Arthroscopic Management of Primary Synovial Chondromatosis of the Ankle: A Case Report and Review of the Literature

Case Reports1 March 1937TULAREMIC MENINGITISReport of Case with Postmortem Observations*EDGAR R. PUND, M.D., F.A.C.P., MILFORD B. HATCHER, M.D.EDGAR R. PUND, M.D., F.A.C.P.Search for more papers by this author, MILFORD B. HATCHER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-10-9-1390 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe histopathology of tularemia is adequately described in the literature notwithstanding the few reports of postmortem examinations. But because there are few reported necropsies the pathology of the disease is of particular interest in regard to the distribution of the lesions. Last year Bernstein was able to collect only 18 necropsies and to these he added three of his own. We have reviewed these cases and three additional reports by Beck and Merkel, Amoss and Sprunt, and Kavanaugh to determine the distribution of the lesions. This study was prompted by the occurrence of a fatal case of tularemia which was...Bibliography AMOSSSPRUNT HLDH: Tularemia: review of literature of cases contracted by ingestion of rabbit and the report of additional case with a necropsy, Jr. Am. Med. Assoc., 1936, cvi, 1078. CrossrefGoogle Scholar BARDONBERDEZ RG: Tularemia; report of a fatal case with postmortem observations, Jr. Am. Med. Assoc., 1928, xc, 1369. CrossrefGoogle Scholar BECKMERKEL HGWC: Tularemia; fatal case of the typhoid form caused by ingestion of rabbit: autopsy report, South. Med. Jr., 1935, xxviii, 422. CrossrefGoogle Scholar BERNSTEIN A: Tularemia: report of three fatal cases with autopsies, Arch. Int. Med., 1935, lvi, 1117. CrossrefGoogle Scholar BLACKFORD SD: Pulmonary lesions in human tularemia; pathologic review and report of a fatal case, ANN. INT. MED., 1932, v, 1421. LinkGoogle Scholar BOWEWAKEMAN DPDC: Tularemia and pregnancy: report of a case, Jr. Am. Med. Assoc., 1936, cvii, 577. CrossrefGoogle Scholar BRYANTHIRSCH AREF: Tularemic leptomeningitis; report of a case, Arch. Path., 1931, xii, 917. Google Scholar BUNKERSMITH CWEE: Tularemia; report of four cases, one fatal, with autopsy report, U. S. Nav. Med. Bull., 1928, xxvi, 901. Google Scholar FOULGERGLAZERFOSHAY MAML: Tularemia; report of a case with postmortem observations and a note on the staining of Bacterium tularense in tissue sections, Jr. Am. Med. Assoc., 1932, xcviii, 951. CrossrefGoogle Scholar FRANCISCALLENDER EGR: Tularemia; microscopic changes of the lesions in man, Arch. Path., 1927, iii, 577. Google Scholar GOODPASTUREHOUSE EWSJ: The pathologic anatomy of tularemia in man, Am. Jr. Path., 1928, iv, 213. Google Scholar GUDGER JR: Tularemic pneumonia; report of a case, Jr. Am. Med. Assoc., 1933, ci, 1148. CrossrefGoogle Scholar GUNDRYWARNER LPCG: Fatal tularemia: review of autopsied cases with report of a fatal case, ANN. INT. MED., 1934, vii, 837. LinkGoogle Scholar HAIZLIPO'NEIL JOAE: A case of meningitis due to Bacterium tularense , Jr. Am. Med. Assoc., 1931, xcvii, 704. CrossrefGoogle Scholar HARTMAN FW: Tularemic encephalitis, Am. Jr. Path., 1932, viii, 57. Google Scholar HARTMANBEAVERGREEN HRDCRG: The occurrence of tularemia in Minnesota in 1921: report of two cases—one fatal with necropsy report, Minnesota Med., 1933, xvi, 559. Google Scholar KAVANAUGH CN: Tularemia; a consideration of 123 cases, with observations at autopsy in one, Arch. Int. Med., 1935, lv, 61. CrossrefGoogle Scholar MASSEE JC: Tularemia in Georgia; report of a fatal case, Jr. Med. Assoc. Georgia, 1931, xx, 66. Google Scholar PALMERHANSMANN HDGH: Tularemia: report of a fulminating case with necropsy, Jr. Am. Med. Assoc., 1928, xci, 236. CrossrefGoogle Scholar PERMARMACLACHLAN HHWW: Tularemic pneumonia, ANN. INT. MED., 1931, v, 687. Google Scholar RICHMCCORDOCK ARHA: The pathogenesis of tuberculous meningitis, Bull. Johns Hopkins Hosp., 1933, lii, 5. Google Scholar SIMPSON WM: Tularemia; study of rapidly fatal case (four days, seven hours), Arch. Path., 1928, vi, 553. Google Scholar VERBRYCKE JR: Tularemia, with report of a fatal case simulating cholangitis with postmortem report, Jr. Am. Med. Assoc., 1924, lxxxii, 1577. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Augusta, Georgia*Received for publication November 19, 1936.From the Department of Pathology, University of Georgia School of Medicine, Augusta, Georgia. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTULAREMIC MENINGITISDie psychischen Störungen bei InfektionskrankheitenDie psychischen Störungen bei Infektions- und TropenkrankheitenVeränderungen des Zentralnervensystems bei weiteren infektiösen ErkrankungenTularemic Meningism and Serous MeningitisTularämieTularemia in infancy 1 March 1937Volume 10, Issue 9Page: 1390-1398KeywordsAutopsyHistopathologyLesionsMeningitisTularemia Issue Published: 1 March 1937 PDF downloadLoading ...

