Form Of Pigmented Villonodular Synovitis Research Articles

Localised pigmented villonodular synovitis of Hoffa’s fat pad- treatment using 70 degree arthroscope and superolateral portal: a case report

<p class="abstract">The localized form of pigmented villo-nodular synovitis (PVNS) is a rare pathological entity characterized by limited involvement of the synovium. The knee is the most commonly affected joint, and the disorder presents as a nodular, pedunculated lesion. The lesion usually presents as mechanical symptom such as locking of the knee. We report a case of localized PVNS that involved patellar fat pad an extremely rare area of involvement, previously described only in 4 cases, presenting as palpable mass. Complete excision of the lesion was performed through superolateral portal with use of 70-degree arthroscope. 70-degree<sup> </sup>arthroscope allows us to completely visualize infra-patellar region through superolateral portal and is recommended than 30-degree arthroscope for treatment of infra-patellar lesions. Patient was symptomless at 3 months follow up.</p><p class="abstract"> </p><p> </p>

Localized pigmented villonodular synovitis of the ankle: Expect the unexpected.

We present the technique, results and discuss arthroscopic treatment of the localized form of pigmented villonodular synovitis (LPVNS) of the ankle. Medical records of five patients diagnosed and treated for ankle LPVNS with a minimum five-year followup were retrospectively reviewed. All patients were treated arthroscopically, altered synovial tissue was resected and a sample of tissue was sent for pathohistological examination for the definitive diagnosis. No recurrence was noted at a mean followup of 6.5 years, both clinically and by MRI at one year postoperatively. Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and an improvement was noted from an average score of 65.6 prior to treatment to 94.6 at final followup. Considering the results of this case series, and the absence of complications, arthroscopy is a viable option for treating LPVNS of the ankle.

Intra-articular post-traumatic ankle joint mass imitating localized pigmented villonodular synovitis (LPVS), the aid of ankle arthroscopy for diagnosis and treatment—A case report

Intra-articular post-traumatic ankle joint mass is a rare entity that may mimic other pathologies, mainly localized form of pigmented villonodular synovitis (LPVS) regarding the clinical and imaging characteristics. We report the case of a 16-year-old female patient that presented an intra-articular ankle joint mass 8 months after an ankle joint sprain for which magnetic resonance imaging (MRI) suggested LPVS as possible diagnosis due to the presence of hemosiderin deposits. Diagnosis of a post-traumatic hematoma of her ankle joint was made via fine needle aspiration (FNA) biopsy and anterior ankle arthroscopy. At one-year-follow-up after the arthroscopic excision of the hematoma, the patient remained asymptomatic and pain free while MRI revealed no pathologic findings. This case demonstrates that LPVS is not always the diagnosis when hemosiderin deposits are depicted on the MRI of a solitary intra-articular mass. The FNA biopsy under direct arthroscopic view assists the diagnosis and guides the treatment plan in cases that no definite diagnosis has been reached preoperatively by MRI.Level of evidence IV, case report.

Localized form of pigmented villonodular synovitis of the knee: The meniscal mime

The localized form of pigmented villonodular synovitis of the knee is a rare condition with non-specific symptoms. This makes diagnosis especially difficult when the meniscus is affected. A full assessment with several imaging modalities can help support the preoperative diagnosis. But in the case reported here, the full clinical and paraclinical assessment (X-rays, CT arthrography and MRI) was wrong – the localized form of pigmented villonodular synovitis had mimicked a lateral meniscus injury and was only detected during arthroscopy. The lesion was excised surgically and the diagnosis was confirmed through postoperative histopathology.

Pigmented Villonodular Synovitis: Current Concepts About Diagnosis and Management

At present, the treatment strategies in patients with localized and diffuse forms of pigmented villonodular synovitis have more or less been standardized. However, these strategies are not optimal because high recurrence rates persist and studies with a sufficient level of evidence are lacking. This systematic review article describes all known treatment options for intra-articular pigmented villonodular synovitis and their clinical results. Based on this research, we provide guidelines to support physicians in making the optimal treatment decisions. Given the rarity of the disease, randomized studies are not to be expected, but an international registry through existing networks would offer the benefit of getting a better insight into the outcome of this disease. Therefore, we propose a basic set of data to be investigated and ideally to be reported on in such a registry.

