Abstract
Pigmented villonodular synovitis (PVNS) is a rare benign neoplasm involving the synovial joints and tendon sheaths. It can be classified into localised and diffuse type. The diffuse type of PVNS is larger and very aggressive, clinically mimicking as soft tissue sarcoma. Radiological investigation can aid in knowing the relation of the mass to the joint cavity and invasion of surrounding structures. A biopsy can pose a diagnostic challenge for pathologists. Surgical excision is the treatment of choice. Histopathological examination is necessary for a definite diagnosis.
 Keywords: Pigmented villonodular synovitis; diffuse; soft tissue sarcoma; histopathology.
Highlights
Pigmented villonodular synovitis or tenosynovial giant cell tumour is a rare, benign neoplasm associated with synovial proliferation and hemosiderin deposition inside the joints, tendon sheaths, and bursae (1, 2)
Localised Pigmented villonodular synovitis (PVNS) are smaller masses commonly involve fingers (85%), followed by wrist, ankle, and knee joint
We present a rare case of diffuse PVNS in a 55-year-old female who presented with swelling over the right calf
Summary
Pigmented villonodular synovitis or tenosynovial giant cell tumour is a rare, benign neoplasm associated with synovial proliferation and hemosiderin deposition inside the joints, tendon sheaths, and bursae (1, 2). We present a rare case of diffuse PVNS in a 55-year-old female who presented with swelling over the right calf. X-ray of the right knee showed soft tissue density in the posteromedial aspect of the distal third of the thigh and upper third of the leg without any bone erosions (Fig. 2). Magnetic resonance imaging (MRI) showed a well-defined, lobulated, enhancing lesion measuring 20cm X 11cm X 9cm in the posteromedial aspect of the upper third of the leg and lower third of the thigh, involving the intermuscular plane between semimembranosus and biceps femoris muscles, which is communicating with the knee joint (Fig. 3A & 3B). After making a clinical diagnosis of soft tissue sarcoma, incisional biopsy from the mass was done, which showed sheets of foamy histiocytes, plasma cells, lymphocytes, and occasional giant cells. Stroma was very cellular, showing closely packed, medium-sized polyhedral cells containing round to oval, plump nucleus with
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