Cartilaginous Nodules Research Articles

Role of synovium-derived fibrous cartilage in temporomandibular joint synovial chondromatosis.

Synovial chondromatosis (SC) of temporomandibular joint (TMJ) occupies 3% SC cases. In other joints like hip and knee which were composed hyaline cartilage (HC), loose bodies (LBs) were reported to be a HC feature. However, condyle surface and disc in TMJ are fibrous cartilage (FC). Therefore, we proposed a different pathogenesis of TMJSC. LBs and synovium were collected from seven TMJSC patients, and histological and immunohistological examinations were performed. Three ways of HC formation were discovered: regular-shaped cartilaginous nodules (CNs) in sublining layer (SL) of vascularized synovium, regional chondrification of SL, and finger-like tissue with a tail attaching to synovium. Detached LBs could fuse and were only positively stained by aggrecan. Without synovium attachment to LBs, fused LBs remained a hyaline extracellular matrix (ECM). However, after synovium attachment, transformation from HC to FC occurred. Two types of FC were observed. First type FC was featured by vertical-distributed type I collagen fibers imbedding few chondrocytes, suggesting mature phase with superior mechanical features. Second type FC was featured by medium-density chondrocytes with type I collagen and aggrecan-positive ECM, suggesting primary phase. The transformation process started in appearance of 2nd type FC deriving from synovium covering LB, and gradually replaced HC from periphery to center. Three ways of HC formation were closely related. Different with SC in other joints, hyaline ECM in LBs of TMJSC could be replaced by FC deriving from synovium, during which 2nd type FC first replaced HC and then transformed to 1st type FC.

Articular abnormalities that may mimic arthritis.

There are numerous abnormalities that present with similar signs and symptoms to arthritis. In this article some of these conditions that can masquerade as arthritis are discussed. Synovial osteochondromatosis is an uncommon benign disorder marked by the metaplastic proliferation of multiple cartilaginous nodules in the synovial membrane of the joints, bursae, or tendon sheaths. Pigmented villonodular synovitis, also known as diffuse-type tenosynovial giant cell tumor, is a locally destructive fibrohistiocytic proliferation, characterized by many villous and nodular synovial protrusions which affects the joints. Synovial hemangioma is a rare benign lesion whose pathogenesis is still unclear. It commonly affects the knee joint, although the other articulations, such as elbow, wrist, and ankle may also be involved. Lipoma arborescens, also known as villous lipomatous proliferation of the synovial membrane, is a rare intra-articular disorder characterized by a non-neoplastic lipomatous proliferation of the synovium. The term “arborescens” refers to the characteristic tree-like morphology of the lesion, which resembles a frond-like mass.

Arthroscopic Management of Synovial Chondromatosis of the Temporomandibular Joint. Case Series and Systematic Review.

Synovial chondromatosis (SC) is a benign condition that is characterized by the formation of cartilaginous nodules within the synovial tissue of a joint that may detach and form loose bodies inside the articular space. The purpose of this study is to evaluate the use of surgical arthroscopyfor the treatment of SC ofthe temporomandibular joint (TMJ). A series of six patients treated with arthroscopy (one patient requiring an open arthrotomy due to the size of the loose bodies) in our centre between 1997 and 2016 is presented and results are discussed. A systematic review of the literature of patients with SC treated with arthroscopy or arthroscopy-assisted open arthrotomy is also carried out. Pain, which was the main symptom in our patients, and maximum mouth opening both improved significantly after surgicaltreatment. Three of the patients were diagnosed with primary SC, and the other 3 had a previous diagnosis of internal derangement. None of the patients showed signs of relapse during the follow-up period. Surgical arthroscopy is a minimally invasive procedure that allows the extraction of loose bodies and even partial synovectomy of the affected membrane with good results and without recurrence of the disease. This technique can be useful in cases of SC with loose bodies measuring less than 3mm or without extra-articular extension.

Atypical synovial chondromatosis of the right knee: A case report.

