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Koutalos AA, Ragias D, Rizniotopoulos E, Tsanadis K, Xydias E, Tsoukalas N, Charalampakis N, Trogkanis N, Ioannou M, Malizos KN, Tolia M. Diffuse pigmented villonodular synovitis of the knee joint: 3-year follow-up of a case report. Radiat Oncol J 2022; 40:270-275. [PMID: 36606304 PMCID: PMC9830041 DOI: 10.3857/roj.2022.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/06/2022] [Indexed: 12/27/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a proliferative, recurrent and locally invasive disease of the synovium. The symptoms of the disorder are not typical and thus it is very often misdiagnosed. Most of the times, magnetic resonance imaging presents the nodular model of development and sets the basis for the diagnosis. The final diagnosis will be set by the pathological evaluation of the lesion's biopsy. PVNS may be localized (nodule with a clear boundary with/without presence of single pedicle) or diffuse (extensive involvement of the adjacent nerves and vessels). Depending on the extension of the PVNS, a different management approach is performed, lesion excision vs. resection, followed by radiotherapy respectively. We report a case of diffuse PVNS in the knee joint, treated with surgical excision and adjuvant radiotherapy as well as follow-up imaging after a time period of 3 years.
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Affiliation(s)
- Antonios A. Koutalos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Dimitrios Ragias
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece,Correspondence: Dimitrios Ragias Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110, Larissa, Greece. Tel: +306934373163 E-mail: ,
| | | | | | - Emmanouil Xydias
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Nikolaos Tsoukalas
- Department of Oncology, 401 General Military Hospital of Athens, Athens, Greece
| | | | - Nikolaos Trogkanis
- Department of Radiation Oncology, Attikon General University Hospital, Athens, Greece
| | - Maria Ioannou
- Department of Pathology, Medical School, University of Thessaly, Larissa, Greece
| | - Konstantinos N. Malizos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Maria Tolia
- Department of Radiotherapy, Faculty of Medicine, University of Crete, Heraklion, Greece
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Papamerkouriou YM, Posantzis MI, Kouremenos D, Manousakis C, Plessas SI. Arthroscopic Technique for the Treatment of Localized Pigmented Villonodular Synovitis of the Knee. Cureus 2020; 12:e7832. [PMID: 32467807 PMCID: PMC7249763 DOI: 10.7759/cureus.7832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
| | - Markos I Posantzis
- Orthopaedics, General Hospital of Nikaia "Saint Panteleimon", Piraeus, GRC
| | - Dimitrios Kouremenos
- Orthopaedics, General Children's Hospital "Panagiotis & Aglaia Kyriakou", Athens, GRC
| | - Christos Manousakis
- Orthopaedics, General Children's Hospital "Panagiotis & Aglaia Kyriakou", Athens, GRC
| | - Spyridon I Plessas
- Orthopaedics, General Hospital of Nikaia "Saint Panteleimon", Piraeus, GRC
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Fang Y, Zhang Q. Recurrence of pigmented villonodular synovitis of the knee: A case report with review of literature on the risk factors causing recurrence. Medicine (Baltimore) 2020; 99:e19856. [PMID: 32312009 PMCID: PMC7220429 DOI: 10.1097/md.0000000000019856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Pigmented villonodular synovitis is a rare disease which may involve any joints. It has localized and diffuse forms, and the latter is more aggressive with a higher recurrence rate. Different treatments are applied to each form of the disease, but there is no standard surgical procedure or any consensus on whether adjuvant therapy should be used. Many factors may lead to recurrence of the disease; however, there is no reliable way to predict the recurrence. PATIENT CONCERNS A 21-year-old female patient presented with a one-year history of progressive pain of the right knee. DIAGNOSES Pigmented villonodular synovitis. INTERVENTIONS We performed an anterior approach arthroscopic synovectomy and a posterior approach open synovectomy in the popliteal fossa, but the patient declined to take radiotherapy as a post-surgical adjuvant therapy. Then, she received a repeat arthroscopic synovectomy 20 months later because of the recurrent lesions, and a radiotherapy was performed 6 weeks after the second surgery. OUTCOMES There were no abnormal signs in the right knee on magnetic resonance imaging scanning 6 months after the second surgery. The range of motion of her right knee was normal. LESSONS Pigmented villonodular synovitis is a rare disease which may involve any joints. Surgical resection plus adjuvant therapy is recommended for patients with risk factors of recurrence.
