Case Of Primary Synovial Chondromatosis Research Articles

A case of primary synovial chondromatosis with peripheral osteoma in the temporomandibular joint

A case of primary synovial chondromatosis with peripheral osteoma in the temporomandibular joint

Primary Synovial Chondromatosis of the Elbow

We present a rare case of primary synovial chondromatosis of the elbow joint as well as a review of the literature and discuss the clinical, imaging, histological findings and clinical outcome of this condition. It is a benign condition characterized by nodular proliferation and metaplasia of the synovium. Histology findings however suggest that the condition is not solely a metaplasia as the cartilage is often very cellular and could be interpreted as a neoplastic process. This may explain in rare cases the incidence of recurrences and malignant transformation of this condition. Awareness of the atypical histology is paramount and therefore referral to a tertiary oncology centre is mandatory. An experienced pathologist is crucial for the correct diagnosis, prognosis and management of this condition.

Primary Synovial Chondromatosis of the Elbow

We present a rare case of primary synovial chondromatosis of the elbow joint as well as a review of the literature and discuss the clinical, imaging, histological findings and clinical outcome of this condition. It is a benign condition characterized by nodular proliferation and metaplasia of the synovium. Histology findings however suggest that the condition is not solely a metaplasia as the cartilage is often very cellular and could be interpreted as a neoplastic process. This may explain in rare cases the incidence of recurrences and malignant transformation of this condition. Awareness of the atypical histology is paramount and therefore referral to a tertiary oncology centre is mandatory. An experienced pathologist is crucial for the correct diagnosis, prognosis and management of this condition.

Primary synovial chondromatosis of the first tarsometatarsal joint: a rare case report

Primary synovial chondromatosis is a rare condition and commonly involves a single large joint, although it may involve any synovial joint. It occurs as a result of metaplasia and focal formation of cartilage in the intimal layer of the synovial membrane. Diagnosis could be made after thorough clinical and radiological assessment. Diagnosis must be confirmed by histopathological examination, because malignant transformation has been reported. Here, we report a case of primary synovial chondromatosis on an extremely rare location involving the first tarsometatarsal joint.

A Rare Case of Primary Synovial Chondromatosis of the Ankle

ABSTRACT Synovial chondromatosis is a condition where the synovial lining of joints, tendons, or bursa undergoes metaplasia into cartilaginous loose bodies. Primary synovial chondromatosis of the ankle joint is very rare and less commonly reported in literature. We report a case of primary synovial chondromatosis of the ankle that we encountered in our clinic. A 33-year-old male patient presented with a history of multiple swellings around his right ankle joint, along with dull aching pain. Both the clinical examination and X-rays were suggestive of primary synovial chondromatosis of the ankle. We performed an open loose body removal and synovectomy of the ankle. Histopathology confirmed the diagnosis of primary synovial chondromatosis. We report this case owing to its rarity of presentation. How to cite this article Chathoth V, Sankaranarayanan S. A Rare Case of Primary Synovial Chondromatosis of the Ankle. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):53-55.

Surgical Treatment of Synovial Chondromatosis of the Long Biceps Tendon Sheath

Objectives:Primary synovial chondromatosis (PSC) is a rare benign neoplasm that affects diarthrodial joints. The reported cases of PSC in the literature are mostly localized in the knee, followed by the hip, elbow, wrist and shoulder. We report the surgical treatment of a rare case of PSC localized in the long biceps tendon sheath.Methods:A 66-year-old woman presented severe pain in her left shoulder without any traumatic event. The pain was rated on Visual analog scale (VAS) as 4 to 7. At the physical examination, a palpable mass was found medial to the bicipital groove of the left shoulder. Functional examination of the left shoulder revealed painful limitation at 150 abduction, at 130 forward elevation and at 40 external rotation. Constant Murley Score was measured as 65. A magnetic resonance image (MRI) revealed the presence of 2x2x1.8 cm lesion within the biceps tendon sheath, rotator cuff tear and a bone cyst in the great tubercule. The treatment of choice was the open surgical treatment with excision of the lesion, curettage and spongious allografting of the bony cyst and repair of the rotator cuff with two suture anchors. The histological examination was consistent with PSC without any malignant transformation. The shoulder was immobilized postoperatively for 2 days in a sling. Immediate passive ROM exercises were started at third day for 6 weeks.Results:At the 6 week follow-up, the patient achieved full symmetric restoration of motion. She had returned to full activity. Visual analog scale was rated 0 to 1 and Constant Murley Score was measured as 92. Functional examination of the left shoulder reveled 170 of abduction, at 160 forward elevation and at 40 external rotation. At 1-year follow-up, clinical findings were unremarkable, with no sign of recurrence.Conclusion:PSC is a benign, idiopathic lesion of the synovial membranes of the diarthrodial joints. PSC is observed rarely in extra-articular shoulder involvement. Although the diagnosis of PSC is often clear with the results of radiological and intraoperative findings, it needs to be verified histologically. Surgical treatment is preferred to avoid the risk of malignant transformation, possible damage to the neighboring anatomical structures and functional disability as seen in our patient.

