Diagnosis Of Pigmented Villonodular Synovitis Research Articles

Diagnostic value of synovial fluid analysis in pigmented villonodular synovitis (PVS)- a proposal of diagnostic criteria

PVS is an idiopathic lesion that affects the synovial joints,tendons,sheats and bursea through the production of tumour-like growths. Diagnosis of PVS is difficult. Arthroscopy and biopsy together with microscopic examination are usually a base. According to our experience, cytologic features of synovial fluid are a very useful diagnostic tool in PVS.

Dynamic MR-imaging in the diagnosis of pigmented villonodular synovitis of the knee

The aim of this report was to study the rate of contrast enhancement at MRI in pigmented villonodular synovitis (PVNS). Dynamic MRI was performed in a patient with PVNS just before and 1 week and 3 years following synovectomy of the knee. As opposed to patients with rheumatic disease the patient with PVNS showed a slower enhancement rate before synovectomy than 1 week after. At 3 years follow-up the patient with PVNS showed an enhancement rate just above that of the normal controls. The results indicate that PVNS has features more common to hyperplastic or neoplastic lesions than to inflammatory ones. The results at 3 years follow-up also suggest that dynamic MRI may indicate the efficacy of arthroscopic synovectomy.

Pigmented villonodular synovitis. Case reports and review of the literature

Because this disease is so rare the optimum treatment of pigmented villonodular synovitis (PVNS), in particular the diffuse form differs in the literature. The most important surgical procedures are arthroscopic and open synovectomy. The prevention of disease progression, as well as joint destruction and dysfunction, depends upon the early diagnosis of PVNS. During 1994 and 1995, we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months. Two patients were treated with complete synovectomy, one patient underwent partial synovial resection, and in the final case an arthrodesis was performed. Our results indicate that an MRI is essential for diagnosis and treatment planning. For the localized form of PVNS, it appears that a partial synovectomy is appropriate. However, in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium, a total synovectomy is indicated because of the high recurrence rate. In our study, all four patients had disease involving secondary bony lesions and, in one case, joint destruction. Based on our findings, it is clear that early surgical therapy is the only recommended curative intervention. The decision regarding the surgical approach, arthroscopic versus open, depends on the form of PVNS, the extent of the disease and secondary changes of the joint.

Pigmented Villonodular Synovitis of the Temporomandibular Joint

Pigmented villonodular synovitis is a proliferative disorder affecting the synovium and may be an aggressive local process with bone destruction and invasion of contiguous structures. Involvement of the temporomandibular joint is very rare. We report a rare case of pigmented villonodular synovitis of the temporomandibular joint that invaded the infratemporal fossa with bone destruction of the mandibular condyle. Magnetic resonance imaging was effective in delineating the extent of the lesion in the infratemporal fossa. Fine-needle aspiration cytology showed multinucleated giant cells and round or spindle-shaped cells with hemosiderin deposits. The tumor was resected en bloc through a combined temporocervical and infratemporal fossa approach. The postoperative histological diagnosis was a variant of pigmented villonodular synovitis. Fine-needle aspiration cytology and magnetic resonance imaging proved to be useful in the preoperative diagnosis of pigmented villonodular synovitis of the temporomandibular joint and in the preoperative planning that is required to obtain adequate surgical margins.

Outcome following radiation treatment for high-risk pigmented villonodular synovitis