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Duan Y, Qian J, Chen K, Zhang Z. Necessity of adjuvant postoperative radiotherapy for diffuse pigmented villonodular synovitis of the knee: A case report and literature review. Medicine (Baltimore) 2018; 97:e9637. [PMID: 29504995 PMCID: PMC5779764 DOI: 10.1097/md.0000000000009637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pigmented villonodular synovitis (PVNS) is an idiopathic, proliferative disorder lesion of synovial tissue, which is regarded as a benign disease, but has a local invasion. Up to now, these are no consensus about the etiology and pathogenesis of PVNS. Because of the lack of typical clinical features, misdiagnosis and delayed diagnosis are not uncommon, magnetic resonance imaging (MRI) can assist diagnosis and histopathological examination is recognized as the gold standard for the final diagnosis. Because this disease is so rare, there is no standard treatment. Surgical resection of the lesion is considered the preferred treatment, but postoperative recurrence is a problem that cannot be ignored. Postoperative radiotherapy is necessary, especially for patients with diffuse PVNS of the knee. PATIENT CONCERNS A 27-year-old female teacher presented with 3 years chronic pain of the right knee, and progressive swelling aggravated for 1 week. The range of motion of the knee was limited. DIAGNOSES Clinical and laboratory examination failed to provide definitive diagnosis. Imaging can assist in diagnosis, and pathology is the gold standard. Erythrocyte sedimentation rate (ESR), antihemolytic streptococcus O (ASO), and rheumatoid factors (RF) were all negative. Joint puncture revealed giant cell tumor of the synovial membrane. PVNS was confirmed by postoperative pathology. The characteristic T2 weighted low signal of MRI suggests the recurrence of PVNS. INTERVENTIONS The patient underwent 2 stages of treatment: open synovectomy was performed in the first place and postoperative external radiotherapy was not considered. After 2 years of disease-free remission, she was diagnosed with a recurrence of the disease by MRI. Further, arthroscopic total synovectomy of the right knee was performed and external beam radiotherapy was carried out after the operation. OUTCOMES Up to now, the patient was followed up for 3 years without any sign of recurrence. LESSONS Adjuvant postoperative radiotherapy can improve the local control rate, it is a reliable treatment method for diffused PVNS.
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Affiliation(s)
| | | | | | - Zhuo Zhang
- Department of Oncology Radiotherapy, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China
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Gao M, Li H, Liang X, Fu X, Li X. Multifocal pigmented villonodular synovitis coexisting in both the knee joint and the patella: a case report and literature review. BMC Musculoskelet Disord 2017; 18:293. [PMID: 28683727 PMCID: PMC5501528 DOI: 10.1186/s12891-017-1654-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/30/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUD Pigmented villonodular synovitis (PVNS) is an uncommon entity of proliferative lesion of the synovium, presenting with different clinical signs and symptoms. PVNS rarely forms an osteolytic lesion in a bone. Here we report a unique case of PVNS with a nodular lesion in the left patella. CASE PRESENTATION A 37-year-old female was referred to our hospital with complaints of ongoing left knee pain and a painful and palpable mass in her left popliteal fossa. MRI demonstrated a nodular lesion in the left patella, diffuse affected synovial tissue in the left knee and an extra-articular mass in the left popliteal fossa. After a primary diagnosis of PVNS had been established, combined arthroscopic synovectomy and open resection were performed. The postoperative pathological diagnoses of the resected mass from the popliteal fossa, the affected synovial tissue and the lesion in the patella were consistent with PVNS. At 1-year follow-up, no evidence of recurrence was noted. CONCLUSIONS Based on brief literature review of PNVS, we presented a very rare case of PVNS with a nodular lesion in the left patella, diffuse affected synovial tissue in the left knee and an extra-articular mass in the left popliteal fossa.