An Unusual Pulmonary Mass With Mediastinal Invasion and Multiple Intrapulmonary Nodules in a 52-Year-Old Man

Background:Primary synovial chondromatosis is a rare disease characterized by the presence of metaplastic cartilaginous nodules arising from the synovia. Synovial chondromatosis has been widely described in the large joints, including elbow, hip, and knee joints, but very rarely in the foot or ankle. Data on the arthroscopic management of this condition in the ankle are also limited.Case Report:A 50-year-old woman of Asian-Indian origin presented with the right lateral ankle pain of 1-month duration, associated with swelling and numbness of the joint. Magnetic resonance imaging revealed multiple loose bodies (at least 8) within the anterior ankle joint recess intracapsularly. She subsequently underwent right ankle arthroscopic debridement, synovectomy, removal of loose bodies, and microfracture with good post-operative recovery.Conclusion:We report a rare case of ankle synovial chondromatosis with multiple loose bodies managed arthroscopically. Arthroscopic approach is a good alternative to open arthrotomy for the treatment of synovial chondromatosis of the ankle.

A case of primary diffuse synovial chondromatosis of the ankle with long-term follow-up is reported. Trauma is implicated as a precipitating factor. This unusual, distinctive synovial neoplasm presents readily recognizable pathological features (Fig. 2). Specific diagnostic criteria are presented. The differential diagnosis of primary synovial chondromatosis includes secondary reactive synovial chondromatosis and synovial chondrosarcoma. The usual sources of osteochondritic loose bodies, on the other hand, are traumatic joint disruption, osteoarthritis, and infectious disorders. Acute primary synovial chondromatosis is adequately treated by removal of the loose bodies and synovectomy. Postoperative prognosis is dependent on the stage of the disease at the time of surgery. In this acute case, the patient had minimum impairment, and ankle roentgenograms twenty years after the arthrotomy were normal (Fig. 3).

Primary synovial chondromatosis consists of cartilaginous metaplasia of the synovium, which leads to the production of intra-articular and periarticular osteocartilaginous bodies [8, 12, 18, 19]. The nomenclature has evolved with time to include chondromatosis of the joint capsule, diffuse enchondroma of the joint capsule, joint chondroma, synovial osteochondromatosis, and synovial chondromatosis [8, 9, 16, 18, 20]. Primary synovial chondromatosis most commonly occurs in young and middle-aged adults and is rarely found in children (youngest patient reported was 14 years old) [12, 19]. The entity usually involves the synovium of large joints (knee, hip, elbow, and shoulder) [3, 8, 15, 16, 18, 19, 26] but has been reported in the hand [2, 10–12, 20, 26]. To our knowledge, only two cases have been reported in the interphalangeal joint of the thumb [13, 14]. We report on a 13-year-old female with primary synovial chondromatosis of the inter-phalangeal (IP) joint of her thumb.

