Diagnosis Of Pigmented Villonodular Synovitis Research Articles

Case Report: Cytodiagnosis of pigmented villonodular synovitis involving carpal bones of right wrist

Background Pigmented Villonodular Synovitis (PVNS) is a rare disease of osteoskeletal tissue. Cytodiagnosis of PVNS on fine needle aspiration (FNA) smears is therefore rarely reported. The PVNS usually affects the larger joints. The involvement of the smaller joints and bones are uncommon. Case presentation The reported case is one such rarity wherein the diagnosis of PVNS was carried out on the FNAC. The case showed the involvement of all carpal bones except for the pisiform. The 2nd- 5th metacarpal bases were also found to be involved in the disease process. The presence of sheets of synoviocytes with brown altered hue to the cytoplasm along with multinucleate giant cells and pigmented macrophages were characteristically present in the smears of FNA. The diagnosis was confirmed on the tissue biopsy. The present case is reported for its unusual multiosteotic involvement of wrist joint bones and the metacarpal bones simultaneously with radiological evidence. The cytomorphology of the lesion in the present case were noteworthy as a learning experience in reporting of PVNS of wrist joint on FNA smears.

Possibilities of ultrasonography in the diagnosis of pigmented villonodular synovitis. Clinical case

Pigmented villonodular synovitis is a rare proliferative disease of the synovial membrane, which most often affects the knee joints. Being a benign disease, at the same time, this pathology is often aggressive, and in some cases spreads to the soft tissues outside the joint. There are two forms of monoarticular damage: localized and diffuse. The diffuse form gives frequent relapses. To date, there are no standards for the management of this disease, just as there are no early markers for the detection of pigmented villonodular synovitis. This joint lesion has a long asymptomatic course, or it has symptoms of non-specific recurrent arthritis, so the patients can later be referred for magnetic resonance imaging, which is the only non-invasive method of diagnosing this pathology. At the same time, in modern conditions, most patients with recurrent synovitis will undergo an ultrasound examination of the joint according to the diagnostic standards. Ultrasonography made for abovementioned synovitis is insufficiently described in the medical literature. The aim of our study was to highlight the current data on the diagnosis and management of patients with pigmented villonodular synovitis and to describe our own clinical case. A feature of our clinical case was the detection of characteristic symptoms using ultrasonography. Irregular thickening of the synovial membrane with nodular forma­tions and villous growths, with the length of villi up to 7 mm near the patella with single loci of blood flow, was revealed by ultrasound examination and power Doppler mapping. Shear wave elastometry of the synovial membrane was performed. It demonstrated a significant increase in the stiffness of the synovial membrane, which can be a patho­gnomonic symptom of this pathology. The diagnosis of villonodular synovitis was confirmed histologically after surgical treatment. Subsequently, the patient had a recurrence of the pigmented villonodular synovitis, which was also detected by ultrasound diagnostics. Thus, pigmented villonodular synovitis of the knee joint is a rather rare pathology that requires differential diagnosis with inflammatory joint diseases. The final diagnosis is based on histological exa­mination. MRI and ultrasound diagnostics are non-invasive methods that can detect this pathology with high accuracy. The advantage of ultrasonography is its availability and non-invasiveness. The increase in stiffness of the synovial membrane along with its proliferation, which we found, can serve as an additional criterion of villonodular synovitis, and, according to the data available to us, has not been described in the literature so far.

The causes of unsatisfactory results and mistakes in treatment of patients with pigmented villo-nodular synovitis (teno-synovial giant-cell tumor) of a knee joint

Objective. To reveal the causes of unsatisfactory results and mistakes in treatment of patients with pigmented villo-nodular synovitis of a knee joint with the objective to improve this disease diagnosis, as well as the results of treatment and rehabilitation/ Materials and methods. Through the period 2010 - 2018 yrs we conducted a retrospective analysis of medical documents (the case histories) in 77 patients with pathohistologically verified diagnosis of pigmented villo-nodular synovitis of a knee joint, who were treated in the clinic of Institute of Traumatology and Orthopedics (ITO), Kyiv and operated on a knee joint. Results. The causes of unsatisfacory results of treatment for pigmented villo-nodular synovitis of a knee joint are the disease severity, and its diffuse form, absence of the diagnosis-treatment algorithm for this process and rehabilitation of the patients, what leads to diagnostic and tactical mistakes on the treatment process stages. Conclusion. The awaiting tactics in diagnosis and treatment of pigmented villo-nodular synovitis constitutes a wide-spread tactical mistake. Insufficient knowledge of traumatologists in a knee joint surgery leads to tactical faults as well. Most treatment mistakes occur as a consequence of unreadiness of orthopedist-traumatologist for possible intraoperative accidental revealing of pigmented villo-nodular synovitis of a knee joint, as well as because of absence of intraoperative tactics and material gears for treatment of this disease and its outcomes.

