DOI: 10.1016/j.mric.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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Ricci V, Chang KV, Güvener O, Mezian K, Kara M, Leblebicioğlu G, Stecco C, Pirri C, Ata AM, Dughbaj M, Jain NB, Özçakar L. EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Shoulder. Am J Phys Med Rehabil 2022; 101:e29-e36. [PMID: 34923500 DOI: 10.1097/phm.0000000000001833] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT In this dynamic protocol, ultrasound examination of the shoulder using different maneuvers is described for several/relevant shoulder problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine]) will help musculoskeletal physicians perform a better and uniform/standard approach.
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Affiliation(s)
- Vincenzo Ricci
- From the Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, A.S.S.T. Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei City, Taiwan (K-VC); National Taiwan University College of Medicine, Taipei, Taiwan (K-VC); Department of Physical and Rehabilitation Medicine, Mersin University Medical School, Mersin, Turkey (OG); Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine, Prague, Czech Republic (KM); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, LÖ); Hand Surgery Unit, Department of Orthopaedics and Traumatology, Hacettepe University Medical School, Ankara, Turkey (GL); Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CS, CP); Department of Physical Medicine and Rehabilitation, Doctor Ayten Bozkaya Spastic Children Hospital and Rehabilitation Center, Bursa, Turkey (AMA); Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait City, Kuwait (MD); and Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population and Data Sciences, University of Texas Southwestern, Dallas, Texas (NBJ)
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Elamin M, Yeluri V, Khatir H, O'Grady P, Bennani F. Subacromial impingement by a lipoma arborescens. SICOT J 2021; 7:12. [PMID: 33704057 PMCID: PMC7949903 DOI: 10.1051/sicotj/2021004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Subacromial impingement syndrome (SIS) is the leading cause of shoulder pain. A systemic approach for abnormal causes of SIS is recommended to avoid misdiagnosing rare or sinister pathologies. To our knowledge, only nine cases of subacromial lipoma arborescens associated with impingement syndrome have been reported in the literature. In this report, we briefly discuss histopathologic and radiological signs of an unusual case of impingement syndrome caused by subacromial "lipoma arborescens" and describe arthroscopic synovectomy after the failure of conservative management. The patient remains symptom-free five years after surgery.
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Affiliation(s)
- Mohamed Elamin
- Department of Orthopaedics, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
| | - Venkatramana Yeluri
- Department of Orthopaedics, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
| | - Hisham Khatir
- Department of Orthopaedics, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
| | - Paul O'Grady
- Department of Orthopaedics, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
| | - Fadel Bennani
- Department of Pathology, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
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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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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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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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Abstract
Lipoma arborescens is a chronic, slowly progressive intra-articular lesion characterised by villous lipomatous proliferation of the synovium, usually involving the suprapatellar pouch of the knee joint. It is an uncommon cause of intra-articular masses that presents as slowly progressive painless swelling of the joint, which persists for many years and is accompanied by intermittent effusions. We highlight this condition to raise awareness of its clinical spectrum and imaging features, so that early diagnosis and appropriate treatment can be given, and misinterpretation of this condition as other more complex intra-articular masses is avoided. This pictorial essay aims to provide a brief yet comprehensive review of the clinical features, distribution, morphological types and imaging characteristics of lipoma arborescens, including its common differential diagnoses and management.
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Affiliation(s)
- Sarat Kumar Sanamandra
- Department of Diagnostic and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore 169608.
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de Melo EF, Rivera LMS, Quiroz LAD, Bica BERG. [Lipoma arborescens of the knee in a patient with ankylosing spondylitis: case report and literature review]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:381-3. [PMID: 25805185 DOI: 10.1016/j.rbr.2013.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/05/2013] [Indexed: 10/24/2022] Open
Abstract
Lipoma arborescens (LA) is defined as a villous lipomatous proliferation of the synovial membrane with diffuse substitution of the synovial tissue by mature fat cells. The injury is very rare, involving the knee joint (suprapatellar region) and is associated with degenerative joint disease. We describe the case of a male patient, suffering from ankylosing spondylitis with monoarthritis of the right knee and swelling in suprapatellar region important. The diagnosis of lipoma arborescens was confirmed from the MRI of the right knee.
