A severe headache due to pigmented villonodular synovitis in a rare location: facial nerve on temporomandibular joint. A case report

BACKGROUND

Pigmented villonodular synovitis (PVNS) is an infrequent benign tumor-like proliferative lesion developing from the synovial membranes of the joint, tendon sheath, and bursa.

CLINICAL PRESENTATION

A 44-year-old woman with numbness on the right side of her face, severe headaches, and swelling in temporomandibular region is presented. On head and neck magnetic resonance imaging, an encapsulated mass approximately 2 cm was detected. The fine-needle aspiration biopsy resulted as suspicion of mesenchymal tumor. A complete resection with the capsule was performed over the temporal branch by monitoring of the facial nerve. The final histopathologic examination resulted as a giant cell tendon sheath tumor.

CONCLUSION

Headache is not the main symptom in PVNS, but in severe pain spreading from the temporomandibular region, physical examination should be done carefully for slight swelling, and the possibility of pigmented villonodular synovitis should be considered. Because of the high recurrence rate, en bloc resection is necessary.

Arthroscopic treatment of diffuse pigmented villonodular synovitis of the elbow

INTRODUCTION

Pigmented villonodular synovitis (PVNS) is a rare pathology of the elbow, but presents a risk of progression with cartilage destruction. Surgical treatment consists in synovectomy, as complete as possible. Arthroscopy is an excellent tool for the exploration and treatment of intra-articular lesions in the elbow, but the results in PVNS of the elbow have never been evaluated. The aim of this study was to assess the recurrence rate of PVNS of the elbow after arthroscopic synovectomy, and secondarily to assess pain, joint range of motion, functional scores and complication rate.

MATERIAL AND METHODS

We performed a retrospective study of a continuous series of 8 patients operated on between February 2012 and February 2019, with a mean age of 43.7 years. The operated side was the dominant side in 75% of cases. Surgery consisted in the most complete synovectomy possible, performed arthroscopically. Recurrence, clinical evaluation, with pain at rest and on mpvement on visual analogue scale (VAS) and joint range of motion, functional MEPS and DASH scores, and any complications were collected.

RESULTS

At a mean 66.4 months' follow-up, 2 patients required revision surgery for recurrence. At the last follow-up, VAS for pain at rest was 0.9 and 1.9 for pain on movement. MEPS score was 85.6 and DASH score 82.2. No neurological, vascular or infectious complications of arthroscopic synovectomy were found in our series.

DISCUSSION

Arthroscopic synovectomy in the treatment of PVNS of the elbow was a reliable and safe therapeutic alternative, with a low complications rate and 2 cases of recurrence (25%) in our study. This was the first study to report the results of arthroscopic surgical treatment of elbow PVNS.

LEVEL OF EVIDENCE

IV Retrospective study without control group.

Two-stage TKA for tuberculosis septic arthritis of the knee masquerading as pigmented villonodular synovitis: A case report

A 25-year-old female presented with left knee pain following arthroscopic synovectomy for presumed pigmented villonodular synovitis (PVNS). Radiographs and magnetic resonance imaging demonstrated tricompartmental arthritic changes. She underwent a two-stage procedure first involving antibiotic spacer implantation, followed 1 week later by spacer removal and definitive total knee arthroplasty (TKA) once initial intraoperative culture results were negative. Subsequent cultures confirmed tuberculosis septic arthritis. Repeat evaluation 1 year postoperatively showed no complications and patient satisfaction with left knee function. This is a unique case report in the United States describing 1-year outcomes following staged TKA for tuberculosis septic arthritis masquerading as PVNS.

The diabetic knee

Diabetes is a multisystemic and multifaceted syndrome, and its clinical impact is wide ranging and varied. The musculoskeletal complications of diabetes, too cover a broad spectrum of joints and presentations. Relatively less attention is paid, however, to the diabetic knee. This communication describes the bidirectional relationship between diabetes and the knee, and the potential influence this may have on therapy.