Radiosynoviorthesis after Surgery in the Treatment of Patients with Ankle Pigmented Villonodular Synovitis: A Case Series

Pigmented villonodular synovitis (PVNS) of the ankle is a very rare, locally aggressive, proliferative disorder. Although surgical excision represents the standard curative treatment, the PVNS relapse rate is high. We present our study of five young athletes (range 20–36 years) with a histopathological diagnosis of PVNS of the ankle, who were treated by surgery and adjuvant radiosynoviorthesis (RSO). The operation involved either arthroscopic (four patients) or open (one patient) debridement, followed by intraarticular RSO with the radiopharmaceutical erbium-169 (169Er). They were evaluated with the Foot Function Index (FFI) and a visual analog scale (VAS) for pain. At a median follow up period of 47 months (range 36–54 months), all five patients reported marked pain relief with improvements in their daily activities. In particular, the median FFI decreased from 77% (range 71.0%–84.5%) pre-treatment, to 0.5% (range 0%–6%) after treatment. The median VAS score decreased from 4 (range 3–7) to 0 (range 0–1), respectively. Throughout the follow-up period, there were no major complications regarding either therapeutic intervention (arthroscopic or open debridement, RSO). Based on these results, it can be concluded that adjuvant RSO with 169Er following surgical excision is effective and safe in the treatment of PVNS of the ankle.

Pigmented Villonodular Synovitis Treated as Spondyloarthritis for Four Years- A Case Report

Pigmented villonodular synovitis (PVNS) is a rare disorder where abnormal synovial proliferation and insidious swelling are the characteristic features. As insidious joint swelling has many common causes and PVNS is rare entity, so that it may be missed or under evaluated. Here inconclusive biopsy findings at an early stage and features resembling spondyloarthritis (SpA) delayed the diagnosis. A 28-year-old young man presented with insidious swelling of knee. Here repeated aspiration and synovial fluid analysis with routine serological and radiological examination were inconclusive. Then he was labeled and treated as spondyloarthritis (SpA) for four years without improvement. After four years of sufferings he admitted here and reached the diagnosis of PVNS with the help of MRI and synovial biopsy. Sometimes rare disease diagnosis is complicated by the absence of typical features and inconclusive reports. Common differentials may mimic the diagnosis and rare disease may loss the attention. Here PVNS was treated as SpA for four years before being diagnosed.
 Bangladesh Med J. 2017 May; 46 (2): 53-55

Our clinical outcomes in patients operated with the diagnosis of pigmented villonodular synovitis

Our clinical outcomes in patients operated with the diagnosis of pigmented villonodular synovitis

Pigmented Villonodular Synovitis of the Knee: An Underappreciated Source of Pain in Children and Adolescents.

