Localized Pigmented Villonodular Synovitis Research Articles

Intra and extraarticular localized pigmented villonodular synovitis

<p class="abstract">A 28 year old woman had a history of knee trauma and presented with unilateral knee acute swelling and pain symptoms with sudden onset, which was there from last 2 years. She had been treated for seronegative rheumatoid patient for 1 year. Recent expansion of the LPVNS (localized pigmented villonodular synovitis) caused the development of a tender palpable soft tissue mass in the anterolateral aspect of the knee and acute reduced mobility. Preoperative magnetic resonance imaging of the knee revealed the presence of only the soft tissue mass and mild degenerative changes. Open synovectomy was performed successfully to excise the mass. Intraoperatively, macroscopic features of the bright brown inflamed synovium suggested LPVNS, which was confirmed histopathologically. Postoperatively, the symptoms of limited mobility and pain were appreciably relieved. Recurrence was not observed during the clinical follow up at 1, 6 or 18 months after surgery. Here, we reported the unique case of localized pigmented villonodular synovitis of the knee in a misdiagnosed patient with intra and extraarticular lesion, which might be attributed to the history of knee trauma and the focal defect of the lateral patellar retinaculum. Open synovectomy effectively relieved the symptoms of limited mobility and pain and no recurrence was observed prior to 18 months postoperatively. To reduce misdiagnosis, MRI examinations are recommended for all patients suspected of having PVNS, including those who have a history of hyperuricemia.</p>

Open synovectomy treatment for intra- and extraarticular localized pigmented villonodular synovitis of the knee: a case report

BackgroundPigmented villonodular synovitis (PVNS) is a rare, benign, proliferative neoplastic process that commonly affects synovial-lined anatomic spaces. The diffuse type (DPVNS) is characterized by invasion of the entire joint synovium, while the localized type (LPVNS) is characterized by a relatively normal synovial appearance. This report describes a unique case of massive intraarticular LPVNS with an extraarticular extension through the lateral patellar retinaculum. No similar cases have been found in the literature.Case presentationA 58-year-old woman had a history of hyperuricemia and knee trauma and presented with unilateral knee acute swelling and pain symptoms with sudden onset. Recent expansion of the LPVNS caused the development of a tender palpable soft tissue mass in the anterolateral aspect of the knee and acute reduced mobility. Preoperative magnetic resonance imaging of the knee revealed the presence of only the soft tissue mass and mild degenerative changes. Open synovectomy was performed successfully to excise the mass. Intraoperatively, macroscopic features of the bright brown inflamed synovium suggested LPVNS, which was confirmed histopathologically. Postoperatively, the symptoms of limited mobility and pain were appreciably relieved. Recurrence was not observed during the clinical follow-up at 1, 6 or 18 months after surgery.ConclusionsHere, we report the unique case of localized pigmented villonodular synovitis of the knee in a misdiagnosed patient with intra- and extraarticular lesion, which might be attributed to the history of knee trauma and the focal defect of the lateral patellar retinaculum. Open synovectomy effectively relieved the symptoms of limited mobility and pain and no recurrence was observed prior to 18 months postoperatively. To reduce misdiagnosis, MRI examinations are recommended for all patients suspected of having PVNS, including those who have a history of hyperuricemia.

Arthroscopic Technique for the Treatment of Localized Pigmented Villonodular Synovitis of the Knee.

Pigmented villonodular synovitis (PVNS) is caused by a proliferation of the synovial membrane and can be a rare cause of pain and locking of the knee. In its localized form, it can be removed arthroscopically. We describe in detail a step-by-step arthroscopic technique applied to treat a 27-year-old patient who had been suffering from pain and episodes of locking for a year and whose left knee MRI revealed an intra-articular mass. The formation was completely enucleated arthroscopically and histological analyses confirmed the diagnosis of localized PVNS. There were no complications, and the patient was symptom-free at the six-month follow-up with no clinical or radiological evidence of recurrence.

