1
|
Long-term Outcomes of Diffuse or Recurrent Tenosynovial Giant Cell Tumor Treated with Postoperative External Beam Radiation Therapy. Pract Radiat Oncol 2022; 13:e301-e307. [PMID: 36460182 DOI: 10.1016/j.prro.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Tenosynovial giant cell tumor (TGCT) is a rare proliferative disorder of synovial membrane that previously was known as pigmented villonodular synovitis. Primary treatment involves surgical resection; however, complete removal of all disease involvement is difficult to achieve. Radiation may be useful to reduce the risk of recurrence. We report and update our institutional experience treating diffuse and recurrent TGCT with postsurgical external beam radiation therapy. METHODS AND MATERIALS We performed a retrospective chart review of 30 patients with TGCT from 2003 to 2019 treated with radiation therapy. Each patient was evaluated for demographics, radiation treatment parameters, surgical management, complications, and outcome. RESULTS With mean follow-up of 82 months (range, 3-211), 24 patients (80%) who underwent surgery followed by radiation therapy did not experience any further relapse, and all 30 patients achieved local control (100%) with additional salvage therapy after radiation therapy. The most common site of disease was the knee (n = 22, 73%), followed by the ankle (n = 5, 16%) and the hand (n = 3, 10%). Seven patients (24%) presented at time of initial diagnosis and 23 (76%) presented with recurrent disease after surgical resection, with an average of 2.6 surgical procedures before radiation therapy. After resection, 18 of 30 patients (67%) demonstrated residual TGCT by imaging. The median radiation therapy dose delivered was 36 Gy (range, 34-36 Gy) in 1.8 to 2.5 Gy/fractions for 4 weeks. In the assessment of posttreatment joint function, 26 sites (86%) exhibited excellent or good function, 2 (7%) fair, and 2 poor (7%) as determined by our scoring system. There were no cases of radiation-associated malignancy. CONCLUSIONS Among patients with diffuse or recurrent TGCT, postsurgical external beam radiation therapy provided excellent local control and good functional status, with minimal treatment-related complications. Postsurgical radiation therapy is a well-tolerated noninvasive treatment that should be considered after maximal cytoreductive resection to prevent disease progression and recurrence.
Collapse
|
2
|
Recurrence of pigmented villonodular synovitis of the knee: A case report with review of literature on the risk factors causing recurrence. Medicine (Baltimore) 2020; 99:e19856. [PMID: 32312009 PMCID: PMC7220429 DOI: 10.1097/md.0000000000019856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Pigmented villonodular synovitis is a rare disease which may involve any joints. It has localized and diffuse forms, and the latter is more aggressive with a higher recurrence rate. Different treatments are applied to each form of the disease, but there is no standard surgical procedure or any consensus on whether adjuvant therapy should be used. Many factors may lead to recurrence of the disease; however, there is no reliable way to predict the recurrence. PATIENT CONCERNS A 21-year-old female patient presented with a one-year history of progressive pain of the right knee. DIAGNOSES Pigmented villonodular synovitis. INTERVENTIONS We performed an anterior approach arthroscopic synovectomy and a posterior approach open synovectomy in the popliteal fossa, but the patient declined to take radiotherapy as a post-surgical adjuvant therapy. Then, she received a repeat arthroscopic synovectomy 20 months later because of the recurrent lesions, and a radiotherapy was performed 6 weeks after the second surgery. OUTCOMES There were no abnormal signs in the right knee on magnetic resonance imaging scanning 6 months after the second surgery. The range of motion of her right knee was normal. LESSONS Pigmented villonodular synovitis is a rare disease which may involve any joints. Surgical resection plus adjuvant therapy is recommended for patients with risk factors of recurrence.
Collapse
|
3
|
Necessity of adjuvant postoperative radiotherapy for diffuse pigmented villonodular synovitis of the knee: A case report and literature review. Medicine (Baltimore) 2018; 97:e9637. [PMID: 29504995 PMCID: PMC5779764 DOI: 10.1097/md.0000000000009637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pigmented villonodular synovitis (PVNS) is an idiopathic, proliferative disorder lesion of synovial tissue, which is regarded as a benign disease, but has a local invasion. Up to now, these are no consensus about the etiology and pathogenesis of PVNS. Because of the lack of typical clinical features, misdiagnosis and delayed diagnosis are not uncommon, magnetic resonance imaging (MRI) can assist diagnosis and histopathological examination is recognized as the gold standard for the final diagnosis. Because this disease is so rare, there is no standard treatment. Surgical resection of the lesion is considered the preferred treatment, but postoperative recurrence is a problem that cannot be ignored. Postoperative radiotherapy is necessary, especially for patients with diffuse PVNS of the knee. PATIENT CONCERNS A 27-year-old female teacher presented with 3 years chronic pain of the right knee, and progressive swelling aggravated for 1 week. The range of motion of the knee was limited. DIAGNOSES Clinical and laboratory examination failed to provide definitive diagnosis. Imaging can assist in diagnosis, and pathology is the gold standard. Erythrocyte sedimentation rate (ESR), antihemolytic streptococcus O (ASO), and rheumatoid factors (RF) were all negative. Joint puncture revealed giant cell tumor of the synovial membrane. PVNS was confirmed by postoperative pathology. The characteristic T2 weighted low signal of MRI suggests the recurrence of PVNS. INTERVENTIONS The patient underwent 2 stages of treatment: open synovectomy was performed in the first place and postoperative external radiotherapy was not considered. After 2 years of disease-free remission, she was diagnosed with a recurrence of the disease by MRI. Further, arthroscopic total synovectomy of the right knee was performed and external beam radiotherapy was carried out after the operation. OUTCOMES Up to now, the patient was followed up for 3 years without any sign of recurrence. LESSONS Adjuvant postoperative radiotherapy can improve the local control rate, it is a reliable treatment method for diffused PVNS.