Diffuse Pigmented Villonodular Synovitis as a Rare Cause of Graft Failure Following Anterior Cruciate Ligament Reconstruction

This case report describes a 42-year-old woman who was diagnosed with pigmented villonodular synovitis (PVNS) in the knee. The patient had received a bone-patella tendon-bone autograft reconstruction of her anterior cruciate ligament (ACL) 22 years prior to her diagnosis of PVNS. After a traumatic event that tore her ACL graft, she underwent a second surgery to repair the initial reconstruction. However, her pain and joint instability remained unresolved. When radiolucent lesions in her tibia and femur were identified through a radiographic image, the patient was referred to the authors' orthopedic oncology clinic. Additional imaging, including magnetic resonance imaging, revealed PVNS, and she was scheduled for debridement and a complete synovectomy of the knee. After surgery, the patient's pain decreased dramatically. She continues to maintain an active lifestyle despite a relatively minor decrease in range of motion. In this case, PVNS proved to be an unlikely complication after ACL reconstruction. The patient remains at risk for the development of degenerative arthritis. [Orthopedics. 2018; 41(1):e142-e144.].

[Unusual presentation of pigmented villonodular synovitis of the hip joint: case report and review of the literature]

INTRODUCTION

Pigmented villonodular synovitis (PVNS) is a rare clinical entity with higher incidence in women (3:1) and an age of presentation between 20 and 40 years. The hip is a rare site of appearance, being involved in only 15% of all cases.

CASE REPORT

47-year-old male with 10 years of evolution characterized by a limited range of motion, pain associated with an increase in volume and shortening of the pelvic limb. Imaging studies showed destruction of the hip joint and extension to the pelvis. The histopathology report described pigmented villonodular synovitis. His final treatment was left hemipelvectomy.

DISCUSSION

The presentation of the diffuse pigmented villonodular synovitis of the hip has a lower incidence and a locally aggressive behavior. It is necessary to consider differential diagnoses that include malignant neoplasms. The standard treatment is surgical.

Pigmented villonodular synovitis of the elbow with rdial, median and ulnar nerve compression

Pigmented villonodular synovitis (PVNS) is a rare, idiopathic proliferative disorder of the synovium. While, PVNS of elbow is extremely rare. We report an 82-year-old female patient with 20-year-history of gradually increased PVNS in her left elbow. The multiple masses were located in anterior, medial and lateral of elbow. Her radial, median and ulnar nerves were compressed by the tumor. We resected tumor of extra-articular part piecemeally and released the compression of nerves. After the surgery, the patient gained a functional recovery. Two years after surgery she had a tumor recurrence, but without any symptoms of nerve compression syndromes. We discussed its clinical diagnosis, radiological features, MRI findings, pathophysiology, and treatment.

[Pigmented villonodular synovitis causing ankle pain]

A rare case of diffuse pigmented villonodular synovitis is described. Because of unspecific symptoms as oedema and pain and uncertain relation with trauma the diagnosis was delayed for almost two years, until a MRI showed diffuse hypodense infiltrative lesions involving soft tissue structures around the ankle. Treatment was a radical open synovectomy of the ankle and subtalar joints and tenosynovectomy of the tendons around the ankle.

An unusual case of knee locking

Knee locking is an incapacitating condition that requires urgent orthopaedic intervention. The most common cause is meniscal injury, followed by torn anterior cruciate ligament, osteochondral loose bodies and foreign bodies in the joint space. This report describes a patient who had an unusual case of left knee locking. After clinical examination and radiological investigations, the provisional diagnosis was a lateral meniscal tear, which was not visible on magnetic resonance imaging. Diagnostic arthroscopy of the left knee revealed a 1-cm yellowish lump on the medial meniscus, and the histology revealed pigmented villonodular synovitis. The menisci and cruciate ligaments were intact.