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Affiliation(s)
- Elisa Fernandes de Melo
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
| | - Lina Maria Saldarriaga Rivera
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Luis Alberto Delgado Quiroz
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Blanca Elena Rios Gomes Bica
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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Balabram D, Cabral CCDSR, Filho ODPR, Barros CPD. Intramuscular lipoma of the subscapularis muscle. SAO PAULO MED J 2014; 132:65-7. [PMID: 24474083 PMCID: PMC10889450 DOI: 10.1590/1516-3180.2014.1321537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/31/2013] [Indexed: 02/07/2023] Open
Abstract
CONTEXT Intramuscular lipomas are benign tumors that infiltrate the muscles. CASE REPORT We describe the case of a 58-year-old female patient with an axillary lump. The lump was a lipoma inside the subscapularis muscle. It is important to differentiate these lesions from liposarcomas and from other diseases that may present as axillary lumps. The most accurate imaging method for differentiating benign lipomatous tumors from liposarcomas is magnetic resonance imaging, but surgical removal of these intramuscular lesions to confirm the diagnosis is recommended. CONCLUSION Intramuscular lipomas are a rare cause of benign axillary lumps and should be considered in making differential diagnoses on axillary masses.
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Affiliation(s)
- Débora Balabram
- Department of Anatomical Pathology and Legal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte Minas Gerais, Brazil
| | - Carla Cristina de Sousa Resende Cabral
- Serviço de Radiologia e Ultrassonografia de Minas Gerais, Belo HorizonteMinas Gerais, Brazil, MD. Radiologist, Serviço de Radiologia e Ultrassonografia de Minas Gerais (Sermig), Belo Horizonte, Minas Gerais, Brazil
| | - Omar de Paula Ricardo Filho
- Laboratory of Anatomical and Diagnostic Pathology, Belo HorizonteMinas Gerais, Brazil, MD. Pathologist, Laboratory of Anatomical and Diagnostic Pathology, Belo Horizonte, Minas Gerais, Brazil
| | - Cristóvão Pinheiro de Barros
- Instituto da Previdência dos Servidores do Estado de Minas Gerais, Belo HorizonteMinas Gerais, Brazil, MD. Breast Surgeon, Instituto da Previdência dos Servidores do Estado de Minas Gerais (IPSEMG), Belo Horizonte, Minas Gerais, Brazil
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Kim RS, Kim YT, Choi JM, Shin SH, Kim YJ, Kim L. Lipoma arborescens associated with osseous/chondroid differentiation in subdeltoid bursa. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2013; 7:116-9. [PMID: 24167404 PMCID: PMC3807946 DOI: 10.4103/0973-6042.118916] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lipoma arborescens (LA) is a rare benign lesion of unknown etiology. It is characterized histologically by villous proliferation of the synovial membrane and diffuse replacement of the subsynovial tissue by mature fat cells. This condition affects the knee joint most commonly. Cases involving other locations including glenohumeral joint,[1] hip,[2] elbow,[3] hand[4] and ankle[5] have been rarely described. Involvement of the subdeltoid bursa has also been reported, but to date no case has described LA with osseous/chondroid differentiation of this bursa. Another significant finding in our case was the coexistence of LA with intermuscular lipoma, SLAP lesion and labral cyst.
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Affiliation(s)
- Ryuh Sup Kim
- Department of Orthopaedic Surgery, School of Medicine, Inha University, Incheon, Korea
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Lipoma arborescens of the biceps tendon sheath. Skeletal Radiol 2013; 42:1461-4. [PMID: 23677483 DOI: 10.1007/s00256-013-1638-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 02/02/2023]
Abstract
Lipoma arborescens, described as lipomatous infiltration and distention of synovial villi resulting in a frond-like appearance, most frequently affects the suprapatellar recess of the knee. While there have been reports of this entity involving the upper extremity joints, bursa, and tendon sheaths, we present the first reported case of lipoma arborescens isolated to the biceps tendon sheath. We describe imaging and histologic findings with clinical correlation.
