Treatment Of Pigmented Villonodular Synovitis Research Articles

Digitalized diagnosis and treatment of pigmented villonodular synovitis of temporomandibular joint: a case report.

Pigmented villonodular synovitis (PVNS) is a rare locally aggressive benign tumor in the temporomandibular joint (TMJ). This paper presents a patient with TMJ-PVNS involving masseteric space, temporal bone, zygomatic process, and mandibular ramus. Digital technique was used to determine the boundary of the lesion and reconstruct the normal glenoid fossa. The temporalis myofascial flap was transplanted between titanium mesh and condyle to reconstruct the disk after the complete resection of the tumor. The patient's facial profile is symmetrical, with a mouth ope-ning of 43 mm. No local recurrence and complications, such as cerebrospinal fluid fistula and encephaloceles, were detected during 30-month follow-up period.

Pigmented villonodular synovitis: literature review and case report

Pigmented villonodular synovitis (PVNS) is a rare disease, its diagnosis has certain difficulties. This is due to the absence of characteristic etiological factors and clinical manifestations of PVNS, as well as the insufficient level of knowledge among doctors. The article presents a review of the literature on the diagnosis and treatment of PVNS, as well as a clinical case, which peculiarity is the late diagnosis of this disease, despite the presence of its certain clinical and morphological manifestations.

Outcomes of arthroscopic management for pigmented villonodular synovitis of the hip.

Early synovectomy is considered as the main treatment of pigmented villonodular synovitis (PVNS) of the hip in young patients with preserved cartilage. The purpose of the study is to evaluate outcomes of arthroscopic management for PVNS of the hip. Patients who underwent primary hip arthroscopy for the treatment of histology-confirmed PVNS by the senior author between January 2012 and December 2016 were retrospectively reviewed. We excluded patients who had less than 1-year follow-up or had undergone primary surgeries with other surgeons and then received revision hip arthroscopic procedures by the senior author. The recurrence of PVNS and postoperative condition of affected hip were assessed by follow-up magnetic resonance imaging (MRI). Patient-reported outcomes of modified Harris hip score (mHHS) and 12-item International Hip Outcome Tool (iHOT-12) were collected at latest follow-up. Nine patients (2 males, 7 females) with a mean age of 24.3 ± 11.2years (range 14-44years) were included in this study. Localized PVNS was observed in four patients, and diffuse PVNS was observed in five patients. No patient presented with advanced osteochondral destruction. Five patients received single adjuvant radiosynoviorthesis. No patient had evidence of recurrence based on follow-up MRI. Patient-reported outcomes were obtained in eight patients at mean 55.8 ± 26.1months (range 24-84months) after the index surgery. The mean mHHS was 94.6 ± 4.9 (range 84.7-100) and the mean iHOT-12 was 93.3 ± 20.2 (range 50-120). No patient needed secondary surgery during the follow-up period. Arthroscopic subtotal synovectomy can offer favorable short to mid-term outcomes in the treatment of hip PVNS in case of no advanced osteochondral damage at presentation.

Postoperative radiotherapy for pigmented villonodular synovitis (PVNS): case series and literature review

Abstract Purpose: Pigmented villonodular synovitis (PVNS) is a rare benign proliferative disease of the synovium with locally aggressive behaviour. We reviewed our experience using external beam radiotherapy (RT) in the treatment of PVNS. Method: We report five cases of PVNS who underwent Arthroscopic Synovectomy followed by postoperative RT in National Oncology centre in Oman. The total dose RT ranges between 30 and 36 Gray (Gy) Three-dimensional radiotherapy technique. Conclusion: Postoperative RT is effective in preventing disease recurrence and should be offered following maximal cytoreduction to enhance local control in PVNS.

Pigmented Villonodular Synovitis Around the Elbow Joint That Required Upper Arm Amputation

Pigmented villonodular synovitis (PVNS) is a relatively rare benign proliferative disorder of the synovium, and it commonly occurs in the knee joint. A unique case of huge PVNS originating around the elbow joint that required upper arm amputation is reported. A 74-year-old woman had a 5-month history of right elbow pain and noticed a mass measuring 8 × 5 cm on the olecranon side. She had a past history of undergoing tumor resection and flap surgery 9 years earlier, diagnosed as a giant cell tumor involving the right elbow region. She had chronic renal failure, with a shunt on the right forearm. On magnetic resonance imaging, the tumor around the elbow joint showed low signal intensity on T1-weighted images and low to high intensity on T2-weighted images. It was thought that it was difficult to preserve the limb because of the size of the tumor and the shunt blood vessel. Therefore, upper arm amputation was performed. The histological diagnosis was PVNS. There was no recurrence of PVNS postoperatively. In the treatment of PVNS, initial surgery with complete resection of the synovial membrane and careful postoperative follow-up are considered important. J Med Cases. 2020;11(7):201-203 doi: https://doi.org/10.14740/jmc3503

