Lipoma Arborescens Research Articles

E028 A differential diagnosis for treatment resistant psoriatic arthritis

Abstract Background/Aims This case involves a 45 year old gentleman with established psoriatic arthritis with axial and peripheral joint involvement. His disease was managed with subcutaneous methotrexate and etanercept. Despite improvement in axial symptoms and resolution of symptoms at other peripheral joints, he had ongoing severe monoarthritis of his right knee with significant pain and swelling. Methods In spite of several joint aspirations and intra-articular steroid injections [ten in total], escalation of dose of methotrexate, addition of sulfasalazine and switch of biologic to adalimumab, the patient’s right knee symptoms persisted. Further imaging was performed. An US scan showed chronic synovial hypertrophy with fatty metaplasia and an MRI scan showed frond like synovial thickening, suggestive of lipoma arborescens. Results The patient was referred to the orthopaedic surgeons and underwent excision synovectomy. The histopathology reported fibrofatty tissue with areas of chronic synovitis with presence of lymphoplasmacytic aggregates. The patient’s knee symptoms persisted for five years in total after clinical improvement at other joints; post-synovectomy, his right knee symptoms were improved. Lipoma arborescens is a benign progressive intra-articular lesion characterised by villous lipomatous proliferation of the synovium; it frequently affects the knee joint suprapatellar pouch. Villous proliferation of the synovium occurs, with subsequent replacement of synovial connective tissue by adipocytes. Conclusion Lipoma arborescens has been described occasionally in association with psoriatic arthritis. It is felt to occur as a reactive response to chronic synovial irritation; in this case from an inflammatory affront. Given the rarity of lipoma arborescens, coupled with the patient’s known underlying diagnosis of a seronegative arthritis, there was significant delay in his diagnosis. This case highlights the need to consider other causes of persistent joint pain and swelling when maximal therapeutic options have been unsuccessful. Disclosure A. Jacobs: None. M. Callan: None.

Blau syndrome presenting as lipoma arborescens

Blau syndrome presenting as lipoma arborescens

Uncommon synovial pathologies

The synovium is a specialized tissue lining the synovial joints, bursae, and tendon sheaths of the body. It is affected by various localized and systemic disorders. Synovial diseases can be broadly classified as inflammatory, infectious, degenerative, proliferative, hemorrhagic, and neoplastic. Injuries to other structures within the joint, such as cartilage, may also be caused by pathological processes that affect the synovium. Early detection of synovial diseases is critical to avoid irreversible joint damage. Understanding the typical imaging features of synovial diseases can help in accurate diagnosis and prompt treatment. Therefore, imaging plays a crucial role in detecting synovial diseases at an early stage. This pictorial review highlights the unusual synovial pathologies, such as synovial chondromatosis, pigmented villonodular synovitis (PVNS), giant cell tumor of tendon sheath (GCTT), hemophilic arthropathy, lipoma arborescens, and synovial sarcoma.

Primary Lipoma Arborescence of Bilateral Knees in an Adolescent Patient: A Case Report

Primary Lipoma Arborescence of Bilateral Knees in an Adolescent Patient: A Case Report

Lipoma Arborescens Might Be an Unusual Cause of Knee Pain in Adolescents: A Case Report

Lipoma arborescens (LA) is a rare benign soft tissue tumor characterised by a hyperproliferation of villi and fat cells in the joint synovium. It is most frequently localized in the knee as reported here. This is a case report of a 16-year-old adolescent, affected by type I diabetes mellitus, who reported left knee pain and functional limitation to medical attention. She performed a physical examination, MRI and biopsy using an arthroscopic approach, leading to the LA diagnosis and classification. The LA has been thus treated with an arthroscopic synovectomy, which is the treatment of choice for LA, characterized by a low recurrence rate.

Lipoma Arborescens: A Rare Cause of Synovial Mass of the Knee at Pediatric Age with 10 Year Follow-up

Lipoma Arborescens: A Rare Cause of Synovial Mass of the Knee at Pediatric Age with 10 Year Follow-up

Ipoma arborescens an uncommon diagnosis for swelling knee

Lipoma Arborescens is an extremely rare and benign condition affecting joints synovial tissue. It should be suspected in patients with very slow mono-articular swelling.

Magnetic Resonance Imaging of Synovial Diseases of Knee

A specialized tissue called synovium lines the body’s tendons, bursae, and synovial joints. It is affected by various localized or systemic disorders. These are classified into inflammatory, infectious, degenerative, traumatic, hemorrhagic, and neoplastic. Synovial damage leads to irreversible joint destruction. Imaging plays an important role in the early detection of the disease entity and enables for proper treatment. This article focuses on magnetic resonance imaging of synovial diseases pertaining to knee – (1) infective synovitis; (2) rheumatoid synovitis; (3) pigmented villonodular synovitis; (4) lipoma arborescens; (5) synovial hemangioma; and (6) synovial sarcoma.