Subacromial bony erosion: a rare presentation of pigmented villonodular synovitis of the shoulder

Pigmented villonodular synovitis (PVNS) rarely affects the shoulder. We describe two cases of PVNS arising from the shoulder joint, which caused rotator cuff tears and sub-acromial bony erosion, and which were treated arthroscopically. Sub-acromial erosion is frequently associated with various glenohumeral joint disorders, but it has not been reported in association with PVNS. We believe PVNS should also be considered in the differential diagnosis of patients who present with sub-acromial erosion.

Polyarticular Form of Pigmented Villonodular Synovitis. Radiation and Surgical Therapy: Long Term Follow-up

We describe a case of 30-year old male followed-up since the age of 6 for severe type of rare combination of polyarticular form of pigmented villonodular synovitis with hereditary malformation constellation consistent with Noonan-like syndrome. Within 20 years, the patient underwent repeated synovectomies of large joints with temporary effect only. Radiation therapy with the dose of 30 Gy in 15 sessions has been applied for active aggressive synovitis of both knees associated with pain and progressive joint destruction. Favorable effect lasted for 3 years. Progressive destruction with range-of-motion limitation required successive total joint replacement of both knee joints. Left knee prosthesis has been revised for aseptic loosening after 3.5 years. It is now 5 years since the right knee primoimplantation and 3 years since the left knee reimplantation without signs of component loosening or recurrence, with satisfactory clinical and functional outcome.

[Erosive intervertebral joint lesions. A case of pigmented villonodular synovitis]

Pigmented villonodular synovitis (PVNS) is a rare proliferative lesion that can affect synovial membranes, tendon sheaths, and bursae. It is usually a monarticular disease of the lower extremities, and so far fewer than 30 cases of spinal involvement have been reported in the literature. We describe a patient with progressive lumbar pain and spinal claudication, in whom a CT scan of the lumbar spine revealed destruction fo facet joints L3 to L5. An open biopsy was performed, which led to the diagnosis fo PVNS. The patient underwent successful surgical resection of the tumour mass and stabilization of segments L3 to S1. Two years after surgery the patient has no signs of recurrence. Differential diagnosis of erosive vertebral joint disease is discussed.

High expression level of bone degrading proteins as a possible inducer of osteolytic features in pigmented villonodular synovitis

Protein expression of osteopontin (OPN), osteoprotegerin (OPG), bone sialoprotein (BSP), osteocalcin (OC), RANKL and PTHrP was determined by use of immunohistochemical analysis on tissue arrays (48 cases of PVNS, 20 cases of active (a-RA), non-active rheumatoid arthritis (na-RA), and osteoarthritis (OA)). Additionally, gene expression was analysed using complimentary DNA (cDNA) microarrays. All PVNS cases showed a higher level of both protein and gene expression of RANKL, OPN and BSP in comparison with OA cases. Expression of OPG was not significantly different in PVNS compared to OA. The RANKL/OPG expression ratio was significantly higher in PVNS than in OA. High expressions level of proteins involved in bone degradation in PVNS may promote an intra-osseous propagation of the lesion. This evidence suggests that PVNS might respond to treatment using specific inhibitors of RANKL, OPN and BSP.

Combined ulnar and carpal tunnel syndrome caused by pigmented villo-nodular tenosynovitis: a rare case

Pigmented villo-nodular synovitis/tenosynovitis (PVNS) is a rare cause of combined ulnar and median nerve compression neuropathy at the wrist. In our case, a 53-year-old house-wife had sensorial and motor complaints at her left hand. In clinical examination, painless soft tissue mass was palpated at her wrist and both the tenar and hypotenar muscles were atrophic. Electromyography showed prolonged distal latencies for median and ulnar nerve. A space-occupying soft tissue lesion was revealed in magnetic resonance imaging. Carpal tunnel and Guyon canal were released and lesion was excised. PVNS was confirmed by histopathological examination. If compression neuropathy of medial and ulnar nerves together is caused by a space-occupying lesion, PVNS should be considered in etiology.