Bisphosphonate: A Novel Treatment for Pigmented Villonodular Synovitis

Pigmented villonodular synovitis (PVNS) is an aggressive lesion occurring primarily within joint spaces, usually the knee. A combination of surgery and radiotherapy may be helpful in difficult cases. Recurrence after operation is common. Histologically, PVNS is characterised by the proliferation of synovial lining cells and a heavy diffuse subintimal infiltrate of mononuclear cells, largely macrophages, among which are scattered multinucleated giant cells. Also, it is shown that the giant cells in the PVNS express all the phenotypical features of osteoclasts, including the ability to carry out lacunar resorption. This may account for the bone destruction associated with this aggressive synovial lesion. The osteoclastic cells, which cause bony destruction, are thought to be recruited from normal monocytic pre-osteoclasts by stromal cell expression of the ligand for receptor activator of nuclear factor kappa B (RANKL). Osteoprotegerin acts as a decoy receptor for RANKL blocking the process of osteoclast differentiation. Bisphosphonates stimulate the osteoprotegerin production by osteoblasts, which can lead to a significant reduction in RANKL. Therefore, bisphosphonates can be considered an adjuvant therapy for pigmented villonodular synovitis. Pigmented villonodular synovitis (PVNS) is an aggressive lesion occurring primarily within joint spaces, usually the knee. However, other sites including the hip, temporomandibular joint and bursa have been described. A combination of surgery and radiotherapy may be helpful in difficult cases, although recurrence after operation is common. The outcome after surgical resection has been affected negatively by tumour recurrence and additional bone destruction. Histologically, PVNS is characterised by the proliferation of synovial lining cells and a heavy diffuse subintimal infiltrate of mononuclear cells, largely macrophages, among which are scattered multinucleated giant cells; both mononuclear and multinucleated cells may contain phagocytosed haemosiderin or lipid. It is not known whether this giant-cell-rich synovial proliferation is reactive or neoplastic in nature, but in about one-third of cases PVNS behaves aggressively, causing para-articular osteolysis with the formation of multiple cysts in the bone. Ultrastructural studies of both the villous and nodular forms of PVNS have shown the presence of synovial type A macrophage-like cells and synovial type B fibroblast cells; the multinucleated cells show similar features to type A mononuclear cells, suggesting that they are formed by the fusion of type A cells. Multinucleated giant cells similar to those seen in PVNS may be found in a wide variety of giant cell lesions of bone and extraskeletal soft tissues. The giant cells from these various lesions have all been shown to be capable of lacunar bone resorption, a characteristic feature of osteoclasts. In skeletal giant cell containing lesions, such as giant cell tumour of the bone and giant cell reparative granuloma of the jaw, the giant cells exhibit all the defining characteristics of the osteoclast phenotype. Also, it is shown that the giant cells in the PVNS express all the phePublished online January 23, 2008. Address correspondence and reprint requests to: Hamid Namazi; E-mail: namazih@sums.ac.ir

Pigmented villonodular bursitis/diffuse giant cell tumor of the pes anserine bursa: A report of two cases and review of literature

Pigmented villonodular synovitis (PVNS) is a benign but potentially aggressive lesion, characterized by synovial villonodular proliferation with hemosiderin pigmentation and stromal infiltration of histiocytes and giant cells. This consists of a common family of lesions, including localized and diffuse forms of pigmented villonodular synovitis, giant cell tumor of the tendon sheath (nodular tenosynovitis) and the very rare cases of extra-articular pigmented villonodular synovitis arising from the bursa (pigmented villonodular bursitis or diffuse giant cell tumor of the tendon sheath). The purpose of this paper is to present two rare cases of pigmented villonodular bursitis arising from the pes anserinus bursa. The various differentials along with a review of literature of similar lesions are also being discussed. However, as with other lesions, clinicoradiographic features along with close histological correlation is essential for diagnosis.

