Case report 692: Synovial chondrometaplasia of the 1st costovertebral joint

Chondrosarcoma arising within synovial chondromatosis of the lumbar spine

Synovial chondromatosis is an uncommon benign neoplasm that usually affects large appendicular joints and only rarely the spine. There are only a few small series and case reports documenting malignant transformation of synovial chondromatosis into secondary chondrosarcoma, typically within the hip in the setting of recalcitrant disease and multiple recurrences. Chondrosarcoma arising in synovial chondromatosis of the spine is exceedingly rare, with only one previously published case report involving the craniocervical junction. We present a case of chondrosarcoma arising within synovial chondromatosis of the lumbosacral spine, with the diagnosis made at the time of initial presentation. We describe the clinical, imaging, and histopathological findings and review diagnostic criteria for this difficult diagnosis.

Imaging features of synovial chondromatosis of the spine: a review of 28 cases

OBJECTIVE

To describe the radiographic, CT, and MRI appearance of synovial chondromatosis of the spine.

MATERIALS AND METHODS

Radiology and pathology databases were searched for cases of spinal synovial chondromatosis from 1984 through 2013, yielding 29 patients (16 males, 13 females). The average age was 45 years. Twenty-eight patients had imaging studies available for review including seven radiographs, two myelograms, 13 CT, and 23 MRI exams.

RESULTS

Cases were located in the cervical spine (16), thoracic spine (6), lumbar spine (6), and sacrum (1). Twenty-two cases (79%) had an epidural component. Eighteen (64%) had a neural foraminal component. Sixteen (57%) had a paraspinal component. The mass abutted a facet joint in 96% of cases. Nearly all (96%) showed a normal facet joint without internal erosive changes. Most (79%) showed evidence of chronic extrinsic bony erosion, usually involving the surface of the facet. Only 44% had calcifications as a dominant finding. Most patients (88%) had evidence of neural compression. On T1-weighted MRI, 80% showed intermediate or a combination of intermediate and dark signal. On T2-weighted images, 89% showed heterogeneous signal with discrete areas of dark signal. The majority (83%) showed a peripheral pattern of enhancement, usually peripheral nodular.

CONCLUSIONS

Synovial chondromatosis should be considered in the differential diagnosis when evaluating an epidural and/or paraspinal mass near a facet joint, especially when there is evidence of chronic extrinsic bone erosion, dark signal or nodules on T1 and/or T2, and nonenhancing fluid or myxoid signal centrally with thin or nodular peripheral enhancement.

Synovial chondromatosis of the spine in the skeletally immature: case report and updated review of the literature

Synovial chondromatosis is a benign disorder characterized by the formation of multiple cartilaginous nodules in the synovium of large joints. Synovial chondromatosis of the spine is very rare; this is the first reported case in the skeletally immature pediatric spine. A 12-year-old female presented with a posteriolateral neck mass and discomfort. A two-stage surgical resection of the mass was performed. This case shows that synovial chondromatosis can occur in the immature pediatric spine. Synovial chondromatosis should be included in the differential diagnosis of a calcified paravertebral or lateral neck mass in children.

Synovial chondromatosis of the cervical spine: a case report and review of the literature

Synovial chondromatosis is a benign condition characterized by metaplastic changes of the synovial membrane typically affecting large joints. Cervical spine involvement is rare and has not been reported in a teenager. The authors report a case of cervical synovial chondromatosis in a 19-year-old male presenting with left-sided weakness and numbness from spinal cord compression. After gross total resection was accomplished via laminoplasty, the patient's presenting symptoms improved and continued to do so over the follow-up period. The likely cause of the synovial chondromatosis in this patient was repetitive neck trauma as a child from a motor vehicle accident and football. This case demonstrates that the pathophysiology of this rare entity can initiate in the pediatric population. Although rare, synovial chondromatosis should be considered in the differential diagnosis of calcified extradural masses in the teenage population.

Regrowing synovial chondromatosis in a cervical facet joint with radiculopathy

Synovial chondromatosis (SC) in the spine is rare. There are few reports of associated cervical radiculopathy and there has not been a case reported of regrowing cervical SC. Here we report a 21-year-old man with a SC of a cervical facet joint that extended into the intervertebral foramen and compressed the cervical nerve root. The same symptom developed three years following the first operation. Computed tomography (CT) scans and Magnetic resonance imaging (MRI) showed multiple calcified nodules anterior to the right facet joint of C6-7 that extended into the intervertebral foramen. A mass removal was performed just as in the previous operation with a subtotal facetectomy. When vertebral SC is suspected, complete removal involving the bone and synovium should be considered as the standard treatment option.