Pigmented villonodular synovitis (PVNS) is a benign proliferative synovial disorder most commonly described in adults. The purpose of this study is to describe the presentation and management of a large single-center series of pediatric patients with PVNS of the knee. A retrospective review was performed of consecutive pediatric patients treated for PVNS at a single institution from 2001 to 2016. Inclusion criteria were patients below 20 years of age with surgical treatment of histologically proven PVNS of the knee. Review of the electronic medical record was utilized to gather demographic data, clinical presentation, affected joint, imaging findings, treatment, and disease persistence. Over the 16-year study period, 17 pediatric patients with an average age of 11 years (range, 3 to 19 y) were treated for PVNS of the knee. The average duration of symptoms before orthopaedic evaluation was 16 months. More than half of the children were misdiagnosed with a variety of rheumatologic or orthopaedic conditions before their diagnosis of PVNS. On the basis of magnetic resonance imaging (MRI), PVNS was included as a potential diagnosis in 12 of 17 patients (71%). A total of 27 surgeries were performed in 17 patients. Ten patients were treated with a single surgery and 2 patients were treated with staged biopsy followed by synovectomy. Five patients required ≥2 therapeutic surgeries. The majority of procedures were arthroscopic synovectomies (89%). One patient required open resection of a mass in the posterior compartment of the knee and 1 patient had a manipulation under anesthesia for arthrofibrosis. Ten patients were noted to have nodular disease, 4 diffuse, and 3 mixed. At an average 15-month follow-up, 15 patients (88%) were considered to be disease-free based on clinical examination and/or follow-up MRI. Two patients (12%) had MRI studies following their last surgery with findings consistent with persistent PVNS, but only a single patient had persistent symptoms. This case series of pediatric patients with PVNS of the knee represents the largest single-center cohort in the literature. Although previously considered a disease of young adult patients, PVNS should be considered in pediatric patients with an insidious onset of joint swelling with or without pain. Symptoms may be present for months to years before diagnosis. Patients are frequently misdiagnosed, most commonly with rheumatologic diseases, bleeding disorders, or septic arthritis. MRI with gradient echo sequences is the diagnostic imaging study of choice and arthroscopic synovectomy produces good outcomes with low rates of symptomatic disease persistence. Level IV.

Diffuse Pigmented Villonodular Synovitis Around the Ankle.

Pigmented villonodular synovitis (PVNS) is a rare disorder around the ankle joint. The optimal treatment for diffuse-type PVNS is still controversial because of the high incidence of recurrence. We present the clinical features of our patients and review the current diagnostic and treatment modalities. Five patients with PVNS located around the ankle were surgically treated. In three patients, diffuse PVNS arose from the ankle joint, and in the other two it arose from the calcaneocuboid and intercuneiform joints. The average follow-up time after surgery was 2.9 years (range, 2-4.6 years). The average time between onset of pain and diagnosis of PVNS was 6.4 years (range, 4-10 years). Arthrotomic tumor resection was performed in all of the patients. In the three patients with ankle joint PVNS, both medial and lateral approaches were used. One patient experienced mild infection at the surgical site, but this healed conservatively. No tumor recurrences had occurred after minimum follow-up of 2 years, although mild pain persisted in the three patients with ankle PVNS. Diagnosis of diffuse PVNS is frequently delayed due to vague symptoms and variable growth patterns. Orthopedic clinicians should be aware of the existence of this lesion, and it should be suspected in patients with persistent ankle swelling. To prevent tumor recurrence, accurate evaluation of tumor location and careful operative planning are mandatory. A combined surgical approach involving medial and lateral incision is necessary to expose the entire joint cavity.

Arthroscopic Management of Pigmented Villonodular Synovitis of the Hip in Children and Adolescents.

Background:Pigmented villonodular synovitis (PVNS) is a benign proliferative synovial disorder most commonly described to affect the knee in adults. Literature describing PVNS in the pediatric population is limited to 2 small case series and a handful of single-patient case reports. Within these studies, only 2 patients with PVNS of the hip are described.Purpose:To describe the presentation, management, and outcomes of a single-center series of pediatric patients with PVNS of the hip treated with arthroscopic synovectomy.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review of consecutive pediatric patients treated for PVNS at a single institution was performed. Inclusion criteria consisted of patients younger than 19 years with surgically treated PVNS of the hip.Results:Five pediatric patients with a mean age of 11.0 years were treated for PVNS of the hip from 2011 to 2016. The mean duration of symptoms from onset to surgical treatment was 247 days (range, 3-933 days). Upon review of magnetic resonance imaging (MRI) results, radiologists included PVNS in their differential in 3 patients. Seven surgeries were performed in 5 patients. All therapeutic procedures were arthroscopic synovectomies. Nodular PVNS was present in 4 patients, and diffuse disease was present in 1 patient. At a mean 32-month follow-up (range, 12-63 months), all patients were considered to be free of recurrence based on clinical examination and/or follow-up MRI. Four patients were asymptomatic and returned to all of their previous sports activities.Conclusion:Young age at the time of diagnosis is a point to be highlighted in this cohort, and symptoms may be present for many months prior to diagnosis due to the failure to consider PVNS in children. Therefore, for patients with “atypical” presentations or lack of improvement with treatment for rheumatologic, bleeding, or infectious disorders, PVNS should be strongly considered. MRI with gradient echo sequences is the diagnostic imaging study of choice. One patient with diffuse involvement and preoperative degenerative changes showed progressive changes postoperatively. This type of PVNS may have a worse prognosis, but more diffuse cases are needed before the prognosis can be determined. Arthroscopic synovectomy following a timely diagnosis of PVNS produces good outcomes in nodular cases, with no evidence of symptomatic or radiographic disease persistence among these patients.