Synovial chondromatosis, also known as synovial osteochondromatosis, is a rare, benign condition characterized by the formation of multiple cartilaginous nodules in the synovium of facet spaces. Synovial chondromatosis affects many joints, the knee being the most common. The present report examined a 47-year-old male with symptoms of swelling and pain in the right knee, who was admitted to hospital in September 2015. Following admittance, arthroscopic explorations were conducted. Viscous fluid and multiple cartilage-like clumps were identified in the patient's joints during surgery. There was evidence of synovial hyperemia and edema in the inner and outer lateral recesses of the patellar bursa, accompanied by villous projections. Synovium debridement and removal of cartilage-like free masses were performed. Following 6-month follow-up, the motion of the right knee ranged from 0-150° and no further swelling or pain was experienced by the patient. Following arthroscopy, the international knee documentation committee function score improved from 70.6 to 89.4 points. The results of the present report indicate that arthroscopic exploration is an effective treatment for patients with synovial chondromatosis.

Osteochondroma of distal tibia: A case series

Osteochondroma are cartilaginous, benign bone lesion. They thought to originate within the periosteum as small cartilaginous nodules. They account for about 30% of benign bone lesion. Common in 2nd decade of life. Mostly asymptomatic and common sites are distal femur, proximal tibia and proximal humerus. Genc B et al reported rare case of distal tibial osteochondroma causing fibular deformity and deep peroneal nerve entrapment neuropathy but we had encountered three cases of distal tibial osteochondroma with fibular deformity and deep peroneal neuropathy from last 1year and is not as rare as previously thought.

Primary synovial chondromatosis of knee with both intra-articular and extra-articular involvement: A case report with delayed diagnosis

Primary synovial chondromatosis (PSC) is an uncommon benign disease process of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that progressively undergo detachment, mineralization, and even ossification forming loose bodies. It is usually a monoarticular disease with involvement of large joints with knee being the most common. Involvement of smaller joints such as distal radioulnar, tibiofibular, metacarpophalangeal, and metatarsophalangeal joint has also been reported. This disease process is usually intra-articular. Involvement of extra-articular tissues such as bursae and tendon sheaths is rare, and combination of intra- and extra-articular diseases described here is an extremely rare condition. Herewith, we report a male patient with PSC of left knee with involvement of suprapatellar bursa who presented with recurrent knee swelling and pain with diagnostic delay of 2 years. We have also highlighted the role of imaging in the early diagnosis of this disease and briefly reviewed relevant literature.

Condromatosis sinovial extraarticular de pie. Reporte de un caso y revisión de la bibliografía.

La condromatosis sinovial es una lesión poco frecuente caracterizada por la metaplasia cartilaginosa de la membrana sinovial de pequeñas y grandes articulaciones. Se suelen observar múltiples nódulos cartilaginosos y un grado variable de destrucción articular. Las manifestaciones clínicas son variables y dependen de la localización y el estadio de la enfermedad. Nuestra paciente concurrió con una tumoración en la planta del pie a nivel de la raíz del segundo y tercer dedo, de meses de evolución. Luego de los estudios por imágenes correspondientes y evidenciar la extensión dorsal de la lesión, se decidió realizar la resección en bloque a través de doble abordaje; el análisis anatomopatológico informó condromatosis sinovial. La ausencia de extensión intrarticular fue constatada en la cirugía. Este caso representa una manifestación poco frecuente de la patología no solo por su localización, sino también por su ubicación extrarticular. Según nuestra búsqueda bibliográfica, no se han publicado reportes de casos con condromatosis sinovial extrarticular avanzada (grado 3) en el antepié y creemos que debería ser considerada dentro de las lesiones tumorales de aspecto cartilaginoso en esta localización.

Synovial Chondromatosis.

Synovial chondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia leading to cartilaginous nodules that ultimately break free, mineralize, and even ossify. The most commonly involved joint is the knee. Patients may be asymptomatic or may present with pain, swelling, and limited range of motion. Plain radiographs can be diagnostic and mineralized nodules are pathognomonic. Recommended treatment involves arthroscopic or open removal of loose bodies with or without a synovectomy to prevent further articular and periarticular destruction and to relieve symptoms.

Expression of CD90 decreases with progression of synovial chondromatosis in the temporomandibular joint

Objectives: The aim of the present study was to investigate the factors that contribute to the progression of synovial chondromatosis in the temporomandibular joint (TMJ).Methods: The authors investigated the expression of CD105 and CD90 in specimens from 17 patients with synovial chondromatosis in the TMJ, using immunohistochemical staining, and expression of CD105 and CD90 in cartilaginous nodules was scored semiquantitatively.Results: The expression of CD105 and CD90 was found in almost all the cases. In particular, the expression of CD90 in cartilaginous nodules significantly decreased with the progression of synovial chondromatosis.Discussion: The factors that determine progression of synovial chondromatosis are not fully understood. The results of this study suggest that CD90 may play an important role in the progression of synovial chondromatosis in the TMJ.