Giant Solitary Synovial Osteochondromatosis of The Knee in a Young Female

Introduction: Giant Synovial osteochondromatosis of Hoffa’s body is very uncommon. Although described as a benign disease, it can be destructive and can cause severe osteoarthritis and pain. Case report: We report an 18 year old female patient presented with a calcified mass inside the Hoffa’s body. Clinically, patient presented with eight-month history of progressively worsening left knee pain with associated swelling. The bony mass in the Hoffa’s body was evident on the X-ray. MRI showed synovial affectation. During the arthroscopy, all pathological synovial was removed and the bony mass was extirpated through a mini-arthrotomy. Diagnosis of a giant synovial osteochondromatosis was confirmed by histology and malignancy was ruled out. Five years after surgery the patient has been asymptomatic and motion range is complete. Conclusion: This case of primary synovial chondromatosis is interesting because it was presented in an age, gender and unusual location. At 5 years of postoperative follow-up the patient has had no recurrence and has showed excellent performance of the knee joint.

Giant Synovial Chondromatosis of the Knee Mimicking a Parosteal Osteosarcoma: A Case Report

Synovial chondromatosis is a benign nodular cartilaginous proliferation arising in the synovium of joints. Usually the major weight bearing joint is involved and approximately 70% of cases are the knee joint. The radiolographic features of this condition are variable. Classically, radiographs reveal multiple intraarticular calcifications of similar size and shape, distributed throughout the joint, with typical “ring-and-arc” chondroid mineralization. The classic appearance is not often encountered. Rarely, it would be confused with malignancy such as chondrosarcoma, osteosarcoma or synovial sarcoma. We report a case of primary synovial chondromatosis originating from the intra-articular tissues of the knee, mimicking a parosteal osteoarcoma with the clinical, radiographic and computed tomography (CT) findings.

Femoroacetabular Impingement Due to Synovial Chondromatosis of the Hip Joint

This article describes a rare case of primary synovial chondromatosis of the hip associated with classical femoroacetabular impingement. A 38-year-old man presented with left hip pain of 3 years' duration and range of motion (ROM) limitations. Flexion abduction external rotation and impingement tests were positive and preoperative Harris Hip Score was 68. Radiographs showed multiple loose bodies, a calcified labrum, and a bump at the head-neck junction. Computed tomography (CT) confirmed the findings. Acetabular overcoverage and the crossing over sign were present. The lateral center edge angle was 48 degrees, acetabular roof angle was +2 degrees, alpha angle was 80 degrees, triangular index was 2 mm more than the radius of the femoral head, and anterior offset was 4.5 mm. Magnetic resonance imaging (MRI) revealed an acetabular labral tear, impaction on the femoral head-neck junction, and mild synovial hypertrophy with no acetabular cartilage damage. Loose body removal along with a total synovectomy, excision of the calcified labrum, and osteochondroplasty of the head-neck junction were performed after safe surgical dislocation. At 6-month follow-up, the patient was doing well with a Harris Hip Score of 96, improved ROM, and negative flexion abduction external rotation and impingement tests. Early diagnosis of synovial chondromatosis and impingement can be made by MRI and CT. Clinically, flexion abduction external rotation and impingement tests are positive in 99% and 97% of cases, respectively. Although arthroscopy management has been described for both the entities separately, it has drawbacks. With an open procedure, debridement of the hip joint and excision of femoral and acetabular impingement deformities are possible at the same time.

Primary Synovial Chondromatosis Mimicking Medial Meniscal Tear in a Young Man

Magnetic resonance imaging has recently become a noninvasive and cost-effective diagnostic tool for meniscal pathology in the knee. We report an unusual case of primary synovial chondromatosis for which the clinical diagnosis was medial meniscal tear but magnetic resonance imaging also showed a displaced torn meniscus, causing a so-called “double meniscus sign.” The patient was definitely diagnosed and successfully treated with arthroscopy. We discuss the clinical diagnostic and therapeutic challenges, and the possible pathogenesis.

Recurrence of synovial chondromatosis of the glenohumeral joint after arthroscopic treatment

A case of primary synovial chondromatosis of the shoulder in a 15-year-old girl is presented. Plain radiographs revealed findings characteristic of synovial chondromatosis. The patient was treated by arthroscopic loose body removal and arthroscopic partial synovectomy of the glenohumeral joint. Although immediate postoperative radiographs showed no calcification in the joint, repeated radiographs at 18 months after surgery revealed recurrence of calcification in the subacromial space. Arthroscopic removal of all loose bodies and partial synovectomy appears to be a good method of giving symptomatic relief and early return to work. However, late recurrence should be anticipated.