Collapse
|
4
|
Postoperative radiotherapy for diffuse pigmented villonodular synovitis of the temporomandibular joint. Am J Otolaryngol 2015; 36:106-13. [PMID: 25459320 DOI: 10.1016/j.amjoto.2014.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare/benign condition of the synovial joint lining. It most commonly presents in the knee but has also been reported to occur in the temporomandibular joint (TMJ). Although there are several series reporting the use of postoperative radiotherapy (PORT) for extremity PVNS, there is scant literature on the use of PORT for PVNS of the TMJ. METHODS We conducted a literature review for case reports related to PVNS of the TMJ and discuss two additional cases treated with surgery and PORT. RESULTS 71 cases were found in the literature. 89% were the diffuse subtype. 92% had primary surgery and 7% had PORT. 68% were locally controlled. Both patients treated at our institution are locally controlled. CONCLUSIONS PVNS of the TMJ is a rare entity. Surgery is the mainstay of treatment but PORT may be useful for local control of extensive tumors or positive margins.
Collapse
|
5
|
[Effectiveness of arthroscopic synovectomy in treatment of pigmented villonodular synovitis of knee]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2013; 27:1171-1174. [PMID: 24397125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the effectivness of arthroscopic synovectomy in the treatment of pigmented villonodular synovitis (PVNS) of the knee. METHODS A retrospective analysis was conducted on 13 patients with PVNS of the knee treated with arthroscopic synovectomy between June 2008 and December 2011, including 8 left knees and 5 right knees. There were 9 males and 4 females, aged 25-45 years (mean, 33 years). Of 13 patients, 5 had a history of trauma, and 8 had no history of trauma. The disease duration ranged from 4 months to 80 months (mean, 44 months). The preoperative Lysholm score was 45.3 +/- 4.2, and International Knee Documentation Committee (IKDC) 2000 score was 46.8 +/- 4.9. All patients underwent arthroscopic synovectomy and postoperative radiotherapy. RESULTS The pathological examination proved PVNS in all cases. All incisions obtained healing by first intention after operation. There was no neurovascular injury or knee infection. The average follow-up period was 21.8 months (range, 12-30 months). The Lysholm score was 90.2 +/- 7.4, and IKDC2000 score was 87.8 +/- 3.8 at last follow-up, showing significant differences when compared with preoperative scores (t = 22.64, P = 0.00; t = 24.32, P = 0.00). No recurrence was observed during follow-up. CONCLUSION Arthroscopic synovectomy can be effective in the treatment of PVNS of the knee, and it has the merits of minimal invasion, rapid function recovery of the knee joint, and satisfactory results. So it is a safe, promising, and minimal invasive procedure in treatment of PVNS.
Collapse
|
6
|
[Effectiveness of arthroscopy and/or arthrotomy therapy for diffuse pigmented villonodular synovitis of the knee]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2012; 26:518-521. [PMID: 22702040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the method and the effectiveness of arthroscopy and/or arthrotomy combined with postoperative radiotherapy for diffuse pigmented villonodular synovitis (PVNS) of the knee. METHODS Between September 2000 and August 2010, 97 patients with diffuse PVNS of the knee were treated. There were 38 males and 59 females with a median age of 33 years (range, 8-75 years). The disease duration ranged from 1 week to 30 years, including 52 left knees and 45 right knees. There were 10 recurrent cases. The extention and flexion of the knee joint were (1.9 +/- 2.3) degrees and (122.9 +/- 5.6) degrees, respectively; the Lysholm score was 43.2 +/- 6.7; and the International Knee Documentation Committee (IKDC) score was 53.2 +/- 5.7, preoperatively. According to the scope and degree of the knee joint lesions, simultaneous anterior and posterior synovectomy was performed under arthroscopy in 82 cases, synovectomy under arthroscopy and removal of posterior extraarticular lesion by arthrotomy in 3 cases, synovectomy and the soft tissue lesions resection under arthroscopy in 9 cases, and staging resection and bone graft in 3 cases. After operation, 76 patients received postoperative radiotherapy. RESULTS Popliteal artery was injuryed in 1 case and the branch of popliteal veins were injuryed in 3 cases during operation. Intra-articular hemorrhage occurred in 1 case at 3 days after operation. The other patients achieved healing of incision by first intention without nerve damage and other complications. All patients were followed up 1 year and 3 months to 11 years and 2 months (median, 61 months) postoperatively. During follow-up, 89 cases had no relapse. At 15 months after operation, the extention and flexion of the knee joint were (0.2 +/- 1.3) degrees and (135.9 +/- 6.6) degrees, respectively; the Lysholm score was 89.8 +/- 5.8; and the IKDC score was 87.8 +/- 5.8. All indexes were significantly improved when compared with the preoperative ones (P < 0.05). At 6 months to 8 years postoperatively, 8 cases had occurrence, and they had slight limitation of the range of motion but had no pain and swelling of the knees after reoperation. CONCLUSION According to the scope and degree of the knee joint lesions, arthroscopy and/or arthrotomy combined with postoperative radiotherapy should be chosen for diffuse PVNS of the knee so as to obtain good effectiveness. Radiotherapy and enough total radiation dose are important factors to insure no recurrence.