Knee Swelling in a Teenager - Infection, Inflammation or Malignancy?

A 14 year old previously fit and well boy was referred by the orthopaedic team with a 7 month history of swelling in right knee. Aspiration of the knee joint revealed blood stained fluid, which was negative for bacterial cultures. The swelling and pain progressively got worse, with no systemic symptoms including fever. Further review by the orthopaedic team was followed by blood tests, which showed normal inflammatory markers. MRI of his right knee was reported to show a multi-loculated fluid collection with septae and post contrast enhancement of the collection walls but no involvement of underlying bone. He also had a synovial biopsy which showed synovial thickening and fibroid degeneration and no evidence of granuloma and malignancy. He was then referred to paediatric rheumatology team to consider Juvenile Idiopathic Arthritis (JIA). On examination he had a large swelling of the right knee joint more prominent in his supra patellar region with warmth and minimal restriction of movement. The rest of the joints were normal. In view of the history and clinical course of a teenage boy with large effusion affecting a single knee joint with blood stained synovial fluid, a diagnosis of pigmented villonodular synovitis (PVNS) was considered. He had a repeat MRI, which reported prominent and in some places nodular low signal intensity synovial proliferation around the knee and a large effusion, consistent with PVNS. He was referred back to the orthopaedic team after poor response to intraarticular steroid injection and is currently awaiting synovectomy. Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of uncertain etiology that affects synovial lined joints, bursae and tendon sheaths (Figures 1 and 2), most commonly in the 20-50 years age group, without gender predilection [1]. The disorder results in various degrees of villous and/or nodular changes in the affected structures. PVNS lesions are monoarticular or solitary. Polyarticular disease is uncommon condition. Although a benign condition, PVNS may result in significant morbidity if left untreated. Pain, loss of function, and eventual joint destruction may result. The primary treatment options include surgical resection via synovectomy or radiation therapy [2-3]. The MRI findings

Pigmented villonodular synovitis of 1st MTP joint: A case report

Introduction & aims: Pigmented villonodular synovitis common disease entity particularly in the knee joint but its incidence in the foot is quite rare. Method: A 17 year old female presented to our institution with diagnosis of pigmented villonodular synovitis which had been operated once outside but recurred. Recurrence was confirmed with histopathology. After careful examination and investigations open excision was done. Patient remained pain free for 5 months but again started having pain at first metacarpophalangeal joint and treating physician thought that disease has recurred again After careful physical examination she was found to have a corn at the planter aspect of the first metacarpophalangeal joint. She was sent for the opinion of an expert dermatologist, who excised that corn. Results: Patient is now completely pain free even after one year of the surgical management. Conclusions: PVNS of the forefoot and 1st metatarsal joint, although reported earlier, is rare entity. This report signifies the importance of the differential diagnosis of pain in the foot and particularly in the weight bearing part of the foot and implies that recurrence should be considered only after careful examination.

Pigmented villonodular synovitis of the knee in a 12-month-old girl

Abstract A 12-month-old girl presented with a chronic localised mass on the knee, discomfort and gradually increasing right genu valgum. A diagnosis of pigmented villonodular synovitis was suggested by magnetic resonance imaging and confirmed at the time of surgical excision of the mass. The patient showed no recurrence after 3 years of follow up, and she required no further management. Pigmented villonodular synovitis should be considered in the differential diagnosis of chronic knee swelling in children.

Pigmented villonodular synovitis

Pigmented villonodular synovitis

An unusual case of pigmented villonodular synovitis after unicompartmental knee arthroplasty

Introduction: Pigmented villonodular synovitis (PVNS) after replacement arthroplasty is a potential cause of postoperative pain and hemarthrosis. The disease is difficult to diagnose after arthroplasty, since magnetic resonance imaging (MRI) appearances are subject to metal artifact making them less than ideal. Case Report: A case of a 61­year­old woman with PVNS after unicompartmental knee arthroplasty (UKA). She was treated with an arthroscopic synovectomy with good result. Conclusion: MRI evaluation of the residual side of the knee joint after UKA is valuable for the differential diagnosis of PVNS.