Aortocoronary Saphenous Vein Graft Aneurysm: Diagnosis Using Color Doppler and Contrast Transesophageal Echocardiography

The purpose of this article was to evaluate the different techniques of operative treatment of primary synovial chondromatosis (PSC) of the hip. We performed a systematic review of literature of PSC and also present one case report about arthroscopic treatment of PSC. Our study compares both established operative procedures, open versus arthroscopic surgery, and shows each advantages and complications. One hundred and forty-seven publications were found in a PubMed literature review searching the terms: "synovial chondromatosis", "synovial osteochondromatosis", "synovial metaplasia" and "hip". All included studies were divided into open surgery or arthroscopic surgery concerning the therapeutic strategy and the corresponding results. We could find a total number of 3 reviews about PSC of the hip relating to operative procedures. One patient presented to our outpatient clinic with PSC. After other pathologies causing hip pain were excluded, the patient underwent hip arthroscopy with excision of the loose bodies and partial synovectomy. Diagnosis of PSC was confirmed by histopathology. The patient was examined before and one year after surgery with the Visual Analogue Scale (VAS) and the Hip Outcome Score (HOS ADL). Resecting PSC by hip arthroscopy is a minor surgical, but demanding procedure with minimal risks, even useful in the treatment of elderly patients with moderate osteoarthritis.

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Primary synovial chondromatosis is a benign neoplastic process, occurring mostly in large joints, more rarely in tendon sheaths, and extremely uncommonly in bursae. We describe a patient with primary synovial chondromatosis arising in the fourth intermetatarsal bursa. Knowledge of the bursal anatomy of the forefoot, and of characteristic imaging findings and the pathogenesis of synovial chondromatosis, is essential in including this uncommon entity in the differential when occurring in unusual locations.

BackgroundSynovial chondromatosis occurs rarely in the shoulder, and its details remain unclear. The purpose of this study was to clarify the clinical results of surgical resection and the histopathological findings of synovial chondromatosis in the shoulder.MethodsTen shoulders with synovial chondromatosis that had been operatively resected were reviewed retrospectively. Osteochondral lesions were present in the glenohumeral joint in six shoulders and in the subacromial space in four shoulders. Two patients had a history of trauma with glenohumeral dislocation without recurrent instability, and the other seven patients (eight shoulders) did not have any traumatic episodes or past illness involving the ipsilateral shoulder girdle. The occurrences of osteochondral lesions, inferior humeral osteophytes, and acromial spurs were assessed on radiographs before resection, just after resection, and at final follow-up. The Constant scores were compared before resection and at final follow-up with Wilcoxon signed-rank tests. Resected lesions were histopathologically differentiated between primary and secondary synovial chondromatosis.ResultsInferior humeral osteophytes were found in five shoulders with synovial chondromatosis in the glenohumeral joint, and all four shoulders with synovial chondromatosis in the subacromial space had acromial spur formation. Osteochondral lesions appeared to have been successfully removed in all shoulders on postoperative radiographs. At the final follow-up, however, one shoulder with secondary synovial chondromatosis in the subacromial space showed recurrence of osteochondral lesions and acromial spur formation. The mean Constant score improved significantly from 53.0 points before resection to 76.0 points at a mean follow-up of 6.0 years (p = 0.002). On histopathological evaluation, one shoulder was diagnosed as having primary synovial chondromatosis, while nine shoulders had secondary synovial chondromatosis.ConclusionsThe present study showed that resection of shoulder osteochondral lesions successfully relieved the clinical symptoms and that primary synovial chondromatosis is less common than secondary synovial chondromatosis in the shoulder. Although most of the present osteochondral lesions were clinically determined to be primary chondromatosis, only one case was histopathologically categorized as primary synovial chondromatosis. These results suggest that histopathological identification is needed to differentiate between primary and secondary synovial chondromatosis.