Collapse
|
7
|
Pigmented villonodular synovitis managed by Yttrium 90 after debulking surgery. Saudi Med J 2008; 29:1197-1200. [PMID: 18690320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
The goal of this study was to evaluate outcome of patients with pigmented villonodular synovitis (PVNS) managed by Yttrium90 (90Y) after debulking surgery. Seven patients (3 males and 4 females) with PVNS were studied retrospectively. Mean follow-up was 47.8 months (range 24-97 months). Mean age was 44.8 years (range 20-68 years. Debulking surgeries via arthroscopic synovectomy were performed in 4 cases and in 3 cases via mini arthrotomy. After 90Y injection was applied. Magnetic resonance imaging (MRI) included measurement of synovial thickness in preoperative and at last control. Main musculoskeletal tumor society score was 26 (range, 23-29), main MTS rating was 70.4% (range, 38.5-86.2%). Mean preoperative synovial thickness was 14.9mm range 20-12mm. Synovial thickness was completely disappeared at last MRI examination. There was diffuse joint effusion preoperatively, decreasing at last control. No cases of PVNS recurrence were found. Although we had a small number of cases, we believe that combination of debulking surgery with intra-articular injection of 90Y for PVNS of knee joint is an effective and safe treatment method.
Collapse
|
8
|
Diffuse pigmented villonodular synovitis: preliminary results with intralesional resection and p32 synoviorthesis. Clin Orthop Relat Res 2007; 454:186-91. [PMID: 16906091 DOI: 10.1097/01.blo.0000229345.57092.a2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Because of the high local recurrence rate associated with surgical resection alone, patients with diffuse intraarticular pigmented villonodular synovitis were treated with surgical resection followed by colloidal chromic P32 synoviorthesis. The medical records of nine consecutive patients treated in this manner were reviewed retrospectively to determine the recurrence rate of pigmented villonodular synovitis. All patients had either one or two surgical resections (arthroscopy in one patient, open resection in seven, arthroscopy and open resection in one). The involved joints included six knees and one each, ankle, elbow, and hip. Eight of the nine patients remained recurrence free at a mean followup of 38 months (range, 19-60 months) after surgery. One patient had a suspected asymptomatic recurrence documented by magnetic resonance imaging 29 months after surgery. Seven patients reported their normal activities as unrestricted. Five reported improved activity levels, one reported the activity level remained the same, and one reported activity as the same or better. None reported reduced activity levels. In these patients synoviorthesis with colloidal chromic P32 following gross resection of all obvious pigmented villonodular synovitis provided local disease control in all but one.
Collapse
|
9
|
[Effectiveness evaluation of knee joint 90Y radiosynovectomy]. PRZEGLAD LEKARSKI 2007; 64:450-453. [PMID: 18409343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Chronic knee synovitis with effusion, because of the special role of knee joint is an important therapeutic problem. This leads to searching for new treatment modalities. One of them is radiosynovectomy based on anti-proliferative and anti-inflammatory activity of ionizing radiation. It is made using 90Y mainly (high energy of beta [electrons] radiation [2.2 MeV], large average penetration in soft tissues [3.6 mm] and long physical half-life [2.7 days]). MATERIAL AND METHOD Analyzed material is comprised of 30 patients (33 treatments) suffering from proliferative synovitis of knee joint treated by radiosynovectomy using intra-articular injection of 6 mCi 90Y. In 20 cases the reason of disease was non-specific reactive arthritis, in 5 rheumatoid arthritis, in 3 villonodular synovitis, in 3 psoriasis and in 2 ulcerative colitis. Symptoms duration varied from 3 to 144 months (mean 43). A knee circumference at the treatment day varied from 33.5 cm to 49 cm (mean 41). The operation was based on knee biopsy, evacuation of exudate and delivery of 6 mCi of colloid 90Y. Follow up ranged up to 14 months (mean 4.4). Patients were examined 2 weeks, 1, 3, 6 and 12 months after treatment. During examination a knee circumference was measured, a knee mobility, temperature and patella floating symptom were examined. Pain in treated region was assessed and amount of exudate was measured. RESULTS A knee circumference and exudate amount enlarged during following controls, and compared between the treatment day and the last control did not differ significantly (41 vs. 41.6 cm and 43 vs. 42.5 ml respectively) but number of biopsies decreased. A percentage of patients with impaired knee mobility also did not change (59% vs. 58%). Probably, it was caused by resignation from control examination when symptoms disappeared. A percentage of patients without pain relief decreased from 43.5% 2 weeks after treatment to 20% one year later and a patient percentage with complete pain relief increased from 8.5% to 60%. A patient percentage with increased knee temperature and with floating patella decreased significantly (54 vs. 25% and 83 vs. 48% respectively). CONCLUSIONS Obtained results do not allow to form univocal conclusions regarding effectiveness of 90Y radiosynovectomy. The decreasing biopsies number, decreasing percentage of patient with increased knee temperature and with floating patella; increased percentage of patients with analgetic effect and with total pain relief show a necessity of renewed evaluation of this treatment modality on the base of bigger patients number and longer and more precise observation.