Pigmented villonodular synovitis associated with pathological fracture of the odontoid and atlantoaxial instability. Case report and review of the literature

Pigmented villonodular synovitis (PVNS) is a proliferative disorder of the synovium with a predisposition for the appendicular skeleton. Rarely PVNS can arise from the spine, where this disorder usually presents with localized or radicular pain secondary to involvement of the posterior elements. The authors report the case of an 82-year-old woman who presented with long-standing neck pain and acute upper-extremity numbness and weakness. Computed tomography imaging revealed a mixed sclerotic and lucent lesion affecting the dens and right lateral mass of C-2. There was also a pathological fracture at the base of the dens with 8 mm of anterior dens displacement. Magnetic resonance imaging demonstrated a diffusely infiltrative process that was nonenhancing. Because of instability, the patient underwent transarticular screw fixation, and a biopsy of the lesion was also performed at this time. Histopathological analysis was consistent with a diagnosis of PVNS. To the authors' knowledge, this is the first report of PVNS involving the C-2 vertebra or causing a pathological fracture.

Pigmented villonodular synovitis causing painless chronic knee swelling in an adolescent

It is uncommon for an adolescent to present with a painless chronic knee effusion without a history of trauma. Acute knee effusions are usually caused by internal derangement, patellar dislocations, or fractures. The differential diagnosis of a chronic knee effusion must include the more uncommon diagnoses of juvenile rheumatoid arthritis, septic arthritis, reactive arthritis, synovial osteochondromatosis, synovial hemangioma, synovial sarcoma, or pigmented villonodular synovitis. Radiographic imaging, plain radiographs, and magnetic resonance imaging in addition to a biopsy specimen are most helpful in differentiating these diagnoses. Pigmented villonodular synovitis is an uncommon diagnosis that is rarely seen in an adolescent. Treatment includes synovectomy via arthroscopy or open arthrotomy.

Ultrasound evaluation of cartilage damage in osteochondral lesions of the talar dome and correlation with clinical etiology: a preliminary report

BACKGROUND

The current study aimed to determine whether the acoustic properties of living human cartilage during arthroscopy differ between damage from trauma and that from pigmented villonodular synovitis (PVNS).

METHODS

Nine patients were evaluated with ultrasound during arthroscopy. As a quantitative index of cartilage quality, the percentage maximal magnitude (maximal magnitude of the measurement area divided by that of the intact cartilage; %MM) was selected. After ultrasound evaluation, the measurement points were divided into two groups on the basis of the etiologic findings (group T: cartilage damage from trauma and group P: cartilage damage from PVNS) and analyzed for the presence of significant differences in ultrasound analysis.

RESULTS

In the ultrasound findings, the %MM values ranged from 34.4% to 92.3%. According to the etiologic differences, the mean %MM was 81.0% in group T and 39.3% in group P, and significantly higher in group T than in group P (p < 0.01).

CONCLUSIONS

This study showed a correlation between the ultrasound results and the cartilage lesion etiology. Ultrasound evaluation may be useful for elucidating the process of articular cartilage degeneration with trauma and PVNS.

Surgical treatment of pigmented villonodular synovitis of the hip

BACKGROUND

Pigmented villonodular synovitis of the hip is a rare disease. Synovectomy is generally accepted as the only surgical treatment for the disorder, but there have been few studies with a sufficient sample size and duration of follow-up to allow the evaluation of long-term outcomes. The aim of this study was to determine the long-term outcome of the treatment in sixteen patients.

METHODS

Sixteen patients (nine men and seven women), with a mean age of 35.5 years at the time of surgery, were treated between 1970 and 1996. Complete synovectomy was performed in all patients; in addition, three had a cup arthroplasty, four had a total hip arthroplasty, and one had a monopolar arthroplasty. Clinical and radiographic outcomes were evaluated retrospectively at a mean of 16.7 years postoperatively. Only one patient was followed for less than eight years.