The causes of unsatisfactory results and mistakes in treatment of patients with pigmented villo-nodular synovitis (teno-synovial giant-cell tumor) of a knee joint

Objective. To reveal the causes of unsatisfactory results and mistakes in treatment of patients with pigmented villo-nodular synovitis of a knee joint with the objective to improve this disease diagnosis, as well as the results of treatment and rehabilitation/ Materials and methods. Through the period 2010 - 2018 yrs we conducted a retrospective analysis of medical documents (the case histories) in 77 patients with pathohistologically verified diagnosis of pigmented villo-nodular synovitis of a knee joint, who were treated in the clinic of Institute of Traumatology and Orthopedics (ITO), Kyiv and operated on a knee joint. Results. The causes of unsatisfacory results of treatment for pigmented villo-nodular synovitis of a knee joint are the disease severity, and its diffuse form, absence of the diagnosis-treatment algorithm for this process and rehabilitation of the patients, what leads to diagnostic and tactical mistakes on the treatment process stages. Conclusion. The awaiting tactics in diagnosis and treatment of pigmented villo-nodular synovitis constitutes a wide-spread tactical mistake. Insufficient knowledge of traumatologists in a knee joint surgery leads to tactical faults as well. Most treatment mistakes occur as a consequence of unreadiness of orthopedist-traumatologist for possible intraoperative accidental revealing of pigmented villo-nodular synovitis of a knee joint, as well as because of absence of intraoperative tactics and material gears for treatment of this disease and its outcomes.

Pigmented Villonodular Synovitis Around the Elbow Joint That Required Upper Arm Amputation

Pigmented villonodular synovitis (PVNS) is a relatively rare benign proliferative disorder of the synovium, and it commonly occurs in the knee joint. A unique case of huge PVNS originating around the elbow joint that required upper arm amputation is reported. A 74-year-old woman had a 5-month history of right elbow pain and noticed a mass measuring 8 × 5 cm on the olecranon side. She had a past history of undergoing tumor resection and flap surgery 9 years earlier, diagnosed as a giant cell tumor involving the right elbow region. She had chronic renal failure, with a shunt on the right forearm. On magnetic resonance imaging, the tumor around the elbow joint showed low signal intensity on T1-weighted images and low to high intensity on T2-weighted images. It was thought that it was difficult to preserve the limb because of the size of the tumor and the shunt blood vessel. Therefore, upper arm amputation was performed. The histological diagnosis was PVNS. There was no recurrence of PVNS postoperatively. In the treatment of PVNS, initial surgery with complete resection of the synovial membrane and careful postoperative follow-up are considered important.

Surgical treatment for pigmented villonodular synovitis of ankle

Surgical treatment for pigmented villonodular synovitis of ankle

Arthroscopy in the treatment of pigmented villonodular synovitis of the ankle and subtalar joints: a technique guide and case series

Pigmented villonodular synovitis is a proliferative synovial-based inflammatory process that can lead to joint destruction and debilitating pain. Surgical excision is the “gold standard” for treatment of pigmented villonodular synovitis. Given the limited soft tissues surrounding the ankle in conjunction with the ability of arthroscopy to easily access the entire joint, arthroscopic management of ankle pigmented villonodular synovitis allows for successful treatment while minimizing the surgical complications of an open approach. The preoperative planning and surgical technique are described in detail. Additionally, three patients with pigmented villonodular synovitis in the tibiotalar and subtalar joints who were successfully treated with arthroscopically assisted synovectomy are reported.Three patients with pigmented villonodular synovitis in the tibiotalar and subtalar joints underwent arthroscopically assisted synovectomy without adjuvant radiotherapy. With a mean age of 37.7 yr (range 23-52) and mean follow-up of 83 wk (range 19-184), there was no evidence of recurrence. Mean Short Form-12 scores for physical and mental component summaries were, respectively, 49.05±4.76 and 54.57±4.55. The mean Foot and Ankle Disability Index (FDAI) score for the patients was 88.13±9.6. These results suggest good to excellent results. Arthroscopically assisted synovectomy in patients with pigmented villonodular synovitis of the ankle and hindfoot is an effective treatment option, providing adequate visualization for complete excision while minimizing soft-tissue complications related to larger surgical exposures.