Collapse
|
10
|
External beam radiotherapy as postoperative treatment of diffuse pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys 2006; 67:1130-4. [PMID: 17175116 DOI: 10.1016/j.ijrobp.2006.10.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Revised: 10/18/2006] [Accepted: 10/18/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE Diffuse pigmented villonodular synovitis is a rare proliferative disorder of synovial membranes with invasive and expansive growth patterns. Radical synovectomy is regarded as the treatment of choice. However, because of the high recurrence rates, additive treatment might be useful. Radiotherapy (RT) has been evaluated with positive results, but the optimal treatment schedules are vague. We have reviewed our experience with postoperative RT in cases of suspected or proven residual disease. METHODS AND MATERIALS Between December 1996 and January 2006, 7 diffuse pigmented villonodular synovitis patients underwent RT at our institution. The most common location was the knee joint (5 patients). All patients underwent radical surgery and were treated subsequently with 6-MV photon RT. The total doses applied were 30-50 Gy, depending on the resection status and estimated risk of relapse. For analysis, we retrospectively reviewed all patients in April 2006. RESULTS The mean follow-up time was 29 months (range, 3-112 months). RT had no acute adverse effects. At the assessment, no evidence was found of recurrent or persisting disease in any patient. Of the 7 patients, 6 reported asymptomatic limb function and excellent quality of life; 1 patient had persistent restriction of joint movement after repeated surgery. No radiotherapeutic late effects were seen. CONCLUSION The results of our series have confirmed the efficacy and safety of postoperative RT for diffuse pigmented villonodular synovitis. Hence, this treatment should be considered for patients with suspected or proven residual disease.
Collapse
|
11
|
Abstract
Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder that affects the synovium in young and middle-aged adults. Although most believe that it is an inflammatory process, some believe that it is a benign neoplasm. The optimal treatment is surgery. The local recurrence rate after marginal excision for localized PVNS is low. In contrast, the local recurrence rate after open synovectomy for diffuse PVNS is relatively high. The intra-articular instillation of radioactive isotopes or external beam radiotherapy (approximately 35 Gy in 14-15 fractions over 3 weeks) may significantly improve the likelihood of local control and long-term function in patients with incompletely resected diffuse PVNS. The probability of complications after moderate-dose radiotherapy (RT) is low.
Collapse
|
12
|
Diffuse pigmented villonodular synovitis of the foot and ankle treated with surgery and radiotherapy. INTERNATIONAL ORTHOPAEDICS 2006; 29:403-5. [PMID: 16622915 PMCID: PMC2231588 DOI: 10.1007/s00264-005-0004-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We followed up seven patients with histologically confirmed diffuse pigmented villonodular synovitis in a prospective study between 1992 ans 2001. The mean age at diagnosis was 30.7 years. The patients underwent synovectomy, followed by radiotherapy with a total dose of 35 Gy in 20 fractions. In all cases, the excision was considered incomplete when examined histologically. At an average follow up of 24 (18-36) months, six patients reported better function and reduced levels of pain. One patient remained symptomatic but did not have a recurrence. We conclude that a combined approach to a primary pigmented villonodular synovitis of the foot and ankle may reduce the risk of recurrence without functional impairment.
Collapse
|
13
|
Localized nodular pigmented villonodular synovitis of the upper ankle joint – diagnosis and treatment. Z Rheumatol 2006; 65:231-4. [PMID: 16477454 DOI: 10.1007/s00393-005-0008-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 06/29/2005] [Indexed: 10/25/2022]
Abstract
This paper introduces a case of local pigmented villonodular synovits (PVNS) of the upper ankle joint in a 37-year old patient. PVNS is a neoplasia of the synovial membrane. Two different entities of PVNS are known: generalized diffuse and local nodular. They differ in their degree of destruction and growth configuration, which is crucial for prognosis and operative treatment. The most common location of the local nodular form is the knee joint, followed by the finger joints. Occurrence in the ankle joint is not common but should be considered if clinical findings are present. MRI is the method of choice for diagnosis and assessment of the bone situation. Treatment consists of radical excision of the neoplasia. Radiosynoviorthesis is recommended as a post-operative treatment to increase the probability of a total removal of persisting PVNS cells. The rate of recurrence seems to be between 8 and 46%.
