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Zeoli T, Mathkour M, Scullen T, Carr C, Abou-Al-Shaar H, Wang L, Divagaran A, Dindial R, Tubbs RS, Bui CJ, Maulucci CM. Spinal pigmented villonodular synovitis and tenosynovial giant cell tumor: A report of two cases and a comprehensive systematic review. Clin Neurol Neurosurg 2021; 202:106489. [PMID: 33596487 DOI: 10.1016/j.clineuro.2021.106489] [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: 09/24/2020] [Revised: 11/07/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Pigmented villonodular synovitis (PVNS) is a lesion of uncertain etiology that involves the synovial membranes of joints or tendon sheaths, representing a diffuse and non-encapsulated form of the more common giant cell tumors of the synovium (GCTTS). PVNS was reclassified to denote a diffuse form of synovial giant cell tumor (TSGCT), while 'giant cell tumor of the tendon sheath (GCTTS)' was used for localized lesions. These pathologies rarely affect the axial skeleton. We provide an unprecedented and extensive systematic review of both lesions highlighting presentation, diagnostic considerations, treatment, prognosis, and outcomes, and we report a short case-series. METHOD We describe two-cases and conduct a systematic review in accordance with PRISMA guidelines. RESULT PVNS was identified in most of the cases reviewed (91.6 %), manifesting predominantly in the cervical spine (40 %). Patients commonly presented with neck pain (59 %), back pain (53 %), and lower back pain (81.2 %) for cervical, thoracic, and lumbar lesions, respectively. GTR occurred at rates of 94 %, 80 %, and 87.5 %. Recurrence was most common in the lumbar region (30.7 %). GCTTS cases (8%) manifested in the cervical and thoracic spine at the same frequency. We reported first case of GCTTS in the lumbosacral region. Both poses high rate of facet and epidural involvements. CONCLUSION Spinal PVNS and GCTTS are rare. These lesions manifest most commonly as PVNS within the cervical spine. Both types have a high rate of facet and epidural involvement, while PVNS has the highest rate of recurrence within the lumbar spine. The clinical and radiological features of these lesions make them difficult to differentiate from others with similar histogenesis, necessitating tissue diagnosis. Proper management via GTR resolves the lesion, with low rates of recurrence.
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Affiliation(s)
- Tyler Zeoli
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - Mansour Mathkour
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Saudi Arabia.
| | - Tyler Scullen
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
| | - Christopher Carr
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Leon Wang
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - Adhira Divagaran
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - Rishawn Dindial
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
| | - Cuong J Bui
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
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Thatikunta M, Nuru M, Mathew AE, Altstadt TJ. Tenosynovial Giant Cell Tumor of the Cervical Spine: Case Report and Review of the Literature. Cureus 2020; 12:e12232. [PMID: 33505809 PMCID: PMC7821702 DOI: 10.7759/cureus.12232] [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] [Indexed: 11/20/2022] Open
Abstract
Tenosynovial giant cell tumor (TGCT) is a rare entity that is not well described in the neurosurgical literature. We present a case of a 37-year-old woman with a diffuse subtype TGCT of the cervical spine, affecting the left cervical 6-7 facet joint, with co-incidental cervical trauma. Initial management consisted of subtotal resection and cervical stabilization with cervical 6 to 7 laminectomy, and cervical 4 to thoracic 2 posterior instrumented fusion. Gross total resection was achieved at a later date with a plan for postoperative radiation to prevent a recurrence. The patient was lost to follow-up for radiation treatment and returned 2.5 years later with minor symptoms and recurrence at the surgical site.
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Affiliation(s)
- Meena Thatikunta
- Neurosurgery, University of Louisville Hospital, Louisville, USA
| | - Mohammed Nuru
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Ashley E Mathew
- Pathology, University of Louisville Hospital, Louisville, USA
| | - Thomas J Altstadt
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
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Gader G, Belaïd A, Zehani A, Daghfous A, Zammel I, Badri M. Villonodular synovitis of the lumbar spine: Case report of a rare pathology. Clin Case Rep 2020; 8:2346-2349. [PMID: 33363737 PMCID: PMC7752619 DOI: 10.1002/ccr3.3107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/06/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022] Open
Abstract
Lumbar pigmented villonodular synovitis is rarely localized on the lumbar spine. Awareness of pigmented villonodular synovitis is important despite its rarity because it may mimic several other lesions of this location.