Pigmented villonodular synovitis: a retrospective study of seventy five cases (eighty one joints)

Pigmented villonodular synovitis (PVNS) is a relatively rare, benign proliferation lesion of the synovium of large joints, but there is not much information available about the disease's aetiology, clinical history, differential diagnosis, treatment, and long-term effects. We conducted a study to analyse these aspects of PVNS. We reviewed all clinical data for 75 patients with PVNS (81 joints) who were treated either by synovectomy alone or synovectomy plus arthroplasty. In all cases, the diagnosis of PVNS was confirmed by pathological examination. The ratio of males to females was 27:48, and the average age of patients was 46 years (range, 15-80 years). Lesions were located in the knee, hip, or ankle, and pain and swelling were the main symptoms. Of 75 patients, 42 had a history of trauma to the involved joint. Forty-one patients (43 joints) underwent synovectomy alone, and 34 patients (38 joints) underwent synovectomy and arthroplasty together. Of the 75 patients, 61 had full follow-up data. Twelve patients had recurrent legions detected by pathological examinations; four patients had more than two recurrences. Moreover, five patients developed PVNS after arthroplasty. PVNS occurs most often in middle-aged women and most frequently involves the knee, followed by the hip and ankle. The disease's etiology is varied and unclear. Surgical excision alone or with arthroplasty is an effective treatment, but there is a high rate of recurrence.

Pigmented villonodular synovitis

Background Pigmented villonodular synovitis (PVNS) is a rare benign condition characterized by villous or nodular hyperplasia of the synovium. Few Moroccan studies on this disease have been reported in the literature. The purpose of this study was to evaluate the clinical, radiographic, and pathologic features and outcomes of PVNS in seven patients. Methods This retrospective study examined data from seven patients with pathologically-confirmed PVNS. Patients were selected from the Rheumatology and Orthopaedic Surgery departments over a period of 2 years (January 2009–December 2010). Collected data included disease localization, therapeutic modalities, and outcomes. Results Five women and two men were included. The mean age was 30 years (20–50 years). The knee was involved in five patients, the elbow in one patient, and the hip in one patient. Mean duration of symptoms was 36 months (7 months–12 years). Clinical presentation included chronic pain, functional disability, and joint effusion. There was no inflammatory syndrome or coagulation disorder. Joint aspiration was performed in five patients. Radiographs revealed bone abnormalities in two patients. MRI was performed in all patients and showed images characteristic of PVNS. Synovial biopsy confirmed the diagnosis in all patients. All patients underwent surgical synovectomy with good functional results. None had synoviorthesis. Recurrence occurred in one patient 2 months after surgery. The mean follow-up time was 28±6 months. Conclusions The diagnosis of PVNS is purely histological. MRI allows early recognition and improves the early management of this pathology. Synovectomy should be as complete as possible to reduce the risk of recurrence.

Excision of Extensive Midfoot Pigmented Villonodular Synovitis With Microvascular Anastamosis of Iliac Crest Bone Graft Using External Fixation

Pigmented villonodular synovitis (PVNS) is a relatively rare lesion in the foot and ankle, most commonly involving the ankle joint and atypically, the subtalar and midtarsal joints. It is a benign proliferative disease characterized by an increase in villous or nodular synovium in joints. Resection of the tumor is often indicated in most cases because of the potentially aggressive joint destructive nature of this lesion. This report presents a case of chronic enlarging pervasive midtarsal and metatarsal-cuneiform joint PVNS in a 28-year-old male. This patient had a midtarsal mass that enlarged over a period of 2 years, causing increased pain, deformity, and difficulty with ambulation. Cross-sectional imaging studies identified evidence of erosive disease through much of the midfoot articulations, with biopsy confirming the mass as PVNS. The dimensions of the mass approximated 5.5 cm × 4.1 cm × 2.8 cm. Simple resection was problematic because of the size and multiple joints involved. Amputation was most commonly advised by multiple consultants. The patient preferred attempt at limb salvage. En bloc resection and placement of a revascularized iliac crest bone graft was used to fill the defect. The graft was microvascularly anastamosed and fixated with standard external fixation. Pathologic and histologic specimens from surgical biopsy reconfirmed the diagnosis of PVNS postoperatively. Second-stage arthrodesis was performed when the patient was stable and disease free. The patient was followed postoperatively for 10 years without recurrence and was able to return to full function and partake in moderate athletic activity at last visit. This case describes a retrospective review of the procedure and reconstruction, as well as an overview of current surgical management of PVNS.