Pigmented villonodular synovitis (PVNS) is a rare proliferative process involving synovial membranes. It has a variable course, and while usually benign, may be destructive, resulting in major symptoms and loss of function leading to amputation. Optimum treatment is not always clear, and little information exists with respect to the role of radiotherapy. The purpose was to review our experience with radiotherapy in cases at high risk for recurrence with functional loss including instances where amputation was the sole alternative for symptomatic disease. The records of all patients registered between 1972 and 1992 with a diagnosis of PVNS were identified (21 cases). The records of 14 cases who received radiotherapy after referral were reviewed retrospectively for demographic information, radiotherapy treatment parameters, and tumor outcome. All cases had confirmation of pathologic diagnosis. Six patients had primary and eight had recurrent disease (with a mean of 2.5 prior surgical procedures). All cases had both intra- and extraarticular disease and, without exception, the poorer prognosis diffuse subtype of the disease. The majority had one or more additional risk factors including skin, bone, tendon, neurovascular, or muscle group extension. With a mean follow-up time of 69 months (range 13-250 months), only one patient has shown persistence of disease. With the exception of that single case, all those with measurable disease had obvious disease until at least 12 months and, subsequently, manifested complete responses. The single case was lost from the clinic after 8 months from the initiation of radiotherapy to a dose of 30 Gy in 15 fractions and had a palpable mass at the time. He subsequently was noted to have a persisting mass and an excisional biopsy 9 years later showed PVNS. He remains well 21 years after treatment with good function. Eleven patients enjoyed excellent or good function from the affected limb and three had fair function. All patients had greater use of limb than at the time of treatment. No patient required amputation, and none had evidence of serious radiotherapy complications. These results demonstrate that moderate dose radiotherapy is an effective modality in the treatment of a subset of cases with this rare condition. Its use has permitted avoidance of amputation in very advanced cases with acceptable function preservation. When treatment is indicated we currently recommend gross total removal of PVNS. This is followed by moderate dose radiotherapy (35 Gy in 15 fractions) for residual disease where salvage of subsequent recurrence may compromise function.

Expression of metalloproteinases in pigmented villonodular synovitis

Pigmented villonodular synovitis (PVNS) is an idiopathic proliferative synovial process composed of two predominant cell types: mononuclear histiocytic cells and giant cells. This lesion can be locally invasive and can result in bone cyst formation and late cartilage and bone loss. Because metalloproteinases have been implicated in the joint destruction occurring in inflammatory arthritis and in the ability of certain tumors to invade adjacent tissues, their presence in PVNS was determined. Synovial tissue samples were collected at surgical synovectomy from the knees of 10 patients with a prior histological diagnosis of PVNS. Pigmented villonodular synovitis synovium was examined for the presence of the metalloproteinases collagenase and stromelysin. Messenger RNA (mRNA) for collagenase and stromelysin was present in all patient samples, although in varying amounts. In situ hybridization studies on synovial tissue sections identified synovial lining cells as the predominant cells expressing these metalloproteinases. Occasional infiltrating mononuclear histiocytic cells also were producing metalloproteinase mRNA. Giant cells did not express mRNA for the metalloproteinases collagenase and stromelysin. These results suggest that collagenase and stromelysin may be among the mediators of cartilage and bone loss that can occur in PVNS.

Evaluation of the Hip With Pigmented Villonodular Synovitis

Pigmented villonodular synovitis (PVNS) is an uncommon disorder of the synovium that rarely involves the hip joint. The natural history of an untreated case of PVNS is presented herein. A young adult with a painful hip and destructive changes on plain roentgenograms requires further diagnostic evaluation. The relative value of current imaging techniques is discussed in this report. Plain roentgenograms alone often suggest the correct diagnosis of PVNS of the hip, but traditional criteria have proven to be inaccurate. Computed tomography (CT) is helpful in demonstrating the location and degree of bone loss throughout the pelvis and assists in determining the need for bone graft or prosthetic modification in preoperative planning. Experience with magnetic resonance imaging (MRI) in this disorder is limited, but no clear advantage over CT has been demonstrated thus far. Three-dimensional reconstruction has provided no useful information not already found on plain CT or MRI. For diagnostic accuracy and effective preoperative planning, evaluation should include a complete blood count, sedimentation rate, CT scan, and MRI.

Pigmented villonodular synovitis of the knee. The results of total arthroscopic synovectomy, partial, arthroscopic synovectomy, and arthroscopic local excision.

Twenty-five patients who had had a diagnosis of pigmented villonodular synovitis of the knee were followed for an average of four and one-half years (range, two to ten years) after arthroscopic treatment. Five patients had had localized lesions and had been managed with local resection; all five had improvement, with no apparent recurrence. The remaining twenty patients had had diffuse disease. Of these twenty, eleven had had a complete arthroscopic synovectomy. All eleven had definite improvement in pain and function, and almost all had a decrease in synovitis and an increase in the range of motion of the knee; the disease recurred in only one. The other nine patients had had a partial arthroscopic synovectomy. Although most had some improvement in function and range of motion and a decrease in pain and synovitis, the disease recurred in five of the nine. Thus, in the patients who had had diffuse pigmented villonodular synovitis, the rate of recurrence was lower in those who had had a complete arthroscopic synovectomy than in those who had had a partial arthroscopic synovectomy (p = 0.01).

