Localized Pigmented Villonodular Synovitis Research Articles

膝関節の屈曲制限を呈した限局性色素性じゅう毛結節性滑膜炎の一例

We treated of localized pigmented villonodular synovitis limiting a flexion of the right knee. The case was a 33-year-old male who complained of a limited flexion because of knee pain. Our clinical examinations, there was a mass in the anterolateral femorotibial joint space, restriction of knee motion (0-90°), clear yellow joint fluid. We suspected of a meniscal injury, but MR images demonstrated an intra-articular mass on the lateral side below the patella, suggesting an intra-articular tumor. We opened the joint to recognize the yellow-brown tumor originating in the synovium on the lateral side below the patella, and resected it with surrounding synovia. The pathologic diagnosis of the mass was pigmented villonodular synovitis. At present, 4 months postoperatively, the patient is free of pain, although the motion range of the knee of 0° to 135°.

Localized pigmented villonodular synovitis: Arthroscopic diagnosis and management of an “Invisible” lesion

Pigmented villonodular synovitis (PVNS) is a rare disorder that may involve the synovium of joints, bursa, or tendon sheaths. Monoarticular involvement is typical, with the knee most commonly affected. Localized pigmented villonodular synovitis (LPVNS) involves a discrete region of the synovium. Detection and diagnosis of this entity is clinically challenging, and plain radiographs are usually unremarkable. Magnetic resonance imaging (MRI) has been reported to be sensitive for the detection of synovial abnormalities and is the imaging modality of choice in suspected cases of LPVNS. When the diagnosis remains in doubt, arthroscopy may be used for direct visualization of synovial pathology, as well as to obtain tissue for histologic analysis. Definitive treatment may also be performed at the time of arthroscopy. We present a case of LPVNS in which a large (4 cm) lesion was not apparent on preoperative radiographs or MRI and was also missed on initial diagnostic arthroscopy.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 6 (July-August), 2002: pp E31–E31

Localized Pigmented Villonodular Synovitis of Knee Encircling the lnfrapatellar Tendon: Report of a Case and Paper Review

A 30 year-old female presented with a mass lesion over her right infrapatellar region. The lesion was a painful, soft, movable, well-defined lesion which measured about 3 cm × 3 cm × 3 cm. Magnetic resonance imagings (MRI) of the right knee joint revealed a localized pigmented villonodular synovitis, encircling the infrapatella tendon. Excision of the mass lesion was performed arthroscopically. Histological examination confirmed the diagnosis. Radiotherapy was arranged postoperatively. She was followed for about one and half years without recurrence. Localized pigmented villonodular synovitis is very rare. It is curable with arthroscopy and has a low recurrence rate. ( Mid Taiwan J Med 2002;7:65-9)

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.

Arthroscopic treatment of tumor-like lesions of the knee joint: Localized pigmented villonodular synovitis and ganglion cyst of the anterior cruciate ligament

We present the arthroscopic treatment of a case of localized pigmented villonodular synovitis that led to increasing restriction of knee flexion and the case of a ganglion cyst within the anterior cruciate ligament causing unspecific pain. Both pathologies could be resected arthroscopically with complete relief of symptoms and no recurrence. In cases with unspecific clinical signs and intra-articular masses shown on magnetic resonance imaging, arthroscopy is the next therapeutic step. Localized tumor-like lesions can often be excised without recurrence in the same session.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March), 2001: pp 320–323

Proliferating cell nuclear antigen labelling index in localised pigmented villo-nodular synovitis and its relationship to the size of nodules.

Proliferating cell nuclear antigen (PCNA) is one of the cell cycle-related proteins directly involved in DNA synthesis. It is a marker of cellular proliferation and has been shown to correlate with ploidy and proliferative activity of cells. Its expression has been used to estimate the growth fraction of human cancer and its prognostic value. Pigmented villo-nodular synovitis (PVNS) is characterised by a nodular lesion in the paratendinous synovial tissue or, less frequently, in a joint. Whether PVNS is a neoplastic or inflammatory lesion remains controversial. We have studied immunohistochemical PCNA expression with pc10 monoclonal antibody in 16 paraffin sections, in 16 cases of localised PVNS, or giant cell tumour of tendon sheath. We have found significant correlation between the size of the lesions and PCNA-LI (labelling index).