The Role of Radiotherapy in the Treatment of Pigmented Villonodular Synovitis

The Role of Radiotherapy in the Treatment of Pigmented Villonodular Synovitis

Arthroscopic Technique for the Treatment of Pigmented Villonodular Synovitis of the Hip

Open synovectomy remains the treatment of choice for pigmented villonodular synovitis (PVNS) of the hip but has shown modest results compared with the treatment of other joints. Recent advances in hip arthroscopy permit a thorough evaluation of the joint surfaces, improved access, and decreased postoperative morbidity. We describe an arthroscopic synovectomy technique for PVNS of the hip. The use of additional arthroscopic portals and creation of a large capsulotomy enable successful visualization and extensive synovectomy of the entire synovial lining of the hip. The T-capsulotomy enables extensive soft-tissue retraction for complete exposure. The midanterior portal enables use of an arthroscopic grasper and shaver to directly access and excise the synovial lining of the peripheral compartment while avoiding damage to the medial and lateral retinacular vessels. Technical innovations in hip arthroscopy have enhanced visualization in the central and peripheral compartments, as well as instrument management and diagnostic evaluation of the capsule, therefore allowing enhanced management of PVNS of the hip.

Long-term follow-up results of primary and recurrent pigmented villonodular synovitis.

Adequate documentation of the outcome of treatment of pigmented villonodular synovitis (PVNS) is sparse. Available case series show relatively short follow-up times and often combine locations or subtypes to increase patient numbers. This article describes the long-term follow-up of a single institution's large consecutive series of PVNS. Retrospectively, 107 PVNS patients were identified between 1985 and 2011 by searching pathology and radiology records. Treatment complications, recurrences and quality of life were evaluated. Most patients (85.2%) were primarily or secondarily treated at our institution. Both subtypes, localized PVNS [29 (27%)] and diffuse PVNS [75 (70%)] were represented. The knee was affected in 88% of patients. Treatments received were surgery, external beam radiotherapy, radiosynovectomy, targeted therapy, immunotherapy or combinations of these. Forty-nine (46%) patients had prior treatment elsewhere. The mean follow-up from diagnosis until last contact was 7.0 years (range 0.3-27.4) for localized PVNS and 14.5 years (range 1.1-48.7) for diffuse PVNS. The 1- and 5-year recurrence-free survival rates for diffuse PVNS were 69% and 32%, respectively. Quality of life, estimated by 36-item Short Form Health Survey (SF-36) scores, were not significantly different between localized and diffuse PVNS. However, both patient groups scored lower than the general population norms on the general health component (59.2 and 56.3, respectively, P < 0.05). Recurrence rates of PVNS increase with time. Long-term follow-up shows, particularly in diffuse PVNS, it is a continually recurring problem, and over time it becomes increasingly difficult to cure. The quality of life is decreased in patients with PVNS compared with the general population.

Arthroscopic treatment of pigmented villonodular synovitis of the proximal tibiofibular joint.

Disorders of the proximal tibiofibular joint should be kept in mind in the evaluation of lateral knee pain. They include osteoarthrosis, rheumatic disease, traumatic subluxation or dislocation, ganglion or synovial cysts, synostosis, synovial chondromatosis, pigmented villonodular synovitis and hypomobility of the joint. Peroneal nerve can be at risk with pathologies of the joint either by compressive effect or formation of intra-neural ganglion. A case of pigmented villonodular synovitis of the proximal tibiofibular joint was reported which presented with lateral knee pain. It was successfully treated by arthroscopic synovectomy. Level of evidence V.