RESULTS

Nine patients needed repeat surgery, but only one had recurrent synovitis, as detected with pathological examination fourteen years after treatment with synovectomy and cup arthroplasty. Secondary osteoarthritis developed in all eight patients who had been treated with synovectomy alone, and four of them required a total hip arthroplasty within the follow-up period.

CONCLUSIONS

These results support earlier data indicating that osteoarthritis consistently develops in patients with pigmented villonodular synovitis of the hip. Complete synovectomy seems to be effective in preventing recurrence of the synovitis, but it does not appear to prevent the development of secondary osteoarthritis.

Localized pigmented villonodular synovitis in the anteromedial compartment of the knee associated with cartilage lesions of the medial femoral condyle: report of a case and review of the literature

Localized pigmented villonodular synovitis (PVNS) of the knee is an uncommon entity, presenting with different clinical signs and symptoms. We report on a case of a 42-year-old woman who presented with a 3-year history of knee pain and mechanical problems such as locking. On examination she was found to have a palpable and painful mass over the anteromedial joint line. Magnetic resonance imaging (MRI) revealed a soft tissue mass in the anteromedial compartment of the knee joint. The lesion was completely resected arthroscopically, and histologic examination confirmed the diagnosis of localized PVNS. The patient was free of symptoms, and MRI examination showed no evidence of recurrence at 1-year follow-up.

Pigmented villonodular synovitis about the ankle: a review of the literature and presentation in 10 athletic patients

BACKGROUND

Pigmented villonodular synovitis (PVNS) is relatively uncommon. The disorder results in increased proliferation of synovium causing villous or nodular changes of synovial-lined joints, bursae and tendon sheaths. This study examines the occurrence of PVNS about the ankle and its association with trauma.

METHODS

Ten patients over a 10-year period were identified as having PVNS of the ankle. The average age was 40.2 (range 27 to 62) years. There were four women and six men. Average followup was 4.5 (range 1 to 11) years from the initial surgery. Four patients had bone involvement. All patients who were athletically active before symptoms arose complained of persistent pain and swelling in the lateral ankle. Their initial clinical symptoms were indistinguishable from commonly associated pathologies with persistent lateral ankle pain (i.e. tenosynovitis, osteochondral defects, os trigonum injury, and tendon tears). All patients had magnetic resonance imaging (MRI) revealing PVNS, which is represented by low-signal appearing masses on T1- and T2-weighted images. All patients' histopathology results revealed multinucleated giant cells and foam cells laden with hemosiderin deposits. All patients had synovectomy and tenosynovectomy.

RESULTS

Eight patients were able to return to some sports (range 4 to 12 months); two had continued pain, disability, and inability to return to sports because of recurrence.

CONCLUSIONS

PVNS should be considered in athletically active patients with persistent lateral ankle pain and swelling, particularly if bone erosions are visible on plain radiographs.

Patello-femoral joint pain due to unusual location of localised pigmented villonodular synovitis-a case report

Localised pigmented villonodular synovitis (PVNS) is a rare condition usually affecting the knee. It can be a difficult condition to manage with an average delay in diagnosis of 4.4 years. We describe a case of a localised PVNS lesion interposed between the patello-femoral joint, presenting as 'anterior knee pain'. To our knowledge this has not previously been reported. The lesion was completely excised at arthroscopy resulting in complete resolution of symptoms. Solitary lesions of PVNS should also be considered in the differential diagnosis of unexplained 'anterior knee pain'.

An unusual cause of popliteal cyst

We describe a surgical treatment for popliteal cyst in a 41-year-old woman affected by diffuse pigmented villonodular synovitis (PVNS) of the knee with extra-articular spreading. The treatment consists of an arthroscopic synoviectomy followed immediately by an open removal of the cyst. At 28-month follow-up, the patient is asymptomatic and no evidence of recurrence of PVNS has been seen. We believe that this double surgical approach may reduce the probability of recurrence of PVNS.