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Affiliation(s)
- Mingxuan Gao
- Department of Joint Surgery, Lanzhou General Hospital of PLA, NO. 333 Nanbinhe Road, Qilihe District, Lanzhou, Gansu Province, 730050, China
| | - Hong Li
- Ophthalmology Center, Lanzhou General Hospital of PLA, Gansu, 730050, China
| | - Xiaoyan Liang
- Department of Joint Surgery, Lanzhou General Hospital of PLA, NO. 333 Nanbinhe Road, Qilihe District, Lanzhou, Gansu Province, 730050, China
| | - Xiaoyan Fu
- Ultrasonic Diagnosis Department, Lanzhou General Hospital of PLA, Gansu, 730050, China
| | - Xusheng Li
- Department of Joint Surgery, Lanzhou General Hospital of PLA, NO. 333 Nanbinhe Road, Qilihe District, Lanzhou, Gansu Province, 730050, China.
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Lei P, Sun R, Liu H, Zhu J, Wen T, Hu Y. Prognosis of Advanced Tenosynovial Giant Cell Tumor of the Knee Diagnosed During Total Knee Arthroplasty. J Arthroplasty 2017; 32:1850-1855. [PMID: 28161138 DOI: 10.1016/j.arth.2016.12.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tenosynovial giant cell tumor (TGCT) is a relatively rare disease often misdiagnosed as osteoarthritis. Synovectomy or arthroplasty is the recommended treatment option, but recurrence is common after surgery. This study aimed to determine the prognosis of patients with advanced TGCT that was diagnosed incidentally during total knee arthroplasty (TKA) for osteoarthritis and treated by synovectomy. METHODS From January 2008 to July 2011, TGCT was diagnosed incidentally in 10 patients (a total of 11 individual knees) undergoing posterior-stabilized TKA for an initial diagnosis of osteoarthritis. TGCT was confirmed by histopathology of biopsy specimens. Partial synovectomy was performed for localized-type TGCT (3 knees, 3 patients) and total synovectomy for diffuse-type TGCT (8 knees, 7 patients). RESULTS All patients were female with a mean age of 61.7 ± 6.6 (range 50-70) years. No postoperative infection, nerve injury, or deep venous thrombosis occurred. All patients were followed up for a mean period of 60.9 ± 6.6 (39-83) months, and no recurrence of TGCT occurred. X-ray imaging showed no apparent radiolucent lines around the prosthesis, and no prosthetic loosening, subsidence, or osteolysis. The joints were stable, with a significantly improved range of motion following surgery (109.5° ± 8.8° vs 80.5° ± 16.8°, P < .01). The Knee Society scores for knee joint (90.0 ± 4.1 vs 40.5 ± 8.1) and knee function (81.8 ± 7.5 vs 35.0 ± 13.8) were both significantly improved after surgery (P < .01). CONCLUSION Inactive TGCT could not be diagnosed preoperatively. TKA combined with synovectomy is effective in the treatment of advanced TGCT with degenerative lesions.
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Affiliation(s)
- Pengfei Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Rongxin Sun
- Department of Orthopaedics, The Six Affiliated Hospital, Xinjiang Medical University, Urumchi, People's Republic of China
| | - Hao Liu
- Program of Biology and Biomedical Sciences, Division of Medical Sciences, Harvard Medical School, Harvard University, Cambridge, Massachusetts
| | - Jianxi Zhu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ting Wen
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yihe Hu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
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Arthroscopically-assisted mini open partial synovectomy for the treatment of localized pigmented villonodular synovitis of the knee. A retrospective comparative study with long-term follow up. INTERNATIONAL ORTHOPAEDICS 2016; 41:925-930. [DOI: 10.1007/s00264-016-3348-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/11/2016] [Indexed: 12/29/2022]
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Panagopoulos A, Tsoumpos P, Tatani I, Iliopoulos I, Papachristou D. Giant Cell Tumor of the Patella Tendon Sheath Presenting as a Painful Locked Knee. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:568-73. [PMID: 26302970 PMCID: PMC4554334 DOI: 10.12659/ajcr.893849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 26 Final Diagnosis: Giant cell tumor of the patella tendon seath Symptoms: Efusion • locking knee • pain Medication: None Clinical Procedure: Arthroscopy and open resection of the tumor Specialty: Orthopedics and Traumatology
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Affiliation(s)
- Andreas Panagopoulos
- Department of Sports Medicine, Orthopaedic Clinic, Patras University Hospital, Patras, Greece
| | - Pantelis Tsoumpos