Application of arthroscope in the diagnosis and treatment of pigmented villonodular synovitis of the knee

目的 探讨关节镜手术在膝关节色素沉着绒毛结节性滑膜炎(PVS)诊治中的应用价值.方法 分析总结23例膝关节PVS患者的临床及关节镜手术资料,并行3个月至3年随访,观察诊断和治疗效果.结果 随访时间3～36个月,平均22.6个月.7个月后1例复发,再次镜下全滑膜切除,术后2周后接受放射治疗.术后2个月随访22例膝关节均关节肿胀、积液、疼痛消失,关节活动均良好.按照Lysholm评分标准进行膝关节功能评价:优13膝(56.5%),良9膝(39.1%),差1膝(4.3%).结论 关节镜下诊断与病理诊断符合率高,手术创伤小,可以明显改善膝关节功能,是诊断和治疗PVS的理想手术方法。

Two to 10 Years' Follow-up of Arthroscopic Management of Pigmented Villonodular Synovitis in the Hip: A Case Series

The purpose of this study was to evaluate the results of arthroscopic treatment for pigmented villonodular synovitis (PVNS) of the hip. All patients undergoing hip arthroscopy are prospectively assessed with a modified Harris Hip Score preoperatively and postoperatively at 3, 12, 24, 60, and 120 months. Thirteen patients were identified with histologically confirmed PVNS and minimum 2-year follow-up. These procedures were performed between 2001 and 2008, during which time a total of 1,640 arthroscopic procedures were performed. There was 100% follow-up at a mean of 63 months (range, 24 to 120 months). There were 9 female and 4 male patients with a mean age of 27 years (range, 14 to 46 years). The pattern of involvement was diffuse in 3 patients, nodular in 3, and combined in 7. Concomitant pathology included 7 articular cartilage lesions (3 grade III and 4 grade IV), 6 labral tears, and 4 cases with femoroacetabular impingement. The mean improvement in the Harris Hip Score was 27 points (62 points preoperatively and 89 points postoperatively) (SD, 17 points), with a range of 3 to 56 points. The mean improvement based on pattern of disease was as follows: diffuse, 30 points (SD, 23 points); nodular, 25 points (SD, 18 points); and combined, 26 points (SD, 0.70 points). There were no complications, but one patient was converted to a total hip arthroplasty at 6 years postoperatively. In this cohort the results of arthroscopic management of PVNS have been favorable with minimal morbidity. Arthroscopy may be necessary to substantiate the diagnosis, as well as to assess and address other accompanying damage. The procedure must include both the central and peripheral compartments. The secondary damage and prelude to osteoarthritis cannot be reversed and, when severe, make the less invasive nature of the arthroscopic approach especially appealing. Level IV, therapeutic case series.

Minimal-invasive Technique in Treatment of Pigmented Villonodular Synovitis of Ankle

Pigmented villonodular synovitis (PVNS) is an idiopathic, benign, slowly progressive, proliferative disorder of synovial tissue, tendon sheaths, and bursae. Involvement of the ankle occurs in fewer than 10% of patients with PVNS, and clinical behavior and treatment are not well described. Although PVNS of ankle can be treated with open procedures frequently, in this paper, a case of PVNS of the ankle with marked bone and joint destruction treated by arthroscopic subtotal synovectomy was discussed.

Long-term results of surgical treatment of pigmented villonodular synovitis of the knee

The aim of this study was to evaluate the long-term results of total synovectomy in pigmented villonodular synovitis of the knee (PVNS). Open total synovectomy was performed for 19 patients (9 men, 10 women; mean age: 42.8 years) with PVNS. Of these patients, 15 had diffuse and 4 localized PVNS. The patients were followed for an average of 80.2 months and the average time between the onset of complaints and surgery was 23 months. In 4 patients, PVNS was identified during total knee replacement (TKR) performed due to gonarthrosis. Radiotherapy was performed as an adjuvant treatment in one patient with recurrence. Puncture was performed in 11 patients due to effusion and 8 to 70 cc of fluid was aspirated. Diagnosis was made during the exposure for TKR in 4 patients, by a biopsy in 2 and based on joint puncture and MRI findings in the rest. Recurrence occurred in 5 patients. A second total synovectomy was performed in 4 patients. Radiotherapy was used for the remaining one patient. Two patients were operated three times. During the follow-up, TKR was performed in 7 of the 19 patients. None of the patients developed infection and hemarthrosis requiring puncture nor required amputation or arthrodesis. Three patients had a postoperative knee joint stiffness of 10 to 25 degrees. The patients were evaluated according to the Knee Society Score and 8 (42.2%) had perfect, 9 (47.3%) good and 2 (10.5%) bad results. PVNS is a disease with a high risk of recurrence. No individual or combined treatment method can offer a definitive solution. Open or arthroscopic radical synovectomy is still considered as the gold standard. If necessary, adjuvant intraarticular or extraarticular radiotherapy can be added to the treatment.