Result of arthroscopic treatment of pigmented villonodular synovitis of the knee

PURPOSE

We report 10 years' experience in arthroscopic treatment of pigmented villonodular synovitis (PVNS) of the knee in a series of patients affected by the localized or diffuse form of the disease. The purpose of the study is to critically examine the results of arthroscopic synovectomy in the knee affected by PVNS, to determine the safety and effectiveness of the procedure.

TYPE OF STUDY

Retrospective case analysis.

METHODS

The study population consists of 19 patients, with an average follow-up of 60 months (minimum, 12; maximum, 128). All patients underwent knee arthroscopy. The 3 standard portals were used; posteromedial and posterolateral portals were added if required. Four patients were affected by localized PVNS and were subject to partial synovectomy with excision of the pathologic tissue. The remaining 15 patients presented a diffuse form of PVNS; 7 of them underwent extended arthroscopic synovectomy and 8 underwent partial synovectomy. The diagnosis was confirmed by synovial biopsy.

RESULTS

In the group affected by the localized form of PVNS, the arthroscopic local excision resulted in a complete and persistent regression of the pathology. Among the patients affected by the diffuse form of PVNS, clinical results were better and the recurrence rate was lower in the group treated with extended synovectomy. No relevant complications were encountered. In particular, no cases of infection, stiffness, or neurovascular lesions were seen.

CONCLUSIONS

Arthroscopic synovectomy is an appropriate treatment for knee PVNS. Extended synovectomy must be performed in all cases of diffuse PVNS.

Langerhans cell granulomatosis manifested as pigmented villonodular synovitis

We report an unusual case of Langerhans cell granulomatosis (LCG) manifested as a villous synovial proliferation in a 38-year-old female jogger. One year after the onset of joint symptoms, she had a classical LCG presentation with skin and visceral lymph node involvement. Review of the literature revealed only one case of synovial shoulder joint tenosynovitis associated with LCG in a middle-aged woman. Ours is the first reported case presenting clinically in the synovium of the hip joint as pigmented villonodular synovitis. Histiocytic/dendritic proliferations involving the synovial tissues are not uncommon. These lesions as well as the rare multicentric reticulohistiocytosis (MRH), a systemic monocytoid/histiocytic disorder with multinucleated giant cells, polyarthritis, and papulonodular skin lesions, should be considered in the differential diagnosis. Clinical and pathologic features will distinguish LCG from MRH.

Sweet's syndrome associated with pigmented villonodular synovitis

Sweet's syndrome (acute febrile neutrophilic dermatosis) was first described in 1964. The typical symptoms of Sweet's syndrome are high temperature, peripheral leucocytosis, painful cutaneous rashes (papules, plaques) and arthralgia. Sweet's syndrome has particularly been described in association with neoplastic, infectious and immunological diseases. The pathogenesis of Sweet's syndrome can be explained by a reaction to an antigenic structure with accumulation of immunological complexes and liberation of inflammatory mediators. For the first time we report on a patient with Sweet's syndrome and pigmented villonodular synovitis, which is believed to play the antigenic role in the Sweet syndrome.

Pigment villonodular synovitis of the spine. Case report and review of the literature

Pigmented villonodular synovitis (PVNS) is a disease of the joints which uncommonly involves the spine. We present a 70-year-old woman with radicular symptoms who was found to have a mass arising from a lumbar zygapophyseal joint with extension into the spinal canal. Following gross-total excision of the mass, histology revealed PVNS. One month after surgery, the patient had no symptoms and there was no evidence of residual or recurrent disease.

Localized pigmented villonodular synovitis of the knee: diagnostic challenge and arthroscopic treatment: a report of three cases

The localized form of pigmented villonodular synovitis (LPVS) is a lesion characterized by focal involvement of the synovial membrane. The knee is the most commonly affected joint. We report three cases of LPVS of the knee which were not diagnosed upon clinical evaluation. The aim is to bring the attention of clinicians to this pathological entity, which is often regarded as extremely rare and is therefore not considered in the early differential diagnosis of various knee derangements. Diagnostic and therapeutic arthroscopy was performed. The lesions were completely resected and patohistological findings confirmed the diagnosis of LPVS. All of our three patients have remained asymptomatic at 8, 10, and 12-month follow-ups.