Metachronous Lipoma Arborescens with Involvement of Knee Joint and Tendons Around Ankle

A 15-year-old male presented with pain and swelling in the right knee joint. Magnetic resonance imaging (MRI) findings were typical of lipoma arborescens (LA). He underwent open synovectomy of the knee and a biopsy confirmed LA. 5 years later, he presented with increasing pain and swelling around the ankle joint. MRI was suggestive of LA involving tibialis posterior and flexor digitorum longus. He underwent open synovectomy with resolution of symptoms. In LA, total synovectomy helps resolve the lesion. Patients should be counseled regarding the possibility of the development of LA metachronously. To the best of our knowledge, there are no reported cases in the literature where metachronous LA presented as extraarticular in one and intraarticular in another joint.

Lipoma arborescence of knee joint in an adolescent male patient: a case report

<p>A very uncommon benign synovial membrane tumor is called lipoma arborescens. It often affects a single articulation, the knee. Despite a conventional imaging assessment, the lesion’s histological analysis is still required for the ultimate diagnosis. A 15-year-old boy attended the outpatient clinic of the Lahore General Hospital Lahore, Pakistan with pain and swelling in his left knee that had been steadily worsening over the previous 4 years. There were no concomitant prodromal symptoms, and the swelling was soft and non-tender while also inhibiting knee flexion. Soft tissue shadows were observed on radiographs. A large amount of subarticular erosion in the nearby tibial and femoral condyle was caused by the frond-like proliferation of fatty synovium, according to magnetic resonance imaging. Only the left knee joint showed focused areas of unusually elevated radionuclide uptake during the Technetium (Tc99m) bone scan. After an open synovectomy, the specimen underwent histological analysis, which revealed villiform fatty tissue, a hallmark of Lipoma arborescens coated by somewhat thicker synovium. Although infrequent, open synovectomy is currently the preferred course of treatment for lipoma arborescens, which should be taken into account when making a differential diagnosis of knee diseases. Approximately 3 months after surgery, the patient underwent his most recent follow-up and was asymptomatic with a small amount of joint effusion.</p>

Rare case of intra articular lipoma arborescens of hip join

Lipoma arborescens is a chronic, slow-growing, intra-articular lesion of benign nature, characterized by villous proliferation of the synovium, with replacement of the sub synovial connective tissue by mature fat cells. We present the case report of a 44-year-old male patient with complaints of right hip pain for 4 years. Patient presented with pain, limp and restriction of range of motion at right hip. Plain radiographs followed by MRI scans revealed intra articular lobulated hyper intense lesion with osteoarthritic changes at the right hip joint. Total hip arthroplasty with simultaneous excision of the lesion was planned and carried out for the patient. The aim of the case report presentation is the inclusion of this rare condition lipoma arborescens as a differential diagnosis in such patients and citing the importance of early diagnosis and prompt treatment for the above disease pathology.

Review of a Rare Cause for Swelling of the Knee: Lipoma Arborescens

Review of a Rare Cause for Swelling of the Knee: Lipoma Arborescens

"Secondary Lipoma Arborescens of the Knee Associate with Giant Popliteal Synovial Cyst. A Case Presentation"

Lipoma arborescens is a rare, mainly intra-articular lesion characterized by diffuse replacement of subsynovial tissue by mature fat cells. It can be primary or secondary. The secondary type of lipoma arborescens is the more common. It is associated with an underlying chronic joint inflammation and irritation and is usually affecting the elderly patients. In this paper, we report an unusual case of Lipoma arborescens secondary to gouty arthritis affecting the left knee of a young male associated with a giant popliteal cyst and degenerative changes. An open synovectomy and excision of the popliteal cyst was performed.

Concomitant lipoma arborescens and synovial osteochondromatosis of the knee.

Intra-articular masses are not a rare finding in routine imaging. This is particularly true in patients with underlying joint diseases such as degenerative arthritis. Nevertheless, concomitant presentation is rather uncommon in imaging studies. The authors report an unusual concomitant lipoma arborescens and synovial osteochondromatosis (which has not previously been reported in the literature to the best of the authors' knowledge) in a man in his 60s with a long-standing history of knee osteoarthritis. In this case presentation, we review the differential diagnosis for noninfectious synovial proliferative disorders presenting as intra-articular masses, their potential association with underlying joint pathology, and discuss the key imaging features and appropriate treatment.

Lipoma arborescence following knee arthroscopy: A case report and literature review

Lipoma arborescence is a rare, reactive disease process which commonly occurs due to chronic inflammation or repeated trauma. A limited number of cases have been documented in the literature and little is known regarding the pathogenesis of this condition. Fortunately, it is a benign condition with no known cases of neoplastic conversion. Here, we present the unique case of a lipoma arborescence occurring in a patient who was one year status post arthroscopic medial meniscectomy.