Collapse
|
14
|
Pigmented Villonodular Synovitis of the Distal Radioulnar Joint. Strahlenther Onkol 2006; 182:247-51. [PMID: 16622627 DOI: 10.1007/s00066-006-1480-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 12/30/2005] [Indexed: 10/24/2022]
Abstract
CASE REPORT A 32-year-old female patient underwent surgical synovectomy in the right distal radioulnar joint because of local recurrence of pigmented villonodular synovitis (PVNS) after previous surgery. 7 weeks after her second surgery she received fractionated radiation therapy (RT) to a total dose of 36.0 Gy given in five weekly fractions of 2.0 Gy. Apart from a mild skin erythema the patient had no early morbidity related to the use of RT. After a follow-up of 36 months no local recurrence was detected. CONCLUSION In accordance with literature data the hitherto course of the presented case corroborates that RT is a safe and effective treatment option for the prevention of PVNS recurrence.
Collapse
|
15
|
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare disease of uncertain etiology usually affecting the synovium of weightbearing joints. METHODS We retrospectively evaluated 11 patients who were diagnosed and treated for PVNS of the ankle and foot over a 13-year period with a minimum of 2-year followup. Four patients with ankle joint PVNS and one patient with PVNS of the fifth metatarsophalangeal joint were seen initially at our institution and were treated with surgery alone. Six patients with ankle joint PVNS were referred to our institution for recurrent PVNS lesions; two of these patients were treated with excision alone, and the other four patients had surgical excision followed by radiation therapy with dosages ranging from 3600-4000 cGy. RESULTS No recurrence was noted at a mean followup of 9 years for primary lesions and 3.5 years for recurrent lesions. CONCLUSION Based on these results, surgical excision of primary lesions and excision with postoperative radiation for recurrent lesions are recommended.
Collapse
|
16
|
Pigmented villonodular synovitis of the foot and ankle: a 12-year experience from a tertiary orthopedic Oncology Unit. J Foot Ankle Surg 2004; 43:407-11. [PMID: 15605054 DOI: 10.1053/j.jfas.2004.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pigmented villonodular synovitis is a synovial proliferative process. In the majority of cases, it is monoarticular; however, in the foot and ankle, it can affect more than 1 joint. It may be a challenge to diagnose and treat successfully. Nine patients with foot and ankle pigmented villonodular synovitis synovial disease were reviewed from a tertiary Oncology Unit during a 12-year period. Seven of the patients had ankle involvement and 2 had foot involvement; all of the patients were women. The mean follow-up time was 3.4 years. Seven patients had localized disease and 2 had diffuse disease. All of the patients with localized disease had wide surgical excision and none had recurrence. Both patients with diffuse disease had multiple recurrences after attempted total synovectomy and adjuvant radiotherapy. A review of the diagnosis, imaging strategies, and treatment options is provided.
Collapse
|
17
|
Abstract
A 41-year-old man had a peripheral neuroectodermal tumor develop at the distal third of the fibula 4 years after radiotherapy for relapsed villonodular synovitis. This type of sarcoma usually is classified into the heterogeneic group of small round-cell bone tumors as a subdivision of Ewing's sarcomas. The immuno-staining positivity of the neoplastic cells for the neuron-specific enolase allowed the authors to make the diagnosis of a tumor with neuroectodermal origin. When the histologic study confirmed the diagnosis, the patient was treated with chemotherapy, surgical excision of the tumor, and adjuvant radiotherapy. Radiotherapy is thought to be involved in the genesis of osteogenic sarcomas as it has been shown in several reports, but there is no evidence in the literature of a peripheral neuroectodermal tumor developing after radiotherapy.
Collapse
|
18
|
Irradiation as adjunctive treatment of diffuse pigmented villonodular synovitis of the foot and ankle prior to tumor surgical excision. Med Hypotheses 2003; 61:229-30. [PMID: 12888309 DOI: 10.1016/s0306-9877(03)00149-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this manuscript, the author undertakes a brief description of the diffuse form of pigmented villonodular synovitis and provides a recommendation of pre-surgical tumor irradiation as adjunctive treatment for reduction of recurrence and better preservation of function of the lower extremity.
Collapse
|
19
|
[Quantification of bone scintigraphy as an objective method in the follow-up of radioisotopic synoviorthesis]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2002; 21:426-32. [PMID: 12425890 DOI: 10.1016/s0212-6982(02)72119-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This work tries to provide the clinicians an objective tool that can contribute to the assessment of the results of radioisotopic synoviorthesis (RS). This study aims to assess the value of the quantification of bone scintigraphy in blood pool and late phase of the affected joints treated with 90Y silicate, in order to observe the clinical improvement experienced by most of these patients. A total of 69 bone scintigraphies (BS) in blood pool and late phase have been quantified. They belonged to 23 patients who were treated with RS with 90Y. The first scintigraphy study was performed before the treatment, the second and the third ones were performed 2 and 6 months after treatment. In each BS we quantified the index: counts per pixel of healthy / affected joint. We also have calculated the fraction in the late phase: counts per pixel of healthy bone / counts per pixel of affected and healthy joint. For the comparative statistical analysis of the results we used the Student's t test. We considered statistical significance when p < 0.05. All the patients presented clinical improvement. If we compare the index obtained in BS 2 months after treatment and pre-treatment we find statistical significance (p < 0.05) in the increase of index in the anterior view and late phase. If we compare the index obtained in BS 6 month after treatment and pre-treatment, we find a statistically significant increase in the anterior (p < 0.01) and posterior (p < 0.05) view of the blood pool phase and the anterior view of late phase (p < 0.01). The fraction counts per pixel of healthy bone / counts per pixel of affected and healthy joint did not present a significant increase in any BS control (2 and 6 months). We recommend quantification using the index (counts per pixel healthy / affected joint ) proposed in this work, because it is easy to perform, cheap and reliable in the follow-up of patients treated with RS.