Localized pigmented villonodular synovitis of the knee

Localized pigmented villonodular synovitis (PVNS) of the knee is a rare, idiopathic condition presenting with symptoms that can be confused with various other intra-articular pathologies. The condition is usually monoarticular, the knee being most commonly affected. If totally excised, complete cure can be achieved and recurrence is very rarely reported. In this report, we present 4 cases of patients with different symptomatology but all with PVNS of the knee who underwent arthroscopic treatment. At short-term follow-up, all patients had complete recovery of their symptoms with no apparent recurrence.

Radiologic case study. Pigmented villonodular synovitis

Pigmented villonodular synovitis is a benign, locally aggressive disorder characterized by a unique clinical radiographic, and histopathologic presentation. While it is considered to be a rare disorder, a delay in diagnosis and treatment can potentially result in severe disruption of joint function due to subchondral invasion. Once the diagnosis is confirmed, treatment should consist of complete synovectomy. Recurrence is common, but malignant transformation is rare. The etiology of PVNS is still unknown, and perhaps its future discovery will assist in the definitive treatment of this disorder.

Pigmented villonodular synovitis of lumbar facet joint: a rare cause of nerve root entrapment

STUDY DESIGN

A case report of nerve root entrapment due to pigmented villonodular synovitis of lumbar facet joint is reported for which excision was performed.

OBJECTIVE

To report a rare cause for nerve root claudication.

SUMMARY OF BACKGROUND DATA

Pigmented villonodular synovitis is an uncommon synovial abnormality with an estimated incidence of 1.8 cases per million. Large joints, such as knee and hip, are commonly affected. Involvement of the facet joint is very rare. In our case a high index of suspicion from CT and MRI helped us in the appropriate management.

METHODS

A 71-year-old man presented with severe back pain and right-sided L5 sciatica. CT and MRI scans showed a cystic lesion arising from the L5-S1 facet joint. Excision and adequate decompression in the form of undercutting facetectomy were done.

RESULTS

The patient had symptomatic improvement with surgery, and at the 3-year follow-up he showed no signs of recurrence.

CONCLUSION

Unless pigmented villonodular synovitis is considered in the differential diagnosis of tumors of the vertebral column causing nerve root claudication, it may be overlooked.

Successful arthroscopic treatment of pigmented villonodular synovitis of the knee in a patient with congenital deficiency of plasminogen activator inhibitor-1 and recurrent haemarthrosis

We report the arthroscopic treatment of pigmented villonodular synovitis (PVNS) in a 13-year-old Japanese boy with congenital partial deficiency of plasminogen activator inhibitor-1 (PAI-1). He was admitted to our hospital with recurrent haemarthrosis of his right knee. Characteristic abnormalities of fibrinolysis included shortened euglobulin lysis time, low PAI-1 activity and low PAI-1 antigen levels. In addition, levels of "active PAI" in the plasma, which is a measure of total PAI bound to exogenous plasminogen activator, were very low. These parameters remained low after venous occlusion. The diagnosis of PVNS was established by synovial membrane biopsy, and arthroscopic synovectomy was performed with adjuvant administration of intravenous tranexamic acid. Subsequent bleeding episodes have been well controlled by oral administration of tranexamic acid on demand.

Localized pigmented villonodular synovitis presenting as recurrent dislocation of the patella

A 31-year-old woman presented with a 1-year history of recurrent dislocation of the patella. On examination, she was found to have a mass at the medial patellofemoral joint line. Arthroscopy showed this to be a vascular synovial tumor extending into the medial patellofemoral joint and causing lateral deviation of the patella. The mass was resected with resolution of her symptoms and histologic examination showed this to be pigmented villonodular synovitis. There are an increasing number of case reports of these lesions causing varying mechanical symptoms in the knee and they should be considered as a differential diagnosis.