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Affiliation(s)
- Ghassen Gader
- Department of NeurosurgeryTrauma and Burns CenterBen ArousTunisia
| | - Aymen Belaïd
- Department of RadiologyTrauma and Burns CenterBen ArousTunisia
| | - Alia Zehani
- Department of PathologyLa Rabta HospitalTunisTunisia
| | - Alifa Daghfous
- Department of RadiologyTrauma and Burns CenterBen ArousTunisia
| | - Ihsèn Zammel
- Department of NeurosurgeryTrauma and Burns CenterBen ArousTunisia
| | - Mohamed Badri
- Department of NeurosurgeryTrauma and Burns CenterBen ArousTunisia
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Tenosynovial Giant Cell Tumor, Diffuse Type/Pigmented Villonodular Synovitis in a Pars Defect: A Case Report. Spine (Phila Pa 1976) 2015; 40:E735-9. [PMID: 26067150 DOI: 10.1097/brs.0000000000000923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a rare case of tenosynovial giant cell tumor, diffuse type/pigmented villonodular synovitis (PVNS) in a pars defect in a patient with lumbar spondylolysis. SUMMARY OF BACKGROUND DATE PVNS rarely occurred in lumbar spine, and no studies in the English literature have reported PVNS in a pars defect in lumbar spondylolysis. METHODS The patient was a 14-year-old female presented with a 5-month history of low back pain. Plain radiography showed spondylolysis at L5 and computed tomography revealed a 1 × 2-cm slightly eroding tumorous mass at the left L5 pars. On magnetic resonance imaging, the mass showed intermediate intensity and gadolinium enhancement on T1-weighted images (WI) and high intensity on T2-WI and T2 STAR-WI. After undergoing computed tomography-guided needle biopsy, a pathological diagnosis of PVNS was made and total gross resection was performed. RESULTS The gross appearance and the postoperative pathological diagnosis were consistent with PVNS. The postoperative clinical course was uneventful and postoperative computed tomography and magnetic resonance imaging revealed no residual lesion. CONCLUSION This is the first report of PVNS occurring in spondylolysis. LEVEL OF EVIDENCE N/A.
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Oh SW, Lee MH, Eoh W. Pigmented villonodular synovitis on lumbar spine : a case report and literature review. J Korean Neurosurg Soc 2014; 56:272-7. [PMID: 25368775 PMCID: PMC4217069 DOI: 10.3340/jkns.2014.56.3.272] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/06/2014] [Accepted: 08/14/2014] [Indexed: 12/29/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a benign proliferative joint disease with an uncertain etiology that uncommonly involves the spine. We present a case of PVNS involving the lumbar spine. A 38-year-old male developed back pain and pain in both legs caused by a mass in the L4 region of the right lamina. After gross total tumor removal, the symptoms improved. The pathological finding was synovial hyperplasia with accumulation of hemosiderin-laden macrophages. He was diagnosed with PVNS and experienced no recurrence for up to 2 years after surgery. In this report, we review the previous literature and discuss etiology, clinical manifestations, diagnosis, and treatment.