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Abstract
Lipoma arborescens, a rare benign intra-articular lesion, is characterized by lipomatous proliferation of the synovium in which the subsynovial tissue is replaced by mature adipocytes. Subdeltoid bursa is a rare location for lipoma arborescens, and only a few cases have been reported in the literature. This article reports 2 cases of subdeltoid lipoma arborescens combined with rotator cuff tears, and the possible relationships between subdeltoid lipoma arborescens and rotator cuff tears are discussed. The intra-articular villous proliferations on fat-suppressed T2-weighted magnetic resonance imaging appeared as yellowish-white lipomatous villous proliferations on arthroscopy, and finger-like lipomatous proliferation of the synovium, where the subsynovial connective tissue is replaced by mature adipocytes, on histology. Although further evidence would be necessary, the bony proliferations, in addition to bone-to-bone abrasion and inflammatory processes, may contribute to the relationship between subdeltoid lipoma arborescens and rotator cuff tears. Because this is a rare disease in a rare location, no established treatment guidelines are available for lipoma arborescens in subdeltoid bursa. For the current patients, arthroscopic excision of the lipoma arborescens and concomitant rotator cuff repair were prescribed after more than 6 months of conservative management. All patients had symptom relief and were satisfied with their results. Paying special attention to the radiologic and arthroscopic characteristics of the lipoma arborescens will help physicians and surgeons to achieve a more accurate diagnosis and effective treatment strategy, especially in patients with concomitant rotator cuff tears.
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Coll JP, Ragsdale BD, Chow B, Daughters TC. Best Cases from the AFIP: Lipoma Arborescens of the Knees in a Patient with Rheumatoid Arthritis. Radiographics 2011; 31:333-7. [DOI: 10.1148/rg.312095209] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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A case of intra-articular synovial lipoma of the knee joint causing patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2010; 18:1094-7. [PMID: 19997720 DOI: 10.1007/s00167-009-1005-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
Abstract
Intra-articular synovial lipoma is rare and clinically manifested mostly by mass effect and occasionally by torsion of the stalk. Patellar dislocation rarely occurs owing to a mass effect of intra-articular tumor of the knee joint. The authors present a case of large intra-articular synovial lipoma at the lateral gutter of the knee joint, which presents as patellar dislocation. A 19-year-old man visited our clinic due to pain and limitation of motion owing to mass at his left knee. MRI revealed an intra-articular soft tissue mass at the lateral gutter of the knee joint with considerable mass effect displacing patella from the trochlear groove. Excisional biopsy confirmed the diagnosis of lipoma, and the final diagnosis was intra-articular synovial lipoma with clinical information. The final radiograph showed well-aligned patella on the trochlear groove. After marginal excision, there was no recurrence or tumor-related morbidity.
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Bargiela A, Rodriguez E, Soler R. Lipoma Arborescens of Subacromial-subdeltoid Bursa: Ultrasonographic Findings. J Med Ultrasound 2010. [DOI: 10.1016/s0929-6441(10)60013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Chae EY, Chung HW, Shin MJ, Lee SH. Lipoma arborescens of the glenohumeral joint causing bone erosion: MRI features with gadolinium enhancement. Skeletal Radiol 2009; 38:815-8. [PMID: 19290523 DOI: 10.1007/s00256-009-0686-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 03/02/2009] [Accepted: 03/04/2009] [Indexed: 02/02/2023]
Abstract
Lipoma arborescens is a rare benign intra-articular lesion that principally affects the knee joint. We present a case of lipoma arborescens involving the glenohumeral joint and associated with prominent large bony erosions. The gadolinium diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (MRI) features of this lesion are also described. The characteristic MRI findings permit precise preoperative diagnosis of this rare condition even if it occurs in an atypical location and there are confusing radiological findings.
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Affiliation(s)
- Eun Young Chae
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
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Fenn S, Datir A, Saifuddin A. Synovial recesses of the knee: MR imaging review of anatomical and pathological features. Skeletal Radiol 2009; 38:317-28. [PMID: 18777177 DOI: 10.1007/s00256-008-0570-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 07/15/2008] [Accepted: 07/23/2008] [Indexed: 02/02/2023]
Abstract
The knee joint is a complex anatomical structure playing host to a wide variety of pathological processes. Knowledge of the anatomy of the synovial recesses and plicae relating to the knee is important, as the appearance of pathology in these unusual locations may, even for commonly encountered conditions, lead to diagnostic uncertainty. This review article discusses the magnetic resonance imaging (MRI) anatomy of the knee joint with an emphasis on the synovial recesses and plicae. The MRI appearance of a variety of synovial and osteochondral diseases that may involve these sites is illustrated.