Pigmented villonodular synovitis of the foot and ankle: a report of eight cases

Eight cases of pigmented villonodular synovitis of the foot and ankle are reported. The purpose of this study was to analyze the manifestation of pigmented villonodular synovitis in the foot and to evaluate treatment options. There were four cases in the ankle and hindfoot, one in the first tarsometatarsal joint, and three in the toes. In seven of eight cases, diagnosis was confirmed by magnetic resonance imaging (MRI) scans. The tenosynovial form was found in the toes and the articular form in the hindfoot and ankle. Surgical treatment was performed in all cases: one arthroscopically assisted synovectomy in the ankle joint, two talocrural arthrodeses, one subtalar arthrodesis, one tarsometatarsal arthrodesis, and tumor removal on the toes with arthrodesis of the distal interphalangeal (DIP) joint in two cases. Average follow-up was 4 years. Recurrence occurred in one toe and led to partial amputation. Malunion in one ankle arthrodesis was operated on again with no sign of recurrence. In the toes, the lesion had a tumoral feature; the bone was infiltrated by soft tissue, and the surgical procedure was local removal of the tumor. In the hind-foot, the lesions were intra-articular and required synovectomy, usually with an arthrodesis. In the midfoot, there was a large extraosseous tumor surrounding tendons with destructive articular lesions.

[Villonodular synovitis--a rare condition causing intermittent locking of the knee]

Two patients with intermittent locking, mimicking a meniscal lesion or a loose body and with a palpable tumour in the knee joint are described. X-ray examinations were normal. Athroscopy revealed pedunculated tumours in both knees. The tumours were removed arthroscopically in one patient and by an arthrotomy in the other patient. The histological diagnosis was localized villonodular synovitis (giant-cell tumour) in both patients. This is a benign but very rare condition.

Polyarticular pigmented villonodular synovitis in a child

Pigmented villonodular synovitis is rare in the younger child. Polyarticular involvement in this condition, regardless of patient age, is distinctly uncommon. The authors describe a case of pigmented villonodular synovitis involving multiple joints in a young boy who also had congenital anomalies of the genitourinary tract. Although rare, pigmented villonodular synovitis should be considered in the differential diagnosis of multiple joint swellings in children with congenital anomalies.

Isolated compression of the motor branch of the ulnar nerve

This paper reports four cases of isolated compression of the deep branch of the ulnar nerve, and reviews the various etiologies (tumor, malformation and microtraumatism). The authors stress the importance of the electric examination, particularly conduction velocity in the palm in localizing the nerve lesion. Surgical exploration in these cases revealed a Giant cell tumor, two synovial cysts, and an abnormal fibrous band stretching between the flexor digiti quinti brevis and the opponents digiti quinti. Postoperative courses were uncomplicated and every patient recuperated quickly and completely. Early surgical exploration in such cases is mandatory.

Localized pigmented villonodular synovitis: a rare cause of locking of the knee

A 34-year-old woman presented with a history of recurrent episodes of knee locking and swelling. Arthroscopy revealed characteristic brown colored pedunculated lesions in the intercondylar notch region. These were clearly causing interference to joint motion. The lesions were resected arthroscopically with prompt resolution in symptoms. Histological examination confirmed pigmented villonodular synovitis.

Pigmented villonodular synovitis and synovial chondromatosis arthroscopically diagnosed and treated in the same elbow

This case is a report of arthroscopically diagnosed synovial chondromatosis and pigmented villonodular synovitis in the same elbow. A literature review found no prior reports of an association of these entities. Arthroscopy appears to be effective in the management of pigmented villonodular synovitis and synovial chondromatosis in the elbow.

Pigmented villonodular synovitis arising from the subtalar joint: a case report

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