Collapse
|
20
|
Abstract
Three cases of pigmented villonodular synovitis treated in recent years are described. One case presents a malignant transformation and raises the question of the benign character of these lesions. The therapeutic options are considered as well as the need for a larger series of patients to define therapeutic strategy.
Collapse
MESH Headings
- Adult
- Amputation, Surgical
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Arthroplasty, Replacement, Knee
- Cell Transformation, Neoplastic
- Chemotherapy, Adjuvant
- Cobalt Radioisotopes/therapeutic use
- Combined Modality Therapy
- Disease Progression
- Doxorubicin/administration & dosage
- Fatal Outcome
- Female
- Femur Head/pathology
- Humans
- Ifosfamide/administration & dosage
- Knee Joint/pathology
- Knee Joint/surgery
- Lymphatic Metastasis
- Male
- Middle Aged
- Radioisotope Teletherapy
- Radiotherapy, Adjuvant
- Radiotherapy, High-Energy
- Recurrence
- Retroperitoneal Space
- Sarcoma, Synovial/drug therapy
- Sarcoma, Synovial/pathology
- Sarcoma, Synovial/radiotherapy
- Sarcoma, Synovial/surgery
- Synovial Cyst/diagnosis
- Synovitis, Pigmented Villonodular/diagnosis
- Synovitis, Pigmented Villonodular/pathology
- Synovitis, Pigmented Villonodular/radiotherapy
- Synovitis, Pigmented Villonodular/surgery
Collapse
|
21
|
Combined partial arthroscopic synovectomy and radiation therapy for diffuse pigmented villonodular synovitis of the knee. Arthroscopy 2001; 17:527-31. [PMID: 11337722 DOI: 10.1053/jars.2001.24068] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present the results of combined partial arthroscopic synovectomy and low-dose external-beam radiation therapy (RT) in the treatment of diffuse pigmented villonodular synovitis (PVNS) of the knee. Mechanical synovectomy is an effective tool in treating PVNS of the knee, but when used alone it may be insufficient to eliminate all affected tissue. Intra-articular radiation or external-beam radiation may be added to mechanical synovectomy to treat recurrence but is not routinely done at the time of initial synovectomy. Combining intra-articular synovectomy with RT at the initial treatment for PVNS of the knee may reduce the recurrence rate. We present a prospective study of the treatment of 22 patients with clinical, ultrasonic, and histologically confirmed findings of diffuse PVNS of the knee. Characteristic clinical findings included pain, swelling, and erythema. These patients were treated by the Arthroscopic Surgery Group of the Orthopaedic Service at the Hospital "Hermanos Ameijeiras" in Havana, Cuba from 1990 to 1998. The protocol included anterior (patellofemoral, medial, and lateral) arthroscopic synovectomy and postoperative RT with a total dose of 2,600 cGy. This combination therapy was effective in reducing symptoms of pain and edema, and in improving overall function of patients. Nineteen patients (86%) had good or excellent results at an average follow-up of 33 months (range, 26 to 76 months). Three patients had residual stiffness and swelling, 2 of whom also had pain. Three had clinically and ultrasonically confirmed recurrence of disease and were treated with repeat arthroscopic synovectomy without harmful effects from RT. In all of the cases requiring repeat arthroscopic synovectomy, we observed fibrous bands secondary to reorganization of synovial inflamed tissue, meniscal retraction, and microscopic findings of fibrosis and cellular paucity. Partial arthroscopic synovectomy combined with low-dose RT in anti-inflammatory doses produced good results in the treatment of PVNS without significant complications in our patient series. Partial arthroscopic synovectomy of the knee for PVNS may be combined with RT to reduce the risk of disease recurrence. Adjuvant RT should also be considered for patients receiving a radical synovectomy to treat inaccessible or hidden disease sites. Rates of recurrence with combined partial (anterior) synovectomy and RT approach that of complete synovectomy in this series. Combining RT with radical arthroscopic synovectomy might further reduce recurrence rates.
Collapse
|
22
|
Radiation Therapy for Heterotopic Bone Prevention and Other Joint Conditions. FRONTIERS OF RADIATION THERAPY AND ONCOLOGY 2001; 35:120-34. [PMID: 11351942 DOI: 10.1159/000061272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
23
|
Abstract
Pigmented villonodular synovitis is a rare benign tumor. The high rate or recurrence after surgery exposes the risk of non-conservative or non-functional treatment. External irradiation of post-surgical residual disease seems to be useful for the prevention of relapse and conservation with a good functional result. We report a clinical observation of a case with a diffuse type of pigmented villonodular synovitis of the ankle, operated on three times, and then treated by external irradiation. The published results in terms of response and functional prognosis of 14 cases of multi-recurrent villonodular synovitis treated by irradiation seem to confirm this therapeutic option.