Les tumeurs à cellules géantes des gaines synoviales de la main: à propos de 32 cas

Giant cell tumors of tendon sheath (GCTTS) represent a localised form of pigmented villonodular synovitis. They are usually found in the hand (80% of cases) where it represents the second most common tumor of the soft parts after the ganglion cyst. Its surgical treatment is sometimes difficult because of local extension and the invasion of vital digital structures. We report a retrospective study over 10 years of 32 cases of GCTTS with an average age of 35 years and a sex-ratio of 1. The reason for consultation was the presence of a digital mass, associated with an impairment of finger flexion in 43,7% of patients. A palmar localisation was found in 56,2%, especially in the fifth ray (62,5%) and at the level of the distal phalanx (68,7%). Radiological changes were observed in 4 cases. All patients were treated surgically. Macroscopically the lesion presented as an encapsulated tumor, polylobulated and yellow-brownish which invaded the skin (1 case), extended into the sheath of the flexor tendons (3 cases) and under the extensor tendon (4 cases). In the post operative follow up we noted one case of hypoaesthesia of the pulp and three cases of stiffness of the proximal interphalangeal joint. No skin necrosis was found. With a 4 year average follow up (10 months - 9 years), we noted three reccurrences (9,3%) which were all surgically managed. After analysis of the literature, the authors will describe the clinical aspects and the therapeutic difficulties of this condition.

Diffuse-type giant cell tumor of the subcutaneous thigh

Diffuse-type giant cell tumor is an extra-articular form of pigmented villonodular synovitis. The localized form of this lesion (tenosynovial giant cell tumor) is frequent, representing the most common subset arising from the synovium of a joint, bursa or tendon sheath, with 85% of cases occurring in the fingers. The less frequent diffuse-type giant cell tumors are commonly located in the periarticular soft tissues, but on rare occasions these lesions can be purely intramuscular or subcutaneous We report the case of a 26-year-old female with diffuse-type giant cell tumor of the subcutaneous thigh, remote from a joint, bursa or tendon sheath. A review of the literature did not reveal any similar description of a diffuse-type giant cell tumor completely within the subcutaneous thigh, remote from a joint, bursa or tendon sheath. These lesions were initially regarded as inflammatory or reactive processes, but since the identification of clonal abnormalities in these patients, and in view of their capacity for autonomous growth, they are now widely considered to represent benign neoplasms.

Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Knee

Purpose : To evaluate the efficacy of arthroscopic synovectomy through the direct posteriorposterior approach in pigmented villonodular synovitis (PVNS) of the knee. Materials and Methods : Between January 1997 and May 2004, twenty-one patients underwent an arthroscopic synovectomy for PVNS of knee. The mean follow-up period was 35 months. The arthroscopic and MRI findings revealed the localized form of PVNS in six patients and the diffuse form in fifteen patients. All patients underwent an arthroscopic examination and synovectomy through the direct posterior-posterior approach. The clinical results were evaluated by the range of motion, Lysholm knee score, and the knee pain score using the visual analogue scale (minimum 0-maximum 10). Results : Among the fifteen cases with the diffuse form, three cases (14%) recurred and had secondary arthroscopic total synovectomy. One cases recurred again. Therefore, radiation therapy was performed. The Lysholm knee score improved from 62.5 to 87.3, and the VAS score improved from 5.9 to 1.8. Three patients had a mild limitation in knee motion. However, the others had full range of motion of the knee at the last follow-up. Conclusion : Arthroscopic synovectomy through the direct posterior-posterior approach could be a useful method for the treatment of PVNS of the knee, and can be used as an effective therapeutic tool particularly in posteromedial or posterolateral lesions.

Clustered Localized Pigmented Villonodular Synovitis

Abstract The localized form of pigmented villonodular synovitis (PVNS) is a rare pathologic entity characterized by limited involvement of the synovium. In the knee joint, which is the most commonly affected joint, the disorder generally presents as a single nodular lesion, or rarely as 2 or 3 multiple nodular lesions into the joint. We report 2 cases of localized PVNS in which multiple nodules were clustered in a limited patella fat pad area. Clustered, multiple nodular lesions in a limited area suggested to us to consider a variant of localized forms.