X-chromosome inactivation in patients who have pigmented villonodular synovitis.

We performed a histological examination and DNA analysis on samples of tissue from a forty-seven-year-old woman who had a clinical diagnosis of pigmented villonodular synovitis. The histological examination confirmed the diagnosis. The evaluation of the samples of tissue with preferential X-chromosome inactivation analysis (a molecular biological method for the study of clonality in tumors) showed that the lesion was polyclonal in origin. We concluded, therefore, that pigmented villonodular synovitis is more likely to be a reactive process than a true neoplasm.

The Use of Magnetic Resonance Imaging in the Diagnosis of Pigmented Villonodular Synovitis

Although the clinical and radiographic features of pigmented villonodular synovitis (PVS) have been well described, diagnosis is often delayed and high rates of recurrence after synovectomy are reported. Magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of soft tissue masses. Three patients with biopsy-proven PVS and radiographs showing only effusion underwent MRI in the axial, coronal, and sagittal planes. The margins of the diseased synovium were best demonstrated on long TR/TE (T2-weighted) images. The synovium contained areas of void signal intensity felt to be due to hemosiderin, interspersed with increased signal from both inflammation and fat. In all cases, the margins of the diseased synovium were clearly delineated, allowing classification as nodular or diffuse. No appreciable change in signal intensity was seen when comparing nodular and diffuse forms. MRI is useful but not specific for PVS, since rheumatoid synovitis may show a similar signal pattern. However, MRI in patients with suspected PVS may decrease the time until diagnosis, aid in preoperative planning and obtaining adequate margins of resection, and may be a non-invasive method of long-term follow up for possible recurrence.

Lipid microspherules in synovial fluid of patients with pigmented villonodular synovitis.

We describe 2 patients with pigmented villonodular synovitis. In both patients, synovial fluids (SF) were characterized by the presence of abundant, strongly birefringent lipid microspherules, which appeared as Maltese crosses and were found both inside foam cells and free in the SF. Histologically, the synovial membranes showed pigmented villonodular synovitis, with aggregation of foam cells containing abundant lipid microspherules in their cytoplasm. Observation of numerous birefringent lipid microspherules and foam cells in SF may be a clue to the diagnosis of pigmented villonodular synovitis.

The Use of MRI to Assist in Diagnosis of Pigmented Villonodular Synovitis of the Knee Joint

Pigmented villonodular synovitis (PVNS) of the knee joint remains a difficult and elusive entity to define and characterize. This entity most often appears in the young adult knee with nonspecific clinical features, including a painful range of motion and perhaps a sensation of locking. Detection and diagnosis of this localized soft-tissue mass are difficult because plain roentgenograms may be totally within normal limits. The case of a 21-year-old woman illustrates the use of magnetic resonance imaging (MRI) as an effective technique to define and characterize PVNS. Advantages of MRI include high-resolution/high-contrast multiplanar sections that depict bone, marrow, ligaments and tendons, fat, menisci, and articular cartilage in one image. In addition, MRI is noninvasive and requires no ionized radiation. MRI is an excellent clinical tool for the evaluation of intraarticular tumors of the knee joint.

Arthrosonography in the diagnosis of pigmented villonodular synovitis

Arthrosonography in the diagnosis of pigmented villonodular synovitis

Pigmented Villonodular Synovitis of Joints

In a series of 38 young adults with intra-articular pigmented villonodular synovitis, the joint predominantly affected was the knee. For early diagnosis of intra-articular pigmented villonodular synovitis, a high level of suspicion is necessary for patients with complaints of persistent pain or swelling in the knee, or erosive osteoarthritis of the hip and shoulder of unknown etiology in young individuals. Arthrography of the knee was not found to be a very helpful test in the diagnosis of pigmented villonodular synovitis. Localized intra-articular pigmented villonodular synovitis should be treated by local excision. Diffuse intra-articular pigmented villonodular synovitis of the knee should be treated by extensive synovectomy followed by manipulation under general anesthesia two to three weeks postsurgery. Intra-articular pigmented villonodular synovitis of the shoulder and hip should be treated by extensive synovectomy or by total joint arthroplasty in cases with marked bone destruction and cyst formation.