Primary synovial chondromatosis of the elbow

Very few cases of primary synovial chondromatosis of the elbow have been reported in the literature. This is a study concerning the late outcome of primary synovial chondromatosis in the elbows of 12 patients, 10 men and 2 women, with a mean follow-up of 16 years 10 months. The average age at the time of the initial complaint was 29 years. The histories of 10 patients revealed elbow strain as a consequence of work-related activities. Surgery included removal of loose bodies and partial synovectomy in all patients. A moderate to severe osteoarthritis was found preoperatively in 5 of 12 patients and during follow-up in 7 of 10 patients. The degree of osteoarthritis deteriorated after surgery in 5 of these cases, depending on patient age, length of presurgical history, length of follow-up, and strenuous activities. However, the functional deficiencies were usually moderate and had little significance with respect to the activities of daily living. No recurrence of primary synovial chondromatosis was found. (J Shoulder Elbow Surg 2000;9:319-22.)

Primary synovial chondromatosis: A clinicopathologic review and assessment of malignant potential

This is a clinicopathologic review of 53 cases of primary synovial chondromatosis covering a period of 30 years. The average age at presentation was 41 years (range, 17 to 64 years) with a male/female preponderance of 1.8: 1. The condition was always monarticular, the most common site being the knee joint (70%) followed by the hip (20%). Degenerative joint disease was well established in three patients (5%), all occurring in the hip. Nine patients suffered recurrences (15%), including three that became malignant. There was no relationship between the age and site of the lesion, nor between the degree of cellularity of the cartilage and age or site. However, there was an association between cellularity of the cartilage and the extent of calcification and ossification—highly cellular lesions were poorly calcified and ossified, but heavily calcified lesions were usually of relatively low cellularity. There was no relationship between extent of calcification and ossification and the age of the patient. Three patients suffered malignant change representing a relative risk of 5%, much higher than that quoted in other series. This suggests that primary synovial chondromatosis has a significant potential for malignant change.

Cell proliferation studies in primary synovial chondromatosis.

Primary synovial chondromatosis (PSC) is thought to be a cartilaginous metaplasia, but it may recur locally and malignant change has been reported. Histologically, the cartilage is usually cellular, with binucleate forms. These findings suggest that the disease is not simply a metaplasia but imply a proliferative component. In this study, immunohistochemical detection of Ki-67 protein using an antigen retrieval microwave heating technique and DNA image cytometry (VIDAS image analysis system) has been used to assess the proliferative activity in 20 cases of PSC and the results have been compared with those obtained in other cartilage tissues: ten enchondromas, ten chondrosarcomas, and ten samples of normal articular cartilage. There was no detectable staining for Ki-67 protein in cases of PSC or in benign tissues, but there was a significant association between Ki-67 labelling index and grade in the chondrosarcomas (P < 0.01). The absence of mitotic figures and the lack of Ki-67 protein in PSC are consistent with a metaplasia. All enchondromas gave diploid DNA histograms but non-diploid histograms were obtained i eight cases (40 per cent) of PSC, with significant populations of hyperdiploid and DNA aneuploid cells. The mean DNA content, the percentage of hyperdiploid cells, the percentage of DNA aneuploid cells, and the 2c deviation index were all significantly higher in PSC than in enchondromas (P < 0.01). These findings with image cytometry suggest a proliferative process in the development of at least some cases of PSC. In terms of cell proliferative activity, PSC appears to occupy a position which is intermediate between benign enchondromas and malignant chondrosarcomas, which may explain the aggressive clinical behaviour occasionally seen in this condition.

An immunohistological study of cartilage and synovium in primary synovial chondromatosis.

The antigenic phenotype of cartilage and synovial cells from six cases of primary synovial chondromatosis (PSC) was determined. This was compared with profiles similarly obtained for adult and fetal cartilage cells. The Ki-67 (proliferation-associated) antigen was present on 40-50 per cent of chondrocytes in the proliferative zone of fetal epiphyseal cartilage but absent in chondrocytes of adult articular cartilage and PSC cartilage nodules. The absence of Ki-67 antigen suggests that there were no proliferating cells in the synovium or cartilage in these cases of PSC. In PSC alone, some chondrocytes in the cartilage nodules and mononuclear subintimal cells around the nodules also reacted for CD68, suggesting that growth of the cartilage nodules may occur by a metaplastic process. All synoviocytes in PSC were positive for leucocyte common antigen, HLA-DR, and CD68, a pattern typical of reactive rather than normal synovium.