Arthroscopic Treatment of Pigmented Villonodular Synovitis Involving Bilateral Shoulders

Pigmented villonodular synovitis (PVNS) is a lesion of benign proliferative synovium that invades joint, tendon sheath, and bursa. It mainly occurs in 1 joint, the knee joint or hand, and multi-joint invasion is reported to be <1%. Rare cases have been reported of PVNS occurring in the shoulder joint. Generally, total synovectomy is a standard treatment of PVNS. However, complete synovectomy is sometimes impossible because of difficulty of visualization and access to the whole joint and subacromial space. Therefore, recurrence of the disease is always of concern. This article presents a case of 64-year-old patient with pain and swelling of bilateral shoulder joints of 4 months' duration. Physical examination showed atrophy of the deltoid and infraspinatus and a mass-like protrusion on the anterior portion of left shoulder. Active forward elevation was limited to 30 degrees on the right and 90 degrees on the left. Overall synovial hyperplasia and nodular mass was observed on magnetic resonance imaging. Massive rotator cuff tear and invasion of the lesion toward the subacromial space and deltoid muscle was noted as well. Arthroscopic examination revealed a typical finding of PVNS: yellowish brown pigmentation over the overall joint capsule and subacromial space. Arthroscopic total synovectomy without rotator cuff repair was performed for both shoulders. Clinical outcomes showed good pain relief and no recurrence of the disease, although range of motion and muscle strength was not significantly improved, possibly due to accompanied massive rotator cuff tear. Arthroscopic total synovectomy in the treatment of PVNS of the shoulder joint is a minimally invasive and effective method, which makes it possible to access the whole joint space and subacromial space.

Radiation Therapy for Treatment of Pigmented Villonodular Synovitis: Results of a National Patterns of Care Study

The German Cooperative Group on Radiotherapy in Benign Diseases (GCG-BD) conducted a pattern-of-care study (PCS) to analyze the radiation therapy (RT) practice for pigmented villonodular synovitis (PVNS). In 2007, a structured questionnaire to assess the number of patients, the pretreatments, the RT indication, technique, target volume concepts, outcome data, and possible early or late toxicity was circulated to 227 institutions. Until August 2008, a response was available from 189 institutions (83.2 %), of whom 19 (10.0 %) experienced RT for PVNS. Complete clinical information was available for 41 patients from 14 RT departments. Thirty patients (73.2 %) received postsurgical RT because of primary incomplete resection, 11 patients (26.8 %) as an adjunct after complete resections of recurrences or unclear resection status. The total doses ranged from 30 to 50 Gy (median, 36 Gy), the median single dose was 2.0 Gy. Local control was achieved 95.1%, and 82.9% had no or only slight functional impairment. The early and late toxicity was mild (<or=RTOG Grade II). Radiation therapy is a safe and effective treatment for PVNS in the postoperative setting after incomplete resection, and also as a salvage option for treatment of recurrences it provides a high rate of local control.

Arthroscopic Treatment for Pigmented Villonodular Synovitis of the Shoulder Associated With Massive Rotator Cuff Tear

Our purpose was to investigate arthroscopic treatment of patients diagnosed with pigmented villonodular synovitis (PVNS) of the shoulder and massive rotator cuff tear with the initial presentation of large, recurrent joint effusion. From December 2005 to June 2007, 5 patients (3 males and 2 females) diagnosed with PVNS of the shoulder and massive rotator cuff tear were treated with arthroscopic synovectomy, partial cuff repair, or debridement if the cuff was irreparable. All 5 patients were followed-up for a mean of 22.4 months (range, 12 to 33 months). Outcomes were measured with use of the American Shoulder and Elbow Surgeons (ASES) and University of California at Los Angeles (UCLA) scoring systems. Two patients received partial rotator cuff repair by suture anchors and another 2 received suture repairs only. All of the patients had residual tear with variable sizes. With a mean follow-up of 22.4 months (range, 12 to 33 months), the mean ASES and UCLA scores improved from preoperative values of 48.2 and 7.8 to 80.0 and 29.6 points, respectively (P < .05). All patients were satisfied with the procedure, and no signs of recurrence were noted during the follow-up period. Five cases of PVNS of the shoulder and massive rotator cuff tears with the initial symptoms of shoulder effusion and function limitation were reported. After arthroscopic synovectomy and partial rotator cuff repair or debridement, all patients gained symptomatic and limited functional improvement at an average follow-up of 22 months. Level IV, therapeutic case series.