Collapse
|
24
|
SCVIR Annual Meeting Film Panel Session: case 2. Arterial occlusion secondary to radiation vasculitis. Society of Cardiovascular & Interventional Radiology. J Vasc Interv Radiol 1999; 10:505-8. [PMID: 10229483 DOI: 10.1016/s1051-0443(99)70073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
25
|
Outcome following radiation treatment for high-risk pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys 1995; 32:777-86. [PMID: 7790264 DOI: 10.1016/0360-3016(95)00514-y] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Pigmented villonodular synovitis (PVNS) is a rare proliferative process involving synovial membranes. It has a variable course, and while usually benign, may be destructive, resulting in major symptoms and loss of function leading to amputation. Optimum treatment is not always clear, and little information exists with respect to the role of radiotherapy. The purpose was to review our experience with radiotherapy in cases at high risk for recurrence with functional loss including instances where amputation was the sole alternative for symptomatic disease. METHODS AND MATERIALS The records of all patients registered between 1972 and 1992 with a diagnosis of PVNS were identified (21 cases). The records of 14 cases who received radiotherapy after referral were reviewed retrospectively for demographic information, radiotherapy treatment parameters, and tumor outcome. RESULTS All cases had confirmation of pathologic diagnosis. Six patients had primary and eight had recurrent disease (with a mean of 2.5 prior surgical procedures). All cases had both intra- and extraarticular disease and, without exception, the poorer prognosis diffuse subtype of the disease. The majority had one or more additional risk factors including skin, bone, tendon, neurovascular, or muscle group extension. With a mean follow-up time of 69 months (range 13-250 months), only one patient has shown persistence of disease. With the exception of that single case, all those with measurable disease had obvious disease until at least 12 months and, subsequently, manifested complete responses. The single case was lost from the clinic after 8 months from the initiation of radiotherapy to a dose of 30 Gy in 15 fractions and had a palpable mass at the time. He subsequently was noted to have a persisting mass and an excisional biopsy 9 years later showed PVNS. He remains well 21 years after treatment with good function. Eleven patients enjoyed excellent or good function from the affected limb and three had fair function. All patients had greater use of limb than at the time of treatment. No patient required amputation, and none had evidence of serious radiotherapy complications. CONCLUSIONS These results demonstrate that moderate dose radiotherapy is an effective modality in the treatment of a subset of cases with this rare condition. Its use has permitted avoidance of amputation in very advanced cases with acceptable function preservation. When treatment is indicated we currently recommend gross total removal of PVNS. This is followed by moderate dose radiotherapy (35 Gy in 15 fractions) for residual disease where salvage of subsequent recurrence may compromise function.
Collapse
|
26
|
[Pigmented villonodular synovitis of the hip. Case report]. POLSKI TYGODNIK LEKARSKI (WARSAW, POLAND : 1960) 1993; 48:653-4. [PMID: 7808942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 35-year woman suffering from the tumor of the right groin for 5 years was diagnosed as a diffuse pigmented villonodular synovitis and tenosynovitis following a 7-month follow-up and examinations. Patient was treated with irradiation which produced a subjective improvement but no significant objective response to the treatment was noted.
Collapse
|
27
|
Treatment of pigmented villonodular synovitis with yttrium-90: changes in immunologic features, Tc-99m uptake measurements, and MR imaging of one case. Clin Rheumatol 1992; 11:280-5. [PMID: 1319881 DOI: 10.1007/bf02207973] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pigmented villonodular synovitis (PVNS) is an uncommon proliferative disease of synovium. We report a 35-year-old male with diffuse form of PVNS of left knee, treated with intraarticular injection of 5 mCi of yttrium-90 (Y-90) silicate colloid consisting of two doses with a 3-month interval between them. During follow-up, the affected knee showed clinical improvement and was accompanied by a decrease of the levels of soluble interleukin-2 receptor in sera and synovial fluids (SF). When compared to osteoarthritis subjects, SF lymphocyte subsets of this case before Y-90 therapy showed a lower CD4:CD8 cell ratio and absence of suppressor inducer cells (CD4+ 2H4+). The Tc-99m pertechnetate knee uptake indexes correlated well with clinical improvement. Serial magnetic resonance imaging revealed significant change one year after Y-90 therapy. The findings of immunological assessment suggested that immunoregulatory dysfunction may be related to the pathogenesis of PVNS.
Collapse
|
28
|
Treatment of pigmented villonodular synovitis of the knee with yttrium-90 silicate: prospective evaluations by arthroscopy, histology, and 99mTc pertechnetate uptake measurements. Ann Rheum Dis 1989; 48:1007-13. [PMID: 2559664 PMCID: PMC1003940 DOI: 10.1136/ard.48.12.1007] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The diffuse form of pigmented villonodular synovitis of eight knee joints of eight patients was treated by intra-articular injection of 185 MBq yttrium-90 silicate (90Y). Six patients had a recurrence of disease after one or two surgical synovectomies. After treatment with 90Y once or twice four knees showed clinical improvement with an accompanying decrease of the inflammatory activity as measured by the technetium-99m pertechnetate (99mTcO4-) uptake ratio and the severity of the diseased synovial tissue. Arthroscopy was performed before and six months after each 90Y treatment. The ratio of 99mTcO4- uptake in the inflamed compared with the normal knee joint correlated well with the macroscopical grading of pigmented villonodular synovitis. In all cases areas of persistent synovitis were found after the 90Y injection and this was confirmed both by histological examination and 99mTcO4- uptake measurements. Biopsy specimens taken from the diseased synovial areas showed histologically mostly less prominent and less numerous villi. The cartilage damage was slightly increased in only two cases. No radiological deterioration was found during follow up (mean 24 months, range 12-41). No complications of the radiosynoviortheses were noted.