Endoscopic Resection of Localized Pigmented Villonodular Synovitis in the Hoffa Fat Pad

Pathologies within the fat pad can have either intrinsic or extrinsic causes. Most of them are the consequences of trauma and degeneration, but inflammatory and neoplastic diseases can arise in the fat pad. Pigmented villonodular synovitis is the most common space-occupying lesion of the Hoffa fat pad, followed by ganglion. The purpose of this Technical Note is to describe the details of endoscopic resection of localized pigmented villonodular synovitis in the Hoffa fat pad. Hopefully, this can allow complete resection of the lesion with minimal surgical trauma and scar tissue formation.

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>

Two cases of localized pigmented villonodular synovitis arising from Intercondylar part of knee joint

Two cases of localized pigmented villonodular synovitis arising from Intercondylar part of knee joint

BILATERAL LOCALIZED PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE: CASE REPORT AND REVIEW.

ABSTRACTObjectives Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary.Methods The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor.Results Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28 -year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1- and T2-weighted images. These were associated with hemosiderin pigmentation.Conclusion The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site. Level of Evidence IV; Case series.

A rare case of localised pigmented villonodular synovitis in the knee of a 24-year-old female soccer player: diagnosis, management and summary of tenosynovial giant cell tumours

Localised pigmented villonodular synovitis (PVNS) of the knee is a rare diagnosis, with clinical signs and symptoms mimicking meniscal damage or other common knee injuries.We report the case of a...

Localized pigmented villonodular synovitis of posterior compartment of the knee.

Pigmented villonodular synovitis (PVNS) is an uncommon entity involving articular or extra-articular tissues and maybe localized or diffuse in extent. The knee is by far the commonest joint to get involved. Localized PVNS of the knee can occur in any location but its confinement to the posterior compartment is infrequent. We present our experience of managing localized posterior compartment PVNS of the knee. There were 10 patients (7 males and 3 females) with average age of 33 years. These patients had symptoms of pain, locking, or swelling for a mean of 13.9 years before diagnosis. All the patients underwent arthroscopic synovectomy without adjuvant therapy, and PVNS was proven on histopathology. At an average follow-up of 23 months, no patient had recurrence of symptoms. The average International Knee Documentation Committee (IKDC) score at last follow-up was 85.21. Magnetic resonance imaging evaluation at final follow-up did not reveal any residual disease or recurrence in any patient.

Results and recurrence of pigmented villonodular synovitis of the ankle: does diffuse PVNS with extra-articular extension tend to recur more often?

The aim of this study was to provide the outcomes and to analyze the recurrence of Pigmented Villonodular Synovitis (PVNS) of the ankle joint treated by surgical synovectomy. Thirty-one PVNS cases of the ankle, including 5 localized PVNS cases and 26 diffuse PVNS cases, were treated in our institute between 2004 and 2015. The median age was 35 (range 18-63) years. The 5 localized PVNS cases were treated with partial synovectomy (group I); 10 diffuse PVNS cases limited to intra-articular synovium received arthroscopic comprehensive synovectomy (group II); and 16 cases with diffuse PVNS spreading to extra-articular tendon sheaths underwent combined arthroscopic and open synovectomy (group III). Adjuvant radiotherapy was provided in groups II and III. The American Orthopaedic Foot and Ankle Society (AOFAS) score and subjective grading of procedure were used to evaluate the results. Twenty-seven patients were followed with a median of 54 (range 15-108) months. In the three groups, the average AOFAS score improved from 75 (in all three groups) points preoperatively to 100 (group I), 97 (group II), and 90 points (group III) postoperatively. The rate of good-to-excellent result was 100% in group I and II and 73.3% in group III. Only in group III, recurrence occurred in five cases. Diffuse PVNS of the ankle can be successfully managed with surgical synovectomy and adjuvant radiotherapy. Radiotherapy is not needed for localized PVNS. The recurrence rate in PVNS patients with extra-articular extension is higher. IV.

