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Chraibi O, Rajaallah A, Lamris MA, El Kassimi CE, Rafaoui A, Rafai M. Concurrent arboreal lipoma and synovial chondromatosis in an osteoarthritic knee: Insights from a rare case study - A surgical case report. Int J Surg Case Rep 2024; 119:109786. [PMID: 38788634 PMCID: PMC11143784 DOI: 10.1016/j.ijscr.2024.109786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Conditions mimicking tumors within the knee, such as arborescent lipoma and synovial chondromatosis, are generally benign yet closely linked to inflammatory or degenerative joint diseases. While each condition is commonly documented individually with osteoarthritis, their concurrent presentation within the same knee is extremely rare. This case report adheres to the SCARE 2023 guidelines (Sohrabi et al., 2023) and aims to shed light on the diagnostic and therapeutic challenges posed by the rare coexistence of these conditions, presenting unique management challenges. CASE PRESENTATION We detail the case of a 67-year-old woman who has been suffering from progressively worsening bilateral osteoarthritis for over five years, with significant impairment in her right knee. Symptoms included persistent pain unresponsive to standard treatments, reduced mobility, and recurrent swelling. A comprehensive diagnostic evaluation through clinical examination, radiography, and magnetic resonance imaging (MRI) suggested tricompartmental osteoarthritis complicated by suspected arborescent lipoma. Surgical exploration not only confirmed the presence of arborescent lipoma but also revealed synovial chondromatosis. Both conditions were validated during total knee arthroplasty via histopathological examination, and the patient demonstrated significant functional recovery 18 months postoperatively. CLINICAL DISCUSSION The simultaneous occurrence of arborescent lipoma and synovial chondromatosis within an osteoarthritic knee emphasizes the complex nature of diagnosing and managing advanced joint pathologies. This case highlights the critical need for thorough diagnostic processes to differentiate between multiple potential diagnoses and the vital role of surgical intervention in managing such intricate conditions effectively. CONCLUSION The rare coexistence of arborescent lipoma and synovial chondromatosis in an osteoarthritic knee underlines the complexities of diagnosing and managing joint diseases. It accentuates the necessity of an exhaustive diagnostic approach and demonstrates the efficacy of surgical management in achieving favorable outcomes. This case supports the need for maintaining a broad differential diagnosis and underscores the value of interdisciplinary collaboration in managing complex joint pathologies.
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Affiliation(s)
- Omar Chraibi
- Orthopedics and Traumatology Surgery, 32 Pavilion, CHU Ibn Rochd, Casablanca, Morocco
| | | | - Mohamed Amine Lamris
- Orthopedics and Traumatology Surgery, 32 Pavilion, CHU Ibn Rochd, Casablanca, Morocco.
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Predictive Variables for Interventional Angiography among Patients with Knee Hemarthrosis. Diagnostics (Basel) 2022; 12:diagnostics12040976. [PMID: 35454024 PMCID: PMC9025792 DOI: 10.3390/diagnostics12040976] [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: 01/18/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Studies regarding the variables that could predict the success of conservative treatment for knee hemarthrosis are lacking. This retrospective study evaluated the laboratory variables of patients who had unsatisfactory results from conservative treatment for knee hemarthrosis. Twenty-nine patients conservatively treated for knee hemarthrosis were included and divided into two groups: group A comprised 14 patients who underwent interventional angiography and selective embolization due to failed conservative treatment, and group B comprised 15 patients with successful results after conservative treatment. The results of the serological and synovial fluid tests were evaluated. The mean number of synovial red blood cells (RBCs) was 1,905,857 cells/µL and 7730 cells/µL in groups A and B, respectively (p = 0.01), while the mean number of RBCs per high-power field (HPF) was 68.9 and 3.2, respectively (p < 0.01). Patients who underwent interventional angiography and selective embolization after failed conservative treatment for knee hemarthrosis had higher synovial RBC counts and RBC counts per HPF than those with successful outcomes after conservative treatment. It is necessary to carefully interpret the results of the synovial fluid analysis in patients with knee hemarthrosis; if the synovial fluid analysis shows a synovial RBC count greater than 81,500 and RBC count per HPF greater than 16.3, we recommend immediate interventional angiography rather than continuing conservative treatment.
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Smits M, van de Groes S, Thurlings RM. Synovial Tissue Biopsy Collection by Rheumatologists: Ready for Clinical Implementation? Front Med (Lausanne) 2019; 6:138. [PMID: 31281817 PMCID: PMC6595539 DOI: 10.3389/fmed.2019.00138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/04/2019] [Indexed: 12/19/2022] Open
Abstract
Synovial tissue from arthritis patients is increasingly used for both basic pathophysiological and clinical translational research. This development has been spurred by the development of biotechnological techniques for analysis of complex tissues and the validation of ultrasound guided biopsies for easier tissue sampling. This increasing use of synovial tissue raises questions on standardization of methodologies for tissue processing and cellular & molecular analyses. Furthermore, it raises the question if synovial tissue biopsy analysis may be more widely implemented in clinical practice, what are the methodological hurdles for implementation and what are the lessons that can be learned from previous experience. This will be the focus of this review.