Collapse
|
29
|
The treatment of pigmented villonodular synovitis of the hip. A case report and literature review. Clin Orthop Relat Res 1989:154-60. [PMID: 2912615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Pigmented villonodular synovitis (PVS) is a rare occurrence in the hip joint. A 33-year-old female with PVS of the right hip was successfully treated by synovectomy and total hip arthroplasty. The literature includes 64 cases of PVS involving the hip, with an average patient age of 34.8 years. Multiple methods of initial treatment were encountered including synovectomy alone, synovectomy and total hip arthroplasty, radiation therapy, and arthrodesis. Synovectomy is only effective when articular cartilage is preserved. Total hip arthroplasty, although of concern in such a young population, appears to be the procedure of choice for either advanced cases of PVS or those that have failed joint-sparing procedures.
Collapse
|
30
|
Yttrium 90 synovectomy--a new treatment for pigmented villonodular synovitis. BRITISH JOURNAL OF RHEUMATOLOGY 1987; 26:71-2. [PMID: 3814979 DOI: 10.1093/rheumatology/26.1.71-a] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
31
|
[Treatment of pigmented villonodular synovitis]. ORTOPEDIIA TRAVMATOLOGIIA I PROTEZIROVANIE 1984:50-5. [PMID: 6522011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
32
|
Pigmented villonodular synovitis of the temporomandibular joint. THE JOURNAL OF OTOLARYNGOLOGY 1984; 13:123-6. [PMID: 6726846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Pigmented villonodular synovitis ( PVNS ) is a benign disease of unknown etiology arising from the synovial membranes of joints, bursae, and tendon sheaths. Though histologically benign, it is a very aggressive lesion, capable of bone destruction and widespread infiltration of surrounding tissues. It is a rare disease, usually confined to large joints, particularly the knee. Its propensity for recurrence is emphasized in this report. Involvement of the temporomandibular joint (TMJ) is unusual. It most commonly presents in the TMJ region as a left pre-auricular mass. Symptoms of TMJ dysfunction are usually present, but may be subtle. These may consist of painful mastication, clicking, trismus, malocclusion, and deep pain in the TMJ. Radiological evidence of bone destruction is frequently present, and together with the pre-auricular mass, should suggest the diagnosis. Surgical excision is the preferred mode of treatment. While cosmesis is a consideration, radical excision, including involved bone, is mandatory to prevent recurrence. The effect of radiotherapy on this disease in the head and neck region is documented.
Collapse
|
33
|
Recurrent villonodular synovitis of the knee. Successful treatment with yttrium-90. Clin Orthop Relat Res 1982:139-44. [PMID: 7105568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A 40-year-old woman with recurrent pigmented villonodular synovitis of the knee was treated with Yttrium-90 radiocolloid. The advantages of Yttrium-90 include effectiveness, low cost, simplicity, and low morbidity. The radiophysical properties of Yttrium-90 that make it a useful therapeutic agent are short half-life, pure beta emission and good penetration of the soft tissues. Side effects are few, predictable, and for the most part, avoidable. Radionecrosis of soft tissue, needle tract pigmentation, injection site tenderness, pyrexia, and lymphocyte chromosomal abnormalities have been reported. The indications for intra-articular radiocolloid therapy are the same as for surgical synovectomy, except that it is reserved for patients older than 35 years of age. The pathologic events following Yttrium-90 therapy in experimental animals show coagulation necrosis of the synovium, followed by an intense inflammatory reaction, leading ultimately to fibrosis. Yttrium-90 is a useful adjuvant in the treatment of recurrent pigmented villonodular synovitis.
Collapse
|
34
|
Pigmented villonodular synovitis (PVS) A case report. Scand J Rheumatol 1982; 11:145-9. [PMID: 7123175 DOI: 10.3109/03009748209098180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
35
|
Total lymphoid and local joint irradiation in the treatment of adjuvant arthritis. ARTHRITIS AND RHEUMATISM 1981; 24:38-44. [PMID: 7470170 DOI: 10.1002/art.1780240106] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
36
|
[Results of intraarticular treatment with 90yttrium of persistent knee effusions (author's transl)]. SCHWEIZERISCHE RUNDSCHAU FUR MEDIZIN PRAXIS = REVUE SUISSE DE MEDECINE PRAXIS 1979; 68:1150-5. [PMID: 523427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
37
|
[Results of intraarticular treatment with 90Yttrium of persistent knee effusions (author's transl)]. SCHWEIZERISCHE RUNDSCHAU FUR MEDIZIN PRAXIS = REVUE SUISSE DE MEDECINE PRAXIS 1979; 68:1118-22. [PMID: 504070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|