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Affiliation(s)
- S Fenn
- Department of Radiology, The Princess Alexandra Hospital NHS Trust, Harlow, Essex, UK
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23
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Synovial lipomatosis arborescens of the peroneal tendon sheath. Skeletal Radiol 2008; 37:947-50. [PMID: 18682928 DOI: 10.1007/s00256-008-0558-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 06/24/2008] [Accepted: 06/30/2008] [Indexed: 02/02/2023]
Abstract
The term "lipoma arborescens" has been used to describe the diffuse infiltration of fat within hypertrophic synovial villi, a condition which has been most frequently described in the knee. We advocate the term "synovial lipomatosis arborescens" for this process and present what is, to our knowledge, the first reported case of this disorder isolated to the peroneal tendon sheath, with imaging, intraoperative, and histological correlation.
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In Y, Chun KA, Chang ED, Lee SM. Lipoma arborescens of the glenohumeral joint: a possible cause of osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2008; 16:794-6. [PMID: 18270682 DOI: 10.1007/s00167-008-0493-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
Abstract
Lipoma arborescens is a very rare intra-articular lesion characterized by villous lipomatous proliferation of the synovium, usually involving the knee joint. To date, in the literature, there has been only one reported case of lipoma arborescens in the glenohumeral joint. But, the authors treated the patient conservatively and reported only the magnetic resonance imaging (MRI) findings. We report a case of a patient with lipoma arborescens involving the glenohumeral joint. To our knowledge, this is the first reported case of lipoma arborescens involving the glenohumeral joint managed by arthroscopic synovectomy. We identified reactive bone erosions and arthritic changes in the humeral head in a 22-year-old male patient by arthroscopy.
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Affiliation(s)
- Yong In
- Department of Orthopaedic Surgery, The Catholic University of Korea, Kyonggi-Do, South Korea.
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25
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Abstract
Lipoma arborescens is a rare cause of chronic monoarticular arthritis. It is most commonly seen in the knees, but only a few cases involving other joints, especially the subdeltoid bursa, have been described. To our knowledge, this is the first reported case of lipoma arborescens involving bilateral subdeltoid bursae. Although it is associated with joint effusion, synovial cysts and erosions, the presence of reactive bone formation has not been reported. Magnetic resonance imaging is a very effective method for the diagnosis of this rare condition because of its ability to do tissue characterization.
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Affiliation(s)
- T Pandey
- Department of Radiology, Al-Razi Hospital, Kuwait.
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26
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Huang GS, Lee HS, Hsu YC, Kao HW, Lee HH, Chen CY. Tenosynovial lipoma arborescens of the ankle in a child. Skeletal Radiol 2006; 35:244-7. [PMID: 16235076 DOI: 10.1007/s00256-005-0008-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 05/19/2005] [Accepted: 05/19/2005] [Indexed: 02/02/2023]
Abstract
Lipoma arborescens is a rare entity of the synovium and frequently occurs in the joints. Lipoma arborescens involving the synovial sheaths of the tendons is exceedingly rare. We report a case of a 12-year-old girl with lipoma arborescence affecting the synovial sheaths of the peroneal, posterior tibialis, and flexor tendons. Identification of the typical features of fat tissues in the proliferative synovium on MRI may help in making a correct diagnosis. The clinical presentation and MRI findings are described, and the entity is briefly reviewed.
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Affiliation(s)
- Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, #325 Cheng-Kung Road Section 2, Neihu 114, Taipei, Taiwan, Republic of China.
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27
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Abstract
Lipoma arborescens (diffuse articular lipomatosis) is a rare, benign intra-articular lesion of unknown aetiology. It is characterised by villous proliferation of the synovium and diffuse replacement of the subsynovial tissue by mature fat cells. It forms part of the differential diagnosis for a slowly progressive chronically swollen knee. We present a very rare case of bilateral involvement of the knee and discuss the symptoms, diagnosis and treatment of this condition.
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Affiliation(s)
- A P Davies
- Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, UK.
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28
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Gonçalves M, Len CA, Fernandes ADRC, Terreri MTRA, Hilário MOE. Lipoma arborescens: diagnóstico e imagem. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000400018] [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
O lipoma arborescens é uma lesão intra-articular de origem desconhecida, caracterizada por proliferação vilolipomatosa crônica da membrana sinovial. Pode estar associado a doenças degenerativas, diabetes mellitus, artrite reumatóide juvenil e artrite reumatóide do adulto. O diagnóstico baseia-se em achados de ressonância magnética e de biópsia sinovial. Relatamos o caso de uma paciente do sexo feminino, de oito anos de idade, com lipoma arborescens e história de artrite em joelhos e cotovelos há dois anos, tendo sido observada melhora parcial da artrite após o início do tratamento medicamentoso convencional.