Imaging features of reactive bursitis secondary to osteochondroma.

The purpose of this study was to determine imaging features of reactive bursitis secondary to osteochondroma. Fourteen patients with reactive bursitis secondary to osteochondroma were retrospectively reviewed. The 14 patients were 11 males and 3 females ranging in age from 18 to 67years (mean, 33.6years). The locations were as follows: scapula (n = 2), lesser trochanter (n = 6), greater trochanter (n = 1), distal femur (n = 2), distal fibula (n = 1), iliac bone (n = 2). On CT, six bursae were hypodense and 1 was isodense compared to muscle. All bursae had a thickened wall, 6 contained multiple villous projections and septa. Five bursae contained a few calcifications. On enhanced CT, the bursa displayed mild enhancement of the wall, villous projections, and septa. On MRI, one bursa was hypointense, three were hyperintense, and 5 were isointense relative to muscles on T1-weighted images. All bursae were hyperintense relative to muscles on T2-weighted images. All bursae had a thickened wall, eight contained multiple villous projections and septa. In five bursae, a few fatty villous projections can be seen within the bursa. On enhanced MRI, all bursae displayed avid enhancement of the bursal wall, villous projections, and septa. Reactive bursitis secondary to osteochondroma most often occurred in young male adults. The most common involved site is lesser trochanter. The imaging features is that of an irregular, thick-walled fluid-filled bursa overlying an osteochondroma that containing multiple villous projections and septa. Calcification and/or lipoma arborescens may be developed within the bursa. On contrast-enhanced images, the bursa shows enhancement of the bursal wall, villous projections and septa.

Evaluation and Management of Intra-Articular Tumors of the Knee.

Intra-articular tumors of the knee are most commonly benign. Overall, this is a relatively rare clinical presentation. The differential diagnosis includes pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, synovial hemangioma, and very rarely primary sarcoma (synovial sarcoma being the most common). The clinical presentation for these conditions is usually non-specific, but radiographic and advanced imaging findings are able to differentiate some of these tumors. It is essential to obtain and send tissue specimens to pathology for histologic analysis to rule out a primary malignancy as a missed diagnosis can have grave implications on patient outcomes. This review summarized key aspects of diagnosis and treatment for these conditions.

Lipoma Arborescens: A Case of Massive Knee Swelling

Lipoma arborescens is not so common condition of unknown etiology. The usual presentation is that of a long standing mono articular soft tissue swelling involving the knee joint. This diagnosis is not often made clinically but usually made with the help of Magnetic Resonance imaging and Biopsy. We are reporting a case of chronic massive knee joint swelling so as to raise awareness about the condition and its imaging features, so that misdiagnosis can be avoided and early appropriate treatment can be given. Keywords: Lipoma arborescens, Synovium, Magnetic Resonance Imaging

HISTOMORPHOLOGICAL PATTERNS OF SYNOVIAL LESIONS: A STUDY AT TERTIARY CARE HOSPITAL.

Introduction: Synovium is the soft tissue that lines the spaces of diarthrodial joints, tendon sheaths, and bursae derived from the ectoderm consisting of two components, predominantly a cellular layer, and a second layer made up of fibrous and adipose tissues. Chondrocytes being elements of hyaline cartilage secrete degenerative enzymes in inactive forms and enrich the matrix with enzyme inhibitors. Synovial lesions are characterized by the destruction of hyaline cartilage, due to the activation of degenerative enzymes and decreasing the production of their inhibitors. Materials and methods: It’s a retrospective study of 104 synovial biopsies received in 5 years at a tertiary care hospital. Synovial biopsies were obtained mainly by the open method and a few by the arthroscopic method. Lesions were classified into infective, degenerative, inflammatory, benign, tumor, and tumor-like lesions. Results: Out of 104 lesions, ganglion cyst was commonest 45 cases [43.26%] followed by chronic non-specific synovitis was 15 cases [14.42%], baker’s cyst was 11 cases [10.57%], giant tumor cells of tendon sheath was 09[8.65%], few cases such as tubercular synovitis, rheumatoid arthritis, lipoma arborescens was 2 cases each [1.92%], one case each of septic arthritis, synovial cavernous hemangioma, villonodular synovitis were also noted. The most common age group affected was 31-40 years of age [20.19 %]. Males was predominantly affected in our study [50.96%] Conclusion: Many synovial lesions show similar clinical presentation so histopathological classification is useful to identify its subtypes and the study of synovial biopsy is useful in the diagnosis of various joint diseases.

Lipoma Arborescens of Hip Joint in a Case of Ankylosing Spondylitis

Lipoma arborescens is a rare synovial pathology that is most commonly seen in the knee joint. Only a few cases of this condition have been reported in the hip joint. In present case, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) findings in a case of Lipoma arborescens of the hip joint in association with ankylosing spondylitis is reported.