Synovial osteochondromatosis of the wrist joint: A case report

Synovial osteochondromatosis is a rare condition in which multiple cartilaginous nodules proliferate within the synovial membranes of joints, tendon sheaths or bursae. In general, a complete synovectomy is an effective method to treat this disease. Commonly involved joints are the knee, glenohumeral joint, elbow, hip and ankle, although any articulation may be affected. However, synovial osteochondromatosis occurs rarely in the wrist, and there have been a lack of reports of this occurrence in the literature. The current study presents a case of synovial osteochondromatosis in a 33-year-old man, who was admitted in 2014 with the symptom of swelling of the left wrist joint for 2 years. The swelling had become increasingly painful over the previous 2 months. Physical examination revealed local tenderness and a soft pliable mass, with no involvement of the skin and with moderate pain. X-ray, computed tomography and magnetic resonance imaging of the left wrist revealed a lump at the volar radial side of the left wrist joint without any bone erosion. The lesion was subsequently excised. Histological examination resulted in a diagnosis of osteochondromatosis, which was not considered prior to the surgery. The present case was reported with the aim of analyzing the clinical, imaging characteristic and therapeutic modalities of synovial osteochondromatosis of the wrist. While there was no evidence of recurrence for the subsequent 4 months of post-operative follow-up in the present case, the long-term efficacy of surgical excision requires extended observation.

Cervical Spine Synovial Chondromatosis: A Case Report and Literature Review

Synovial chondromatosis (SC) is an uncommon, generally benign disorder characterized by metaplastic changes of the synovial membrane which give rise to the formation of multiple cartilaginous nodules within the synovium. It typically affects the large joints such as the knee, hips, wrist, ankle and shoulder. Synovial chondromatosis of the spine has been reported but is extremely uncommon. We describe a case of cervical spinal synovial chondromatosis in a 42-year-old female, presenting with an enlarging neck mass without the usual accompanying joint symptoms of pain and swelling. The mass involved the transverse processes of C3-C4 and the paraspinal tissues of the posterior neck, without invasion into the vertebral bone. The final diagnosis was established by correlating radiologic findings with the histopathology of the excised specimen.

A Case Report of Synovial Osteochondromatosis of the Knee Joint with neither Calcification nor a Synovial Lesion on Imaging

Synovial osteochondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that ultimately break free, mineralize, and even ossify. The most commonly involved joint is the knee. Typically, radiographs can be diagnostic and mineralized nodules are pathognomonic. In as many as one-third of cases, however, no calcification or ossification of the cartilage occurs in the early stage of the disease because mineralization is time-dependent. In such cases, gadolinium-enhanced MRI can be useful. Unmineralized nodules are typically peripherally enhanced because they are attached to and derive a vascular supply from the synovium. We experienced an unmineralized case of synovial osteochondromatosis of the right knee joint, in which imaging diagnosis was difficult. Neither calcification nor ossification was observed, but all nodules were released from the synovium as loose bodies and there was no vascular supply. Therefore, MRI did not show a typical appearance. These findings suggest that synovial osteochondromatosis should be considered as a differential diagnosis in a case in which unmineralized loose bodies without a synovial lesion are found in an imaging examination.

Expression of CD90 decreases with progression of synovial chondromatosis in the temporomandibular joint

Objectives: The aim of the present study was to investigate the factors that contribute to the progression of synovial chondromatosis in the temporomandibular joint (TMJ).Methods: The authors investigated the expression of CD105 and CD90 in specimens from 17 patients with synovial chondromatosis in the TMJ, using immunohistochemical staining, and expression of CD105 and CD90 in cartilaginous nodules was scored semiquantitatively.Results: The expression of CD105 and CD90 was found in almost all the cases. In particular, the expression of CD90 in cartilaginous nodules significantly decreased with the progression of synovial chondromatosis.Discussion: The factors that determine progression of synovial chondromatosis are not fully understood. The results of this study suggest that CD90 may play an important role in the progression of synovial chondromatosis in the TMJ.