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29
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Abstract
This article described many of the causes of monoarticular arthritis that are encountered in clinical practice. Although radiologists have relied on conventional radiography and bone scintigraphy, additional imaging methods have been introduced, such as MR imaging, CT scanning, and US. These methods improve visualization of intra-articular and periarticular soft tissue structures and are helpful in the guidance of arthrocentesis, drainage procedures, or percutaneous biopsies. Imaging findings always should be correlated with clinical abnormalities, and, when appropriate, joint fluid analysis.
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MESH Headings
- Adult
- Arthritis/diagnosis
- Arthritis/diagnostic imaging
- Arthritis/therapy
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/diagnostic imaging
- Arthritis, Infectious/microbiology
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/diagnostic imaging
- Arthritis, Reactive/diagnosis
- Arthritis, Reactive/diagnostic imaging
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/diagnostic imaging
- Chondromatosis, Synovial/diagnosis
- Chondromatosis, Synovial/diagnostic imaging
- Diagnosis, Differential
- Female
- Humans
- Lipoma/diagnosis
- Lipoma/diagnostic imaging
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Radionuclide Imaging
- Synovitis, Pigmented Villonodular/diagnosis
- Synovitis, Pigmented Villonodular/diagnostic imaging
- Tomography, X-Ray Computed
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Affiliation(s)
- Aurea V R Mohana-Borges
- Department of Radiology, Veterans Affairs, San Diego Health Care System, University of California-San Diego, 3350 La Jolla Village Drive, Drive, San Diego, CA 92161, USA.
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30
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Affiliation(s)
- K Ikushima
- Department of Orthopedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan
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31
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Abstract
A 76-year-old woman with a longstanding history of right elbow swelling and recurrent joint effusion presented for consultation. There was no history of trauma and conventional radiographs were negative. Computed tomography (CT) and magnetic resonance imaging were performed and showed a frond-like fatty synovial mass and joint effusion. Arthrotomy disclosed a lipoma arborescens of the right elbow.
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Affiliation(s)
- M Levadoux
- Department of Orthopedic Surgery, French Naval Hospital St Anne, Toulon, France
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33
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Soler T, Rodríguez E, Bargiela A, Da Riba M. Lipoma arborescens of the knee: MR characteristics in 13 joints. J Comput Assist Tomogr 1998; 22:605-9. [PMID: 9676453 DOI: 10.1097/00004728-199807000-00018] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Lipoma arborescens (LA) is a rare, poorly understood intraarticular lesion, with few cases reported in the imaging literature. Our purpose was to describe on MR the different morphologic appearances of LA of the knee and to investigate the incidence of associated anomalies. METHOD The medical records and MR findings of 12 patients with proven LA in 13 knee joints were retrospectively reviewed with particular emphasis on the shape of the lesion, location, signal intensity, and past clinical history. RESULTS We found three common morphological patterns of presentation: multiple villous lipomatous synovial proliferations (n = 6), isolated frond-like fat subsynovial mass (n = 2), and mixed pattern (n = 5). Multiple villous lipomatous synovial proliferations and mixed pattern were usually associated with a history of trauma and/or chronic inflammatory diseases. However, the least frequent isolated frond-like fat subsynovial mass appears to originate without antecedent. The durations of symptoms were 1-7 months (multiple villous lipomatous synovial proliferations), 1-20 years (mixed pattern) and 6-7 years (isolated frond-like subsynovial fat mass). CONCLUSION Our study suggest that LA can present with a variety of morphological appearances on MR that may depend on the previous clinical history and duration of the disease.
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Affiliation(s)
- T Soler
- Department of Radiology, Hospital Juan Canalejo, La Coruña, Spain
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34
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Kurihashi A, Yamaguchi T, Tamal K, Saotome K. Lipoma arborescens with osteochondral metaplasia--a case mimicking synovial osteochondromatosis in a lateral knee bursa. ACTA ORTHOPAEDICA SCANDINAVICA 1997; 68:304-6. [PMID: 9247000 DOI: 10.3109/17453679708996708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A Kurihashi
- Department of Orthopedics, Dokkyo University School of Medicine, Tochigi, Japan
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