Arthroscopic treatment for localized pigmented villonodular synovitis of the knee.

This study investigated 11 patients with localized pigmented villonodular synovitis of the knee that was diagnosed and treated by arthroscopic technique. There were six male and five female patients between the ages of 15 and 59 years (mean, 34.6 years). Seven patients reported extension limitation without joint line tenderness. Four of the 11 patients had a history of trauma before the onset of knee symptoms. All patients were treated by arthroscopic resection with partial synovectomy. The most common involved site was the anteromedial synovium near the anterior horn of the medial meniscus (five patients). The remaining cases were located in the anterior fat pad (two patients), suprapatellar pouch, posteromedial compartment, medial gutter, and the anterior horn of the lateral meniscus. Nine patients had one mass, and the remaining patients each had two or three masses. There was no evidence of recurrence at followup for an average of 29.9 months (range, 24-48 months). Arthroscopy is effective in the diagnosis of localized pigmented villonodular synovitis with minimal morbidity, and complete arthroscopic excision can be considered the definitive treatment for localized pigmented villonodular synovitis.

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

Magnetic resonance imaging evaluation and arthroscopic resection of localized pigmented villonodular synovitis of the knee.

Diagnosis of localized pigmented villonodular synovitis is clinically difficult, and plain radiographs are usually normal. This article presents five patients with localized pigmented villonodular synovitis of the knee. Symptoms suggested a meniscal lesion in three patients and a loose body in two. Magnetic resonance imaging performed prior to arthroscopic resection revealed a preoperative diagnosis of a tumor in all five patients. Magnetic resonance imaging is a valuable clinical tool for the assessment of intra-articular soft-tissue tumors of the knee that may otherwise be misdiagnosed.

Localized pigmented villonodular synovitis of the knee: report of four cases

Localized pigmented villonodular synovitis (PVNS) is a rare idiopathic disease, usually associated with symptoms mimicking those of other intraarticular pathologies. The disease usually affects a single joint, the knee joint being the most common joint. Total resection is the preferred treatment. Recurrence is very rare. In this study we present four cases of localized PVNS (1 male, 3 females, at the ages of 36, 19, 59, and 26 years) who were treated with arthroscopic intervention. Clinical results were favorable during follow-up and no early recurrences were encountered.

Diffuse and localized pigmented villonodular synovitis: evaluation of treatment of 38 patients.

We performed a retrospective study of 38 patients with pigmented villonodular synovitis (PVNS) to evaluate the treatment and functional results. The mean age of the patients was 32 (range 12-72) years at the time of treatment. Three types of PVNS have been identified: localized nodules in 9 patients, diffuse PVNS of the entire synovial membrane in 26, a combination of a diffuse involvement of the synovial membrane and an extra-articular presentation in 1, and extra-articular lesions in 2. The location of the lesions was knee (n = 31), hip (n = 3), ankle (n = 2), femoral triangle (n = 1), and gluteal region (n = 1). The procedures performed were surgery alone, surgery combined with radiosynovectomy and radiosynovectomy only. A follow-up was done after a mean of 4 (range 1-19) years in 34 patients. A functional evaluation according to the Musculoskeletal Tumor Society was performed in 31 patients. The mean functional evaluation score of 34 patients was 24 (range 15-30). Most of the ratings were excellent or good, in 6 cases fair, and in 2 cases poor. This study demonstrates that the functional results are good despite residual or recurrent disease; in addition, we showed that functional evaluation after treatment gives an optimal view of the impact and results of the operation.

Pigmented Villonodular Synovitis of the Hand in the Asian Population.

Fifty-five localised pigmented villonodular synovitis (giant cell tumour of the tendon sheath) in the hands and wrists in 53 patients, treated in a local hospital over a 5-year period, were reviewed. The mean age at presentation was 39.9 years, with 84.9% of the cases being Chinese. There was a predilection for the ring finger and females. There was no significant association with antecedent trauma. 56.4% of patients had associated X-rays changes. All patients had complete excision of the tumour and 4 recurrences noted, giving a rate of 7.3%. Follow-up period range from 1 to 5 years. Postoperative morbidity consisted of two cases with mild stiffness. There was good local control with minimal morbidity and low recurrence rate.