Vocal Hoarseness and a Subglottic Mass

We report a patient with tracheopathia osteoplastica (TPO), a rare or perhaps underrecognized disorder, detected in approximately 1 in every 2000 to 5000 patients who undergo bronchoscopy. TPO is marked by proliferation of bony and cartilaginous spurs leading to airway stenosis. Multiple submucosal cartilaginous and osseous nodules can develop in the respiratory tract and may involve the entire trachea and mainstem bronchi. Symptoms may range from a completely silent condition to life-threatening respiratory failure and diagnosis is made based on radiological and bronchoscopic findings. Although the etiology has not been established, TPO can be familial and is sometimes associated with chronic inflammation, such as seen with rheumatic diseases. This case highlights the need for understanding TPO so that it can be differentiated from potentially serious conditions such as necrotizing granulomatous diseases, invasive infections, and cancer.

Transforming growth factor beta 3 involved in the pathogenesis of synovial chondromatosis of temporomandibular joint.

Synovial chondromatosis (SC) of temporomandibular joint is rare proliferative disorder featured by the formation of cartilaginous nodules in synovium and joint space. Transforming growth factor beta 3 (TGF-β3) is closely related to chondrogenic differentiation, and might participate in pathogenesis of SC. We discovered that increased quantity of synoviocytes and blood vessels were observed in SC synovium. The vessel wall and sublining fibroblasts were stained positively by the antibodies against TGF-β3, fibroblast growth factor 2 (FGF-2), and CD34. In loose bodies (LBs), TGF-β3 was mainly expressed in chondrocytes and FGF-2 was expressed in chondrocytes, fibroblasts, and vessel walls. Expressions of TGF-β1, TGF-β3, FGF-2, Sox9, Wnt-4, Foxc2, and VEGF-A mRNA were significantly higher in SC synovium. Stimulation of TGF-β3 on synoviocytes increased alkaline phosphatase (ALP) activity and expressions of chondrogenic genes (Sox9, Col2α1, Aggrecan, Wnt-4, and Wnt-11), osteogenic genes (Runx2, Foxc2, osteocalcin, and Col1α1), and VEGF-A, but failed to influence FGF-2 expression. However, the addition of FGF-2 increased TGF-β3 expression. In conclusion, TGF-β3 existed in synovium and LBs of SC, and was responsible for the pathogenesis of SC.

Chondrocyte clusters adjacent to sites of cartilage degeneration have characteristics of progenitor cells.

The purpose of this study was to investigate the site-specific characteristics and roles of chondrocyte clusters in human knee osteoarthritis. Cartilage explants were obtained from 45 knees undergoing total knee replacement surgery. The explants were taken from 4 locations in the knee: the medial femoral condyle, the medial posterior femoral condyle (MPC), the lateral femoral condyle, and the lateral posterior femoral condyle (LPC). Cartilage degeneration, cell density, and cell arrangement were compared histologically. A live/dead cell viability assay and immunohistochemical analyses using antibodies against STRO-1, FGF2, and Ki-67 were performed. Cell proliferation and cartilaginous nodule production in MPC and LPC explants in monolayer culture were compared. Finally, MPC cartilage explants were cultured to observe histological changes. The cell density of the MPC explants was higher than that of the LPC because of clustering. MPC explants contained more live cells than the LPC did, and the expression of IHC markers in MPC explants was higher than that in LPC. Chondrocytes from MPC proliferated faster and produced more nodules in monolayer culture than those from the LPC and MPC explants were repaired during organ culture. In conclusion, chondrocyte clusters adjacent to severe cartilage degeneration have specific characteristics, with progenitor and proliferative potential.

A rare case of synovial chondromatosis of the inferior TMJ compartment. Diagnosis and treatment aspect.