Synovial chondromatosis presenting with lumbar radiculopathy

STUDY DESIGN

A case report of lumbar synovial chondromatosis with radiculopathy.

OBJECTIVE

To report a case of synovial chondromatosis of a lumbar facet joint that extended into the spinal canal and compromised the lumbar nerve root and raised spinal surgeons' awareness of the possibility of this unusual clinical problem.

SUMMARY OF BACKGROUND DATA

Synovial chondromatosis is an uncommon disorder characterized by the formation of multiple cartilaginous nodules in the synovium of a facet joint. It most commonly affects large joints. Synovial chondromatosis in the spine is rare and there is no previous report of associated lumbar radiculopathy.

METHODS

A 24-year-old woman presented with low back pain and right sciatica lasting 5 months. There was no objective weakness. Computed tomography scans showed multiple calcified nodules anterior and medial to the right apophyseal joint of L5-S1 and extending into the spinal canal. Magnetic resonance imaging showed a lobulated, heterogeneous enhancing extradural mass arising from the anteromedial aspect of the right L5-S1 facet joint. The lesion was removed in multiple pieces with curette after exposure of the corresponding intervertebral space through a conventional interlaminar approach. The histologic examination showed nodules of hyaline cartilage beneath the synovial cell lining.

RESULTS

The patient was completely free of low back pain and right sciatica 5 days after the surgery. All neurologic tests were normal from that point onwards.

CONCLUSION

Synovial chondromatosis may compromise lumbar nerve roots when it extends into the spinal canal from the facet joint. Although synovial chondromatosis of the lumbar spine is rare, it should be included in the differential diagnosis of radiculopathy.

Synovial chondromatosis of the lumbar spine with compressive myelopathy: a case report with review of the literature

Synovial chondromatosis has been rarely reported to occur in the spine with only one case found in the lumbar spine. We describe another case of synovial chondromatosis in the lumbar spine in a 41-year-old man who presented with compressive myelopathy. The tumor was located in the left ventrolateral corner of the epidural space just below the L(4)-L(5) intervertebral space. Besides being extremely rare, our case was unusual in that the juxtaposed facet joint was radiologically normal.

Vertebral synovial chondromatosis. Report of two cases and review of the literature

Synovial chondromatosis is an uncommon disorder characterized by the formation of multiple cartilaginous nodules within the synovium, most commonly affecting large joints. Its involvement with the spine is rare; only six cases have been reported. The authors describe two patients with synovial chondromatosis involving the cervical spine. In the first case, synovial chondromatosis arose from the left C1-2 facet joint. This patient underwent a two-stage procedure including a posterior approach for tumor resection and occipitocervical fusion as well as a transmandibular circumglossal approach to the anterior craniocervical junction to complete the tumor removal. Interestingly, on histopathological examination, scattered foci of low-grade chondrosarcoma were intermixed within the synovial chondromatosis. To the authors' knowledge, this is the first report of secondary low-grade chondrosarcoma arising in vertebral synovial chondromatosis. In the second case, synovial chondromatosis involved the left C4-5 facet joint. Tumor resection and cervical fusion were performed via a posterior approach. In this report, the authors describe the clinical presentation, radiographic findings, operative details, histopathological features, and clinicoradiological follow-up data obtained in these two patients and review the literature pertaining to this rare entity.

Synovial chondromatosis in a facet joint of a cervical vertebra

STUDY DESIGN

A case report of a cervical facet joint synovial chondromatosis.

OBJECTIVES

To correlate the radiologic and histologic features of vertebral synovial chondromatosis with review of the literature.

SUMMARY OF BACKGROUND DATA

Only two previous cases of vertebral facet joint synovial chondromatosis were found in a review of the English language medical literature.

METHODS

A 39-year-old woman had severe cervical pain associated with neurologic signs and symptoms in the left upper extremity. Computed tomographic and magnetic resonance imaging studies were performed.

RESULTS

Imaging studies showed lytic defects in the laminae of C3 and C4, with intermediate T1 and high T2 signal intensities. The diagnostic impression was that of a lymphangioma or synovial cyst. A laminectomy showed synovial tissue in both the C3-C4 facet joint and the lamina bone. Histologic examination disclosed synovial chondromatosis.

CONCLUSIONS

Synovial chondromatosis of the vertebral spine is quite rare, this being only the third reported example. Direct invasion of the cancellous bone, as in this case, also is a very uncommon feature of chondromatosis. It is emphasized that when radiologic studies demonstrate a lesion with cartilaginous characteristics within or juxtaposed to a joint, synovial chondromatosis, despite its rarity, should be included in the differential diagnosis, regardless of the anatomic site.