Malignant pigmented villonodular synovitis of the temporomandibular joint with lung metastasis: a case report and review of the literature

Malignant pigmented villonodular synovitis (PVNS) is an extremely rare lesion. Approximately 30 cases of malignant PVNS have been reported to date and of these, only 1 case involved the temporomandibular joint. Owing to the rarity of well-documented cases and the heterogeneous histologic features of this group of tumors, there has been some confusion regarding its diagnosis. The heterogeneous features of the sarcomatous areas contain fibrosarcomatous, myxosarcomatous, malignant fibrous histiocytomalike or giant cell tumorlike patterns. However, despite the absence of frank sarcomatous change in the histopathogy of PVNS, there have been 3 reported cases of metastatic lesions in the lung or lymph nodes. Here we present an additional case of clinically malignant PVNS with pulmonary metastasis after recurrence. A 29-year-old man presented in our hospital with a recurrent swelling and pain in the right preauricular area, where benign tumor had been previously resected. MRI demonstrated a large mass with a low signal intensity that seemed to demonstrate a ferromagnetic effect. Surgical resection of the lesion was performed and the diagnosis of PVNS with focal atypical cells was made. Unfortunately, at 30 months post surgery, a thoracic CT found a metastatic nodule in the left lower lobe of the lung.

Results of total knee arthroplasty in patients with gonarthrosis resulting from the delayed diagnosis of PVNS: a case series

Pigmented villonodular synovitis (PVNS) is a benign tumor that affects synovial lined joints, tendon sheaths and bursae. It is most commonly seen in one knee joint. The recommended treatment is total synovectomy, while radiotherapy can be used as adjuvant therapy for patients at risk for recurrence. The aim of our study was to show that the devastating effects of inactive diffuse PVNS may not be recognized for years and to evaluate the efficiency of aggressive total synovectomy on patients with PVNS during a follow-up period of 5 years. In the present study, 5 knees of four patients who had been previously followed due to gonarthrosis and diagnosed with PVNS during total knee arthroplasty (TKA) were followed and evaluated for a mean duration of 68 months. Mean age of the patients was 61.2 (52–66). All patients were women. One patient had right knee involvement, two had left knee involvement, and one had both knees involved. All patients had diffuse PVNS. Total synovectomy was performed in all patients in addition to TKA. During the follow-up, recurrence was not seen in any of the patients and prosthesis loosening was not detected. The aim of the present study was to evaluate the effectiveness of total synovectomy over the 5 years following the operation and to show that the devastating effects of inactive PVNS may sometimes be overlooked for years before being recognized during the treatment of the gonarthrosis that develops due to the disease. Although the disease is generally monoarticular, the study also presents a patient with bilateral PVNS.

Pigmented Villonodular Synovitis of the Ankle—Radiation Therapy as a Primary Treatment to Reduce Recurrence: A Case Report with 8-year Follow-up

Pigmented villonodular synovitis (PVNS) is a rare, benign, idiopathic proliferative disorder of the synovium that results in villous and or nodular formations that have been reported to manifest within joints, tendon sheaths, and bursae. The overall incidence includes 2% to 10% that occur within the foot and ankle joints. PVNS has a high rate of recurrence and up to a 45% recurrence rate has been reported despite surgical intervention. Although traditional treatment for PVNS includes synovectomy with arthroplasty of the affected joint, radiation therapy is now suggested as an adjunctive therapy that is believed to reduce recurrence of the disease. We present a case of PVNS where the patient was treated in 2 stages: surgical resection of the tumor with arthroplasty of the ankle joint followed by radiation therapy. A retrospective review of the chart, radiographs, and MRIs was conducted for a 36-year-old, African American female who had been treated and followed for 8 years. Pathologic examination of the tumor confirmed the diagnosis of PVNS. No evidence of recurrent PVNS was identified in the long-term postoperative MRI examination. The fact that ancillary imaging examinations failed to reveal evidence of recurrence and that the patient expresses a very high patient satisfaction supports the potential benefit of adjunctive radiation therapy for this condition.