Abstract
Locking of the knee is a one of the commonest orthopedic outpatient presentation. This patient usually need magnetic resonance imaging (MRI) when there is suspected lesion in the soft tissue clinically. Meniscal tears is the first differential diagnosis when accompany with painful knee. (1, 2)Giant cell tumor (GCT) is benign a localized nodular tenosynovitis often occur in the tendon sheath , Mostly involve the hand tendons in middle age group between 30 and 50 years old , female affect more than male.(3,4) The WHO defines two well-known kinds of giant cell tumor: (1) pigmented villonodular synovitis ( generalized type), which mainly involve the joints of the lower limb and (2) giant cell tumor of the tendon sheath ( localized type) , which usually involve the figures and small joints rarely the large one. (5, 6)This case presented as unusual appearance of GCT arising from the suprapatellar synovial pouch.Informed consent obtains from the patient.
Highlights
Giant cell tumor (GCT) is benign a localized nodular tenosynovitis often occur in the tendon sheath, Mostly involve the hand tendons in middle age group between 30 and 50 years old, female affect more than male.[3,4] The WHO defines two wellknown kinds of giant cell tumor: [1] pigmented
The patient send for magnetic resonance imaging (MRI) which shown a well-localized soft tissue mass in suprapatellar pouch immediate above the patella, with thickened synovium, low signal intensity on T1 and T2 images and reduced enhancement. (Figures 2) I decide to performed excisional biopsy and examine the mass histopathologically to rule out malignant pathology www..jkmc.uobaghdad.edu.iq
Surgical operation details Under spinal anesthesia, a tourniquet was applied and standard surgical incision to the medial side of upper part of the left knee was performed after full aseptic precaution and prophylactic antibiotic inform of 1 gram 3rd generation cephalosporin half hour before surgery After opening the suprapatella pouch carful assessment of the pocket, and raised area was detected and palpated to identify the borders of the mass and the consistency which was rubbery in nature
Summary
A 42 year-old fatty male (BMI 32) consult me with a six months history of pain in his left knee and sometime locking gradual in onset increase during walking and at night, the symptoms worse during climbing ladders. Local examination revealed mild swelling, slight effusion and tenderness above the patella with a full range of movement. The mass about 6-7 cm diameter, mobile in all direction ,soft in constancy with slight tenderness and normal range of movement of the left knee. The patient send for magnetic resonance imaging (MRI) which shown a well-localized soft tissue mass in suprapatellar pouch immediate above the patella, with thickened synovium, low signal intensity on T1 and T2 images and reduced enhancement. Surgical operation details Under spinal anesthesia, a tourniquet was applied and standard surgical incision to the medial side of upper part of the left knee was performed after full aseptic precaution and prophylactic antibiotic inform of 1 gram 3rd generation cephalosporin half hour before surgery After opening the suprapatella pouch carful assessment of the pocket, and raised area was detected and palpated to identify the borders of the mass and the consistency which was rubbery in nature. Microscopic appearance showed a collagenous stroma comprising mononuclear fibrohisteocytic cells (giant cell tumor)
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