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Affiliation(s)
- Marijn Smits
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rogier M Thurlings
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, Netherlands
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Wang CK, Alfayez S, Marwan Y, Martineau PA, Burman M. Knee Arthroscopy for the Treatment of Lipoma Arborescens. JBJS Rev 2019; 7:e8. [DOI: 10.2106/jbjs.rvw.18.00139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hayashi S, Adachi N, Ikuta Y, Shimizu R, Nakasa T, Ishikawa M, Nakamae A, Deie M, Ochi M. Lipoma arborescens in bilateral knee joints accompany gouty tophi: A case-based review of the literature. J Orthop Sci 2019; 24:184-188. [PMID: 27863888 DOI: 10.1016/j.jos.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/04/2016] [Accepted: 10/08/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Seiju Hayashi
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan.
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Ryo Shimizu
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Atsuo Nakamae
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Masataka Deie
- Department of Orthopedic Surgery, Aichi Medical University, Aichi, Japan
| | - Mitsuo Ochi
- Department of Orthopedic Surgery, Hiroshima University, Hiroshima, Japan
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Jang E, Danford NC, Levin AS, Tyler WK. Intra-Articular Tumors: Diagnosis and Management of the Most Common Neoplasms Involving Synovial Joints. JBJS Rev 2018; 6:e8. [PMID: 30589749 DOI: 10.2106/jbjs.rvw.17.00210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Eugene Jang
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
| | - Nicholas C Danford
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
| | - Adam S Levin
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Wakenda K Tyler
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
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Medical image analysis of knee joint lipoma arborescens and arthroscopic treatment. Comput Med Imaging Graph 2018; 66:66-72. [PMID: 29567561 DOI: 10.1016/j.compmedimag.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Arthroscopy is a minimally invasive surgical procedure on a joint in which examination and treatment of knee damage is performed using a surgical device known as the arthroscope. Lipoma arborescens (LA), an infrequent intra-articular lesion, originates from mature adipose cells under subsynovial tissue. The synovial membrane is pale yellow with large villous projections. It is caused by various underlying factors. We found many patients with LA and processed them appropriately.The research was implemented to investigate therapeutic effect of semi-automated arthroscopic diagnosis and treatment for knee joint. METHODS We used the Stryker arthroscopic in surgery that is 4 mm in diameter with angle at 30°. Patients were chosen by biomechanical analysis and scanning mode. All of the patients underwent radiographic imaging examination, Magnetic Resonance Imaging (MRI), Lysholm Score and Visual Analogue Scale (VAS). Arthroscopic limited synovectomy was carried out on these patients. RESULTS The wound of all patients healed up. The content of follow-up includes: chief complaints, range of motion of knee joint, Visual Analogue Scale (VAS) and Lysholm score. No swollen nor effusion of the infected knee was found in all patients during the follow-up. The postoperative symptom was markedly alleviated in fourteen patients and partially alleviated in one. All patients were satisfied with the therapeutic effect. CONCLUSION We performed biomechanical analysis based on knee slight flexion and extension. Arthroscopy is an endoscope for the diagnosis and treatment of joint diseases. Semi-automated arthroscopic debridement is good for early and mid-term osteoarthritis with Lipoma arborescens.
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Fornaciari P, Schai PA, Kurrer MO, Exner GU. Arthroscopic Synovectomy in Bilateral Lipoma Arborescens. J Orthop Case Rep 2017; 6:7-13. [PMID: 28507957 PMCID: PMC5404169 DOI: 10.13107/jocr.2250-0685.606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Lipoma arborescens (LA) is an uncommon condition that consists of a villous lipomatous proliferation of the synovial membrane. Open synovectomy has been previously selected as a curative treatment option. In recent years, some authors have published good results with arthroscopic interventions. We describe a well-documented case of bilateral LA of the knees treated with staged arthroscopic synovectomy. Case Report: A 48-year-old North American woman without a history of trauma presented with recurrent effusions and mild pain in both knee joints for many years. Magnetic resonance imaging examinations confirmed the diagnosis of bilateral LA with multiple villous lipomatous synovial proliferations pattern. Degenerative changes of the medial meniscus were detected bilaterally. The patient underwent bilateral arthroscopic anterior synovectomy and partial medial meniscectomy of the knee with three portal techniques. Arthroscopic the knee joint contained a large number or finger-shaped synovial proliferations with yellowish good vascularized diffuse villous masses in the suprapatellar bursa and intercondylar fossa. The cartilage showed degenerative changes with Outerbridge Grade II to III, which was particularly severe in the femoropatellar compartment. Histopathological examination of the villous masses demonstrated papillary hypertrophy, slight hyperplasia, vascular hyperplasia with a slight degree of stromal fibrosis, and interstitial lymphoplasmacytic inflammation. The adipose cells were reduced in number in relation to a normal finding but had a normal aspect without any pathological changes. 25 months after the first operation, the patient reported pain relief with the preserved function. Magnetic resonance examination of both knee joints at the last follow-up showed no relapse of the disease. The Knee injury and Osteoarthritis Outcome Score improved on the right knee joint from 39.3 preoperatively to 85.1 at the last follow-up, and on the left knee joint from 54.2 preoperatively to 86.3 at the last follow-up. Conclusion: Arthroscopic anterior synovectomy is an efficient method of achieving good results in LA with multiple villous lipomatous synovial proliferations pattern.