Diffuse Pigmented Villonodular Synovitis

Pigmented villonodular synovitis is nonmalignant and nonmetastasizing, but it is locally destructive and can result in considerable disability through infiltration and involvement of surrounding soft tissues and bone. This article briefly describes the clinical picture of the diffuse form of pigmented villonodular synovitis and reports on two cases involving juxta-articular erosions of the calcaneocuboid joint. Treatment involved substantial curettage of bone and resection of infiltrated intrinsic musculature.

Irradiation as adjunctive treatment of diffuse pigmented villonodular synovitis of the foot and ankle prior to tumor surgical excision

In this manuscript, the author undertakes a brief description of the diffuse form of pigmented villonodular synovitis and provides a recommendation of pre-surgical tumor irradiation as adjunctive treatment for reduction of recurrence and better preservation of function of the lower extremity.

Localized nodular pigmented synovitis of the mid-foot

Pigmented villonodular synovitis (PVS) is a rare proliferating process of the synovium, tendon sheaths and bursae usually affecting the bone and joints. Localized nodular synovitis (LNS) is a form of PVS and is characterized by solitary or aggregates of confluent nodules. The incidence of PVS in the United States of America is 1.8 patients per million people while 2.5% of the cases are referred to ankle and foot. The majority of them involve the ankle, metatarsals and toes [4]. The appearance of PVS in the mid-foot is extremely rare. There are only two cases previous reported in the literature to our knowledge. We present a case of localized nodular synovitis of the mid-foot with destructive lesions on the adjacent bones.

Localized Pigmented Villonodular Synovitis of Joints

Background: Pigmented villonodular synovitis (PVNS) occurs in three forms: giant cell tumors of tendon sheaths or bursae, diffuse PVNS of joints, and localized PVNS of joints. Both the diffuse form and the localized form of PVNS of joints are rare disease entities that most often affect the knee joint. The over-all annual incidence rate is 1.8 patients per million in the general population. Six cases of intra-articular localized PVNS were reviewed in this study. Methods: The records of all six patients who had received surgical treatment and pathology-proven localized PVNS of joints between June 1988 and February 1999 were reviewed. The material review included clinical notes, operative records, pathological reports, preoperative and postoperative imaging studies, and histological reports. All patients were called for a follow-up evaluation, and all of them were seen and examined. Results: There were two men and four women. The average age was 37 years (range, 19 to69 years). PVNS was located in the knee joints and managed with marginal excision by either open arthrotomy or arthroscopic operation in all cases. There was no evidence of recurrence at the follow-up evaluation (range, 12 to 126 months: average, 56.3 months). The average duration from onset of symptoms to presentation was 10.7 months-(range, 3 to 36 months). Discomfort was the most common complaint in the clinic (6/6). Conclusions: Preoperative diagnosis is difficult without the use of MR imaging. Painless hemarthrosis is not as common as that reported in the literature, and the ages of these cases are younger than those of patients with diffuse PVNS. The symptoms are more acute in cases of localized PVNS of joints. Marginal excision is the appropriate treatment for patients with localized PVNS.

Localized pigmented villonodular synovitis of the knee: diagnostic challenge and arthroscopic treatment: a report of three cases

The localized form of pigmented villonodular synovitis (LPVS) is a lesion characterized by focal involvement of the synovial membrane. The knee is the most commonly affected joint. We report three cases of LPVS of the knee which were not diagnosed upon clinical evaluation. The aim is to bring the attention of clinicians to this pathological entity, which is often regarded as extremely rare and is therefore not considered in the early differential diagnosis of various knee derangements. Diagnostic and therapeutic arthroscopy was performed. The lesions were completely resected and patohistological findings confirmed the diagnosis of LPVS. All of our three patients have remained asymptomatic at 8, 10, and 12-month follow-ups.