Synovial Chondromatosis (SC) is a rare, benign non neoplastic arthopathy characterized by the metaplastic development of cartilaginous nodules within the synovial membrane. In only 3% of all cases does it affect the temporomandibular joint (TMJ) and cases that arise from the lower compartment are rarely found in literature. The aim of this paper is to report a new case of SC of the inferior TMJ compartment with the description of the clinical, therapeutic and histopathological findings. This article presents a 68-year-old woman with preauricular swelling on the right side, pain, crepitus and limited joint motion. This patient was evaluated by preoperative clinical manifestation, CT scan and MR images. Both showed multiple, calcified loose bodies in the inferior compartment. Based on these images as well as the patient's signs and symptoms, a surgical intervention was performed. A good functional recovery with no signs of recurrence at 36 months of follow up was obtained. Among cases of synovial chondromatosis in literature, only twelve originating in the lower compartment have been reported, this one included. In all the cases treated for SC in the lower compartment, both in literature and in our case report, surgical treatment led to healing.

Disseminated Knee Synovial Chondromatosis treated by Arthroscopy and combined Anterior and Posterior Approaches

Synovial Chondromatosis (also called Synovial Osteochondromatosis) is a rare benign joint disease caused by synovial cartilage metaplasia, the etiology remains unknown and the disease is characterized by the formation of cartilaginous nodules in the synovium. Calcification or ossification can occur at a late stage of the disease. A 48-year-old Chinese woman presented to out-patient department complaining of recurrent and progressively worsening right knee pain, swelling and stiffness after a minor contusion 4 years ago. She underwent careful preoperative imaging and planning followed by a two-stage arthroscopic and open surgery (combined anterior and posterior approaches). Histopathological examination of the specimens confirmed our suspected diagnosis of Synovial Chondromatosis. 15 months after surgery, she has regained full range of movement, but continues to experience residual insidious knee pain when standing for a long time. Synovial chondromatosis is a rare proliferative disorder that causes pain, swelling, and restriction of movement to the joints it affects. It low incidence rate and differential diagnosis makes it sometimes difficult to diagnose, reason why adequate radiology imaging and arthroscopic exploration are decisive for the diagnosis. Surgical lavage and excision have proven to be the reasonable and preferable course of treatment of synovial chondromatosis.

Synovial Chondromatosis of the Ankle Joint: Clinical, Radiological, and Intraoperative Findings.

Synovial chondromatosis, also termed synovial osteochondromatosis, is a rare benign disorder characterized by the presence of cartilaginous nodules in the synovium of the joints, tendon sheaths, and bursae. It most commonly involves large joints, such as the knee, hip, and shoulder, but its presence in smaller joints has also been reported. Nevertheless, ankle involvement is unusual. The diagnosis is commonly made following a thorough history, clinical, physical, and radiographic examination. We report a case of a young patient with primary synovial chondromatosis of the ankle joint and present the clinical, radiographic, and intraoperative findings.

Small molecule-directed specification of sclerotome-like chondroprogenitors and induction of a somitic chondrogenesis program from embryonic stem cells.

Pluripotent embryonic stem cells (ESCs) generate rostral paraxial mesoderm-like progeny in 5-6 days of differentiation induced by Wnt3a and Noggin (Nog). We report that canonical Wnt signaling introduced either by forced expression of activated β-catenin, or the small-molecule inhibitor of Gsk3, CHIR99021, satisfied the need for Wnt3a signaling, and that the small-molecule inhibitor of BMP type I receptors, LDN193189, was able to replace Nog. Mesodermal progeny generated using such small molecules were chondrogenic in vitro, and expressed trunk paraxial mesoderm markers such as Tcf15 and Meox1, and somite markers such as Uncx, but failed to express sclerotome markers such as Pax1. Induction of the osteochondrogenically committed sclerotome from somite requires sonic hedgehog and Nog. Consistently, Pax1 and Bapx1 expression was induced when the isolated paraxial mesodermal progeny were treated with SAG1 (a hedgehog receptor agonist) and LDN193189, then Sox9 expression was induced, leading to cartilaginous nodules and particles in the presence of BMP, indicative of chondrogenesis via sclerotome specification. By contrast, treatment with TGFβ also supported chondrogenesis and stimulated Sox9 expression, but failed to induce the expression of Pax1 and Bapx1. On ectopic transplantation to immunocompromised mice, the cartilage particles developed under either condition became similarly mineralized and formed pieces of bone with marrow. Thus, the use of small molecules led to the effective generation from ESCs of paraxial mesodermal progeny, and to their further differentiation in vitro through sclerotome specification into growth plate-like chondrocytes, a mechanism resembling in vivo somitic chondrogenesis that is not recapitulated with TGFβ.