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Affiliation(s)
- Sung Woon Oh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whan Eoh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Pigmented villonodular synovitis of the thoracic spine. J Clin Neurosci 2014; 21:1679-85. [PMID: 24938389 DOI: 10.1016/j.jocn.2014.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/30/2014] [Indexed: 12/18/2022]
Abstract
Pigmented villonodular synovitis (PVNS) is a proliferative lesion of the synovial membranes. Knees, hips, and other large weight-bearing joints are most commonly affected. PVNS rarely presents in the spine, in particular the thoracic segments. We present a patient with PVNS in the thoracic spine and describe its clinical presentation, radiographic findings, pathologic features, and treatment as well as providing the first comprehensive meta-analysis and review of the literature on this topic, to our knowledge. A total of 28 publications reporting 56 patients were found. The lumbar and cervical spine were most frequently involved (40% and 36% of patients, respectively) with infrequent involvement of the thoracic spine (24% of patients). PVNS affects a wide range of ages, but has a particular predilection for the thoracic spine in younger patients. The mean age in the thoracic group was 22.8 years and was significantly lower than the cervical and lumbar groups (42.4 and 48.6 years, respectively; p=0.0001). PVNS should be included in the differential diagnosis of osteodestructive lesions of the spine, especially because of its potential for local recurrence. The goal of treatment should be complete surgical excision. Although the pathogenesis is not clear, mechanical strain may play an important role, especially in cervical and lumbar PVNS. The association of thoracic lesions and younger age suggests that other factors, such as neoplasia, derangement of lipid metabolism, perturbations of humoral and cellular immunity, and other undefined patient factors, play a role in the development of thoracic PVNS.
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C1-C2 pigmented villonodular synovitis and clear cell carcinoma: unexpected presentation of a rare disease and a review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S465-71. [PMID: 24908254 DOI: 10.1007/s00586-014-3396-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/23/2014] [Accepted: 05/24/2014] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Pigmented Villonodular synovitis (PVNS) is a rare vertebral pathology--around 50 reports, only 3 concerning C1-C2 location. CASE REPORT A 64-year-old man, submitted to a right nephrectomy for a clear cell carcinoma, presented with an asymptomatic osteolytic C1-C2 lesion. Even though the diagnosis of metastatic disease was the most probable, the presence of a solitary lesion without other osseous or systemic localization and the predicted low risk of recurrence imposed a surgical biopsy. A pigmented villonodular synovitis diagnosis was made, a rare vertebral pathology--around 50 reports, only 3 concerning C1-C2 location. No further treatment was assigned precluding the iatrogenic consequences of empirical treatments based on clinical diagnosis with no histopathological support. The patient remains stable at 18 months of follow-up. CONCLUSION A large differential diagnosis should be made when the typical findings for metastatic disease are absent precluding the iatrogenic consequences of empirical treatments based on clinical diagnosis with no histopathological support.
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Kim SJ, Ha DH, Lee SM, Kang H. Desmoid type fibromatosis in the facet joint of lumbar spine: case report and review of literature. Korean J Radiol 2013; 14:818-22. [PMID: 24043979 PMCID: PMC3772265 DOI: 10.3348/kjr.2013.14.5.818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 04/08/2013] [Indexed: 11/22/2022] Open
Abstract
Desmoid type fibromatosis is a benign fibroblastic tumor arising from the fascia or musculoaponeurosis. It may occur in various locations, but most commonly in the shoulder girdle and neck; to our knowledge, there has been no reported case originating from a facet joint of the spine. We report CT and MR imaging findings of a desmoid type fibromatosis, involving the facet joint of the L3-4 spine with bone involvement.
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Affiliation(s)
- So Jung Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam 463-712, Korea
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Müslüman AM, Cavuşoğlu H, Yilmaz A, Dalkiliç T, Tanik C, Aydin Y. Pigmented villonodular synovitis of a lumbar intervertebral facet joint. Spine J 2009; 9:e6-9. [PMID: 19303820 DOI: 10.1016/j.spinee.2008.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 11/07/2008] [Accepted: 12/04/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pigmented villonodular synovitis (PVNS) is a slowly progressive lesion of uncertain etiology that involves the synovial membrane of joints or tendon sheaths. Only rarely does PVNS affect the axial skeleton, where it arises from the vertebral articular facet joint. Its treatment and prognosis remains limited. PURPOSE To describe our management in a patient with PVNS and to review previously published cases. STUDY DESIGN Case report. METHODS This is a case report of a 59-year-old woman who presented left sciatica. Computed tomography (CT) imaging revealed a mixed sclerotic and lucent lesion affecting the left L4-L5 facet joint. Magnetic resonance imaging (MRI) demonstrated a diffusely infiltrative process that originated from the left inferior articular process of L4 vertebra with extension into the spinal canal. A total synovectomy with left L4 hemilaminectomy was performed. Left L5 root was