Tenosynovial Giant Cell Tumor of the thigh

Tenosynovial giant cell tumors (TGCT) are a group of generally benign intra-articular and soft tissue tumors with common histological features. TGCT is also known as pigmented villonodular synovitis. There are localized and diffuse forms. Localized types include giant cell tumors of tendon sheath and localized pigmented villonodular synovitis, whereas diffuse types encompass conventional pigmented villonodular synovitis and diffuse type giant cell tumor. Localized tumors are generally indolent, whereas diffuse tumors are locally aggressive.
 In this article, we report the case of a diffuse-type extra-articular TGCT found in the left thigh of a 73-year-old woman who presented with a painless but gradually progressive swelling in the left thigh since eighteen months. On examination, there was a soft cystic swelling measuring 22 cm. The swelling was fixed to the underlying soft tissues. She had a Computed Tomography scan of the left thigh showing a mass of fluid density, well encapsulated between the muscles of the thigh, measuring 20x10 cm of major axes, compressing the femoral vessels without invading them. The patient had a complete marginal resection of the tumor. The immune-histopathological findings were consistent with those of a diffuse type of Giant Cell Tenosynovial Tumor. At 18 months follow-up, the patient is asymptomatic with no evidence of disease recurrence.
 The extra-articular diffuse type TGCT is more aggressive than the localized type. Although these tumors are benign in the majority of cases, malignant transformation has been reported. Therefore, close follow-up is recommended after tumor excision.

Arthroscopic treatment of intra-artricularly localised pigmented villonodular synovitis of the ankle: 4 cases with long-term follow-up.

Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive benign proliferative pathology of synovial tissue. Lesions are classified regarding location as diffuse or localised which are same as histologically. Intra-articularly localised type is relatively rare, especially in the ankle joint. Because of the high recurrence rate and aggressive nature, localised lesions should be excised totally. We performed a retrospective study of 4 patients with intra-articularly localised PVNS in the ankle joint who were treated by total arthroscopic excision and evaluated for functional results and recurrence rate. Case series. The mean age of the patients was 27 (17-46) years at the time of arthroscopic surgery. The mean follow-up time was 33 (24-48) months. Functional evaluation according to the Musculoskeletal Tumour Society Score was performed, and patients were evaluated for recurrence by MR imaging. In all patients, functional results were excellent and there was no recurrence. This study demonstrates that the intra-articularly localised PVNS can be successfully treated with arthroscopic procedures without recurrence.

Tenosynovial giant cell tumor of subtalar joint: A case report with review of literature

Tenosynovial giant cell tumor (TSGCT) are benign neoplasm affecting synovial lining of joints, tendon, and bursae. These tumor have been broadly divided into localized and diffuse type. Localized include TSGCT of tendon sheath and localized pigmented villonodular synovitis (PVNS) located mainly in hand whereas diffuse encompass conventional PVNS and diffuse-type GCT involving one or more joints. In this article, here, we present a case of TSGCT in subtalar joint which has been never reported till date along with review of literature, dilemma in diagnosis, differential diagnosis, and management of this tumor.

One case report of locking knee of localized pigmented villonodular synovitis of the knee

One case report of locking knee of localized pigmented villonodular synovitis of the knee

Pigmented Villonodular Synovitis: A Comprehensive Review and Proposed Treatment Algorithm.

Evidence now exists suggesting a neoplastic origin for pigmented villonodular synovitis, including a thorough description of the translocations involved. Arthroscopic excision for localized pigmented villonodular synovitis allows for both minimal recurrence and morbidity when compared with open excision; however, open excision still plays an important role in treating posterior compartment nodules. The optimal surgical treatment for diffuse pigmented villonodular synovitis is still a matter for debate, with combined anterior arthroscopic and open posterior excision being considered the preferred method. Radiation therapy has re-emerged as an additional treatment method for pigmented villonodular synovitis; however, the potential for serious toxicity makes it a questionable option, especially for such a benign condition. Small molecule and monoclonal antibody targeted therapies are being investigated as novel treatment methods for pigmented villonodular synovitis, with promising results.