膝関節内けん鞘巨細胞腫の１例

A case of tenosynovial giant cell tumor (TGCT) in the left intercondylar notch was reported. This tumor has been rarely reported until now. A-41-year-old man with left gonalgia showed limited range of motion and hemarthrosis. Although there are slight differences histologically between TGCT and localized pigmented villonodular synovitis (PVS), multinucleated giant cells and no foamy cells were present in this case, which is characteristic of TGCT. Careful follow-up is needed because of possible local recurence or invasion.

Case Report Localized pigmented villonodular synovitis of the knee: arthroscopic treatment

Pigmented villonodular synovitis (PVNS) is a relatively rare condition. It occurs in two forms: a diffuse form involves the entire synovium and occurs in the majority of cases, and a localized form involves a discrete section of the synovium. The disorder almost always involves a single joint and the knee is most commonly affected. We report on three cases of localized PVNS that involved the patellar fat pad and synovium. Diagnostic and therapeutic arthroscopies were performed, and typical localized PVNS was found. Complete resection of the lesions was performed arthroscopically. Arthroscopy can be used as an effective diagnostic and therapeutic tool for identification and treatment of intra-articular localized PVNS of the knee.Arthroscopy 1998 Oct;14(7):764-8

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

Localized pigmented villonodular synovitis of the knee

Pigmented villonodular synovitis (PVNS) is a well-recognized lesion that may affect any joint but is frequently found in the knee. It is a rare condition, especially in the localized form, and is still cause for discussion regarding to its pathogenesis and treatment. We report four cases of localized PVNS each one presenting with different clinical signs and symptoms. In one of our cases, a pedunculated mass and villous-like projections of the surrounding synovium were associated. Each case was studied with magnetic resonance imaging, treated arthroscopically, and the diagnosis confirmed by histological examination. Arthroscopy is an effective tool for both diagnosis and treatment. Arthroscopy 1998 Jul-Aug;14(5):532-6

Subkutane Knoten bei Patienten mit chronischer Polyarthritis sind nicht immer Rheumagranulome

Rheumatoid nodules occur in about 20% of patients with rheumatoid arthritis. Nevertheless, the clinical diagnosis of these subcutaneous nodules is not always supported by the histological investigation - case reports on patients with rheumatoid arthritis and associated localized pigmented villonodular synovitis, epithelioid sarcoma, and Merkel cell tumor are presented.

Localized pigmented villonodular synovitis of the patellar fat pad: A report of two cases

Pigmented villonodular synovitis (PVNS) of the knee is a well-recognized entity. We report on two cases of localized PVNS that involved the patellar fat pad, an area of involvement not previously reported. Diagnostic and therapeutic arthroscopies were performed, and typical findings of localized PVNS were found. Complete resection of the lesions were performed arthroscopically. At short-term follow-up, all symptoms had resolved. Arthroscopy can be used as an effective diagnostic tool for identification of intraarticular PVNS of the knee. In the case of localized involvement, it also can be considered as definitive treatment.

Localized pigmented villonodular synovitis presenting as a locked lateral meniscal bucket handle tear: A case report and review of the literature

Pigmented villonodular synovitis involves proliferation of the synovium of joints, bursa, or tendon sheaths. It is a rare disorder that can occur in two forms. The diffuse form involves the entire synovium and occurs in the majority of cases. The localized form involves a discrete section of the synovium. The disorder almost always involves a single joint, and the knee is most commonly affected. The treatment of choice for the diffuse form is total synovectomy. Recurrence is common. The treatment of choice for the localized form is partial synovectomy. Recurrence is uncommon. We present a case report of a localized pigmented villonodular synovitis presenting as a locked lateral meniscal bucket handle tear in an otherwise healthy 27-year-old man.

Magnetic Resonance Imaging in the Diagnosis of Localized Pigmented Villonodular Synovitis of the Ankle: A Case Report

The use of magnetic resonance imaging (MRI) in pigmented villonodular synovitis (PVS) has been well described in the literature. MRI has been used predominantly with diffuse PVS lesions. We recently had a patient with an unusual case of localized PVS of the ankle with bone and cartilage destruction. Preoperative MRI was useful in the diagnosis of localized PVS and in the planning for surgery. MRI in a patient with this lesion had not been documented previously, but should be considered whenever PVS, either diffuse or localized PVS, is suspected.