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Affiliation(s)
- Paolo Fornaciari
- Department of Orthopaedics, Fribourg Cantonal Hospital, Chemin des Pensionnats 2-6, CH-1708 Fribourg. Switzerland
| | - Pascal A Schai
- Department of Orthopaedics, Wolhusen Cantonal Hospital (LUKS), CH-6110 Wolhusen, Switzerland
| | - Michael O Kurrer
- Department of Surgical Pathology, University Hospital Zurich, CH-8091 Zürich, Switzerland
| | - G Ulrich Exner
- Department of Orthopaedics, Orthopedic Center Zürich (OZZ), Seestrasse 259, CH-8038 Zürich, Switzerland
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Lipoma Arborescens: Review of an Uncommon Cause for Swelling of the Knee. Case Rep Orthop 2016; 2016:9538075. [PMID: 27293937 PMCID: PMC4884798 DOI: 10.1155/2016/9538075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/04/2016] [Indexed: 11/22/2022] Open
Abstract
Lipoma arborescens is a rare cause of chronic monoarticular arthritis, with only a few cases reported in the literature. It is most commonly seen in the knee, but cases in other joints such as the wrist, shoulder, and elbow have also been described. It is a benign condition, in which the subsynovial tissue is replaced diffusely by mature fat cells. We describe a case involving the knee and discuss the symptoms, diagnosis, and treatment.
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Progressive bilateral lipoma arborescens of the knee complicated by juvenile spondyloarthropathy: A case report and review of the literature. Semin Arthritis Rheum 2013; 43:259-63. [DOI: 10.1016/j.semarthrit.2012.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/30/2012] [Accepted: 12/07/2012] [Indexed: 11/21/2022]
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Erol B, Ozyurek S, Guler F, Kose O. Lipoma arborescens of the knee joint. BMJ Case Rep 2013; 2013:bcr-2013-009271. [PMID: 23572269 DOI: 10.1136/bcr-2013-009271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Bekir Erol
- Department of Radiology, Antalya Education and Research Hospital, Antalya, Turkey
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Abstract
We report a patient with a lipoma arborescens in the knee, a chance finding discovered on MRI. This is an unusual cause of swelling of the knee joint; if this condition is present, it is almost always located in the suprapatellar pouch. In this case, the lipoma arborescens was found in the popliteal space.
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Xiao J, Xu Y, Wang J, Feng J, Shi Z. Bilateral Knee Lipoma Arborescens Combined with Osteoarthritis in Elderly Patients. J Int Med Res 2011; 39:1563-9. [PMID: 21986162 DOI: 10.1177/147323001103900448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Here, three cases of combined lipoma arborescens (LA) — a rare neoplastic lesion of the synovium — and osteoarthritis (OA) with bilateral knee involvement in elderly patients are reported. The clinical, magnetic resonance imaging and histological characteristics of this rare condition are described. Limited by the similarity of symptoms between LA and OA and the low sensitivity of X-ray for discerning LA, it was found that a diagnosis of LA could be easily missed. Follow-up data suggested that the treatment of LA was not jeopardized even if the diagnosis was not made preoperatively, since the lesion is easily discerned intraoperatively. The definitive treatment of synovectomy can then be performed without recurrence of the lesion. Based on the evidence of the sequence of symptoms and the progression of untreated LA with static OA at follow up, it is suggested that the aetiology of LA is secondary to OA in elderly patients.
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Affiliation(s)
- J Xiao
- Department of Joint Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Y Xu
- Department of Diagnostic Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - J Wang
- Department of Diagnostic Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - J Feng
- Department of Diagnostic Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Z Shi
- Department of Joint Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Nielsen GP, Rosenberg AE, O'Connell JX, Kattapuram SV, Schiller AL. Tumors and diseases of the joint. Semin Diagn Pathol 2011; 28:37-52. [PMID: 21675376 DOI: 10.1053/j.semdp.2011.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of different diseases affect the synovium, including infection, noninfectious immunologic inflammatory conditions, degenerative arthroses, crystal deposits, trauma, and tumors. Tumors of the synovium are relatively uncommon. Any mesenchymal tumor may arise in the synovium, but most recapitulate its normal counterpart including synoviocytes, blood vessels, fat, and fibrous tissue. These tumors can arise in any synovial lined structures both within joints and in extraarticular locations. Most synovial tumors are benign. Malignant tumors are rare but important to recognize because many are aggressive and must be treated appropriately. Among common nonneoplastic conditions that affect the synovium and surrounding structures are crystal deposits such as monosodium urate crystals, calcium pyrophosphate dihydrate crystals, and hydroxyapatite crystals. These crystal deposits may be asymptomatic or cause severe pain or chronic joint destruction. Their accurate identification is important to guide appropriate therapy.
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Affiliation(s)
- G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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