Tenosynovial Giant Cell Tumor of the Pes Anserine Bursa with Bone Marrow Extension into the Tibia: A Case Report

Tenosynovial giant cell tumor (TSGCT) is classified as a benign fibrohistiocytic tumor according to the World Health Organization (WHO) system of classification of bone and soft-tissue tumors. The proposed causes and pathogenesis include inflammation, trauma, toxin, allergy, and clonal chromosomal abnormalities (1). Jaffe et al. (2) described this condition as pigmented villonodular proliferative lesions arising from the synovium, bursa, or joint. Based on the growth characteristics of TSGCT, it can be divided into two forms: localized type and diffuse type. Localized-type TSGCT encompasses giant cell tumors of the tendon sheath and localized pigmented villonodular synovitis (PVNS), whereas diffuse types include conventional PVNS and diffuse giant cell tumors (3). TSGCT rarely involves the bursa, and only a few exceptional cases of TSGCT arising from the pes anserine bursa have been reported (4). In TSGCT, bone erosion is not an uncommon associated finding, especially in tumors of the tendon sheath of the finger or toe or in the joint space. However, only one previous case of associated bone erosion in TSGCT of the pes anserine bursa has been reported (5). Herein, we report an exceptional case of TSGCT of the pes anserine bursa with bone marrow extension on magnetic resonance imaging (MRI). This case report was approved by the Institutional Review Board of our hospital, and the requirement for obtaining informed consent was waived.

Giant cell tumor of tendon sheath of finger - A case report

Giant cell tumor of tendon sheath is clinically a slow growing soft tissue mass. It can be divided into localized and diffuse types. Localized types include giant cell tumors of tendon sheath and localized pigmented villonodular synovitis. Diffuse types encompass conventional pigmented villonodular synovitis and diffuse-type giant cell tumor.

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.

Intra-Articular Synovial Sarcomas: Incidence and Differentiating Features from Localized Pigmented Villonodular Synovitis

Purpose. To determine the incidence of intra-articular synovial sarcomas and investigate if any radiological variables can differentiate them from localized (unifocal) pigmented villonodular synovitis (PVNS) and if multivariate data analysis could be used as a complementary clinical tool. Methods. Magnetic resonance images and radiographs of 7 cases of intra-articular synovial sarcomas and 14 cases of localized PVNS were blindedly reviewed. Variables analyzed were size, extra-articular growth, tumor border, blooming, calcification, contrast media enhancement, effusion, bowl of grapes sign, triple signal intensity sign, synovial low signal intensity, synovitis, age, and gender. Univariate and multivariate data analysis, the method of partial least squares-discriminant analysis (PLS-DA), were used. Register data on all synovial sarcomas were extracted for comparison. Results. The incidence of intra-articular synovial sarcomas was 3%. PLS-DA showed that age, effusion, size, and gender were the most important factors for discrimination between sarcomas and localized PVNS. No sarcomas were misclassified as PVNS with PLS-DA, while some PVNS were misclassified as sarcomas. Conclusions. The most important variables in differentiating intra-articular sarcomas from localized PVNS were age, effusion, size, and gender. Multivariate data analysis can be helpful as additive information to avoid a biopsy, if the tumor is classified as most likely being PVNS.

Localized Pigmented Villonodular Synovitis of the Proximal Tibiofibular Joint

Pigmented villonodular synovitis (PVNS) is a rare disease. It is a benign neoplastic process typically affecting young to middle-aged adults and most commonly involving the knee, hip, and shoulder joints. The symptoms include diffuse pain and swelling with discomfort. We report a rare case of localized PVNS originating at the proximal tibiofibular joint in a 39-year-old female patient with radiologic changes for short duration of time. The clinical history, plain radiographs, magnetic resonance imaging, and pathologic findings of the reported patient were reviewed. Complete surgical excision was performed and there was no evidence of recurrence after one-year follow-up.