- Department of Sports Medicine, Orthopaedic Clinic, Patas University Hospital, Patras, Greece
| | - Irini Tatani
- Department of Sports Medicine, Orthopaedic Clinic, Patas University Hospital, Patras, Greece
| | - Ilias Iliopoulos
- Department of Sports Medicine, Orthopaedic Clinic, Patas University Hospital, Patras, Greece
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Unlu EN, Yagmurlu B, Teker K, Yilmaz O, Aktas AR, Buyukkaya A, Gurses MA, Kayaalp A, Kos M. WITHDRAWN: Localized tenosynovial giant cell tumor of the knee in usual and unusual locations: MR Imaging features. Eur J Radiol 2015. [DOI: 10.1016/j.ejrad.2015.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bouguennec N, Meyer A, Graveleau N. Localized form of pigmented villonodular synovitis of the knee: the meniscal mime. Orthop Traumatol Surg Res 2014; 100:251-4. [PMID: 24589080 DOI: 10.1016/j.otsr.2013.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 08/21/2013] [Accepted: 09/27/2013] [Indexed: 02/02/2023]
Abstract
The localized form of pigmented villonodular synovitis of the knee is a rare condition with non-specific symptoms. This makes diagnosis especially difficult when the meniscus is affected. A full assessment with several imaging modalities can help support the preoperative diagnosis. But in the case reported here, the full clinical and paraclinical assessment (X-rays, CT arthrography and MRI) was wrong--the localized form of pigmented villonodular synovitis had mimicked a lateral meniscus injury and was only detected during arthroscopy. The lesion was excised surgically and the diagnosis was confirmed through postoperative histopathology.
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Affiliation(s)
- N Bouguennec
- CMC Paris V, 36, boulevard Saint-Marcel, 75005 Paris, France.
| | - A Meyer
- CMC Paris V, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - N Graveleau
- Espace Médical Vauban, 2a, avenue de Ségur, 75007 Paris, France
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Kinsella SD, Sennett BJ, Carey JL. Extra-Articular Pigmented Villonodular Synovitis of the Deep Infrapatellar Bursa: A Case Report. JBJS Case Connect 2013; 3:e133. [PMID: 29252289 DOI: 10.2106/jbjs.cc.m.00165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Stuart D Kinsella
- Perelman School of Medicine at the University of Pennsylvania, 295 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA 19104.
| | - Brian J Sennett
- Penn Sports Medicine Center, Weightman Hall, 1st floor, 235 South 33rd Street, Philadelphia, PA 19104
| | - James L Carey
- Penn Sports Medicine Center, Weightman Hall, 1st floor, 235 South 33rd Street, Philadelphia, PA 19104
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Mutch JAJ, Doyon J, Mottard S. Intra-Articular Metastasis of Lung Carcinoma Presenting as Pigmented Villonodular Synovitis of the Knee: A Case Report. JBJS Case Connect 2013; 3:e41. [PMID: 29252235 DOI: 10.2106/jbjs.cc.l.00249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- J A J Mutch
- Recherche Clinique en Orthopédie, Hôpital Sacré Coeur de Montréal, 5400 Boulevard Gouin Ouest, C-2095, Montréal, QC H4J 1C5, Canada.
| | - Josee Doyon
- Département de Pathologie (J.D.) and Département d'Orthopédie (S.M.), Pavillon Rachel-Tourigny, Hôpital Maisonneuve-Rosemont POES, Bureau #RT-1142, 5305 Boulevard l'Assomption, Montréal, QC H1T 2M4, Canada
| | - S Mottard
- Département de Pathologie (J.D.) and Département d'Orthopédie (S.M.), Pavillon Rachel-Tourigny, Hôpital Maisonneuve-Rosemont POES, Bureau #RT-1142, 5305 Boulevard l'Assomption, Montréal, QC H1T 2M4, Canada
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Abstract
We report a case of localized nodular synovitis of the infrapatellar fat pad impinging on the patellofemoral joint causing limitation of extension. Arthroscopy involved use of a superolateral portal because location of lesion hindered access via a conventional anterior portal. The infrapatellar mass impinged in the patellofemoral joint upon knee extension and retracted upon flexion. Superior-superior triangulation allowed for complete excision of the mass.
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Affiliation(s)
- Jong-Hoon Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Han Ro
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dae-Hee Lee
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea,Address for correspondence: Dr. Dae-Hee Lee, Department of Orthopedics, Korea University Anam Hopital, Korea University College of Medicine, 126-1, Anam-dong-5-ga, Seongbuk-gu, Seoul 136-705, Korea. E-mail:
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