Localized pigmented villonodular synovitis as a rare cause of chronic anterolateral ankle pain in an equestrienne

Summary: An unusual case of localized pigmented villonodular synovitis of the ankle as a rare cause of chronic anterolateral ankle pain in a 16-year-old horsewoman is presented. Intra-articular nodular forms of pigmented villonodular synovitis can only be diagnosed arthroscopically, macroscopic and microscopic aspects being typical. We believe that this lesion is more likely a reactive process secondary to repetitive microtrauma rather than a true neoplasm. Our patient presented with pathology in the left ankle, the side by which one mounts and dismounts a horse, forcing, in both activities, ankle dorsiflexion. Moreover, an English saddle was used by our patient, upon which one rides with the ankle maintained in dorsiflexion. At arthroscopy, the soft-tissue mass was seen to be entrapped in the joint between the talus and the tibia at dorsiflexion of the ankle. This had caused a slowly progressive enlargement of the lesion because of fibrosis resulting from reactive inflammation associated with this repetitive microtrauma, thus causing irritation, pain, and synovitis due to impingement.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 7 (October), 2000: pp 15e–15e

Localized pigmented villonodular synovitis of the knee joint: neoplasm or reactive granuloma? A review of 18 cases.

The localized form of pigmented villonodular synovitis of the knee joint is a rare disease with limited alteration of the synovial membrane, the pathogenesis of which is the subject of controversial discussion. Eighteen cases have been documented in our hospital since 1976. All of the patients had additional cartilage or meniscus damage. Treatment consisted of excision of the lesion and the adjacent synovial membrane, as well as therapy of the additional damage. The patients who had received such therapy were followed for 3-9 yr, without any clinical, sonographic or magnetic resonance tomographic signs of recurrence. In addition to the lack of a tendency towards recurrence, none of the cases displayed any further characteristics of the diffuse form of villonodular synovitis, such as invasiveness or malignant transformation. We therefore suggest that pigmented villonodular synovitis of the knee joint should be classified more strictly than before into a potentially neoplastic (diffuse) form and a reactive granulomatous (local) form. From the cases observed, we conclude that degenerative joint lesions may be the cause of the reactive granulomatous form.

Localized pigmented villonodular synovitis of the knee: report of two cases of fat pad involvement

The localized form of pigmented villonodular synovitis (PVNS) is a rare pathological entity characterized by a limited involvement of the synovium. The knee is most commonly affected. In the knee joint, the disorder generally presents as a nodular, pedunculated lesion protruding into the articular cavity. The lesion is usually revealed by mechanical symptoms such as locking. We report on two cases of localized PVNS that involved the patellar fat pad, an extremely rare area of involvement. Mechanical symptoms were not present. In one case, the lesion reached considerable dimensions without interfering with joint function. Arthroscopic treatment was easily performed. No recurrence was observed at 1-year follow up. Arthroscopy 1998 Jul-Aug;14(5):527-31

Extraarticular Pigmented Villonodular Synovitis of the Shoulder A Case Report

A rotator cuff tear was diagnosed in a 57-year-old woman based on physical examination and magnetic resonance imaging studies. At operation, an abnormal bursal lesion also was found. The lesion was completely extraarticular and was identified histologically as pigmented villonodular synovitis. The patient was treated with complete bursectomy and repair of the rotator cuff tear and remains asymptomatic 21 months after operation. Pigmented villonodular synovitis is a condition characterized by cell proliferation and deposition of hemosiderin into the lining tissues of joints, tendons, and bursae. The extraarticular form of pigmented villonodular synovitis is extremely rare and usually represents an extension of a primary intraarticular process. Only a few cases have been reported in which the lesion was found exclusively outside the joint with no intraarticular segment. In reviewing the literature, no case of exclusively extraarticular pigmented villonodular synovitis of the shoulder was found. The sequelae of extraarticular pigmented villonodular synovitis are poorly understood, but this lesion can be locally invasive, and if left untreated, may destroy surrounding tissues. Therefore, early diagnosis and treatment are important for optimal results.