A cause of erroneous diagnosis of pigmented villonodular synovitis.

An unusual type of benign vascular hamartoma, which shows a curious papillary organization of thrombus and abundant haemosiderin deposition, is liable to be misdiagnosed histologically as pigmented villonodular synovitis. Nine examples of this type of lesion are briefly presented and the differential diagnosis is discussed.

“Nodular tenosynovitis in the ankle region”: Report of a Case

One case of Nodular tenosynovitis in the ankle region was reported. Nodular tenosynovitis, in the great majority of the cases, the lesion is to be observed in the fingers. Sometimes the lesion is found at the ankle. In Japan, 5 cases has been reported at the ankle past ten years.Man, thirty years old, noticed the mass of the right ankle region since August 1969. The mass which gradually developed, was surgically removed on July 1973. Since operation the patient has remained free from Symptoms. Histological examination confirmed the diagnosis of pigmented villonodular Synovitis.

Double-contrast arthrography in the diagnosis of pigmented villonodular synovitis of the knee.

DOUBLE-CONTRAST ARTHROGRAPHY IN THE DIAGNOSIS OF PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEERICHARD D. WOLFE, USAF, MC and VINCENT J. GIULIANO, USA, MCAudio Available | Share

Roentgen Diagnosis of Pigmented Villonodular Synovitis and Synovial Sarcoma of the Knee Joint

In 1941 Jaffe, Lichtenstein, and Sutro (1) wrote of the pathology of certain diseases of joints, tendon sheaths, and bursae. They showed the histologic linkage and essential unity of lesions previously described in the literature under a wide variety of designations, i.e., such synovial and bursal lesions as chronic hemorrhagic villous synovitis, giant-cell fibro-hemangioma, fibro-hemosideric sarcoma, sarcoma fusigigantocellulare, benign polymorphocellular tumor of the synovial membrane; and such tenosynovial lesions as xanthoma, xanthogranuloma, giant-cell tumor, and myeloplaxoma. All of these pathological conditions they grouped together under the name of pigmented villonodular synovitis. These same authors wrote that in joints, pigmented villonodular synovitis may occur in circumscribed or diffuse form. In the circumscribed form, the affected synovial membrane shows one or more yellow-brown sessile or stalked tumor-like nodular outgrowths. In the diffuse form (Figs. 1 and 2) the membrane appears brownishly pigmented and covered by villous and coarse nodular outgrowths. The authors were of the opinion that the condition should not be considered neoplastic, but rather inflammatory in nature, though they had no suggestion to offer with regard to the agent provoking the inflammatory response. Both pigmented villonodular synovitis and tumors of the knee joint may occur as circumscribed or single lesions (1, 2, 3), and in some instances may be demonstrated roentgenographically (Fig. 3). We have thus far been unable from the x-ray appearance alone to do more than hazard a guess as to the character of these solitary lesions. Our principal concern in this communication is with the diffuse synovial lesions, and to these we shall confine our attention. Although the radiographic characteristics of diffuse villonodular synovitis and diffuse intracapsular tumors of the knee joint, of which synovial sarcoma (synovioma) is the most common, are often identical, the general characteristics of this group are as a rule so typical that, after seeing a few cases, the radiologist is able almost at a glance to classify a new one as belonging in this broad category. These characteristics are as follows (Figs. 4–7): bones of a young adult; monarticular involvement; excessive amount of synovitis, which may appear smooth in outline and homogeneous in density, but is particularly diagnostic when it is, in part at least, nodular in outline and density, as is frequently the case; joint spacing symmetrical and normal, giving no indication of cartilage abnormality; completely normal appearing bones, without even osteoporosis; no evidence of thigh or leg atrophy: in summary, excessive synovitis, often nodular in outline and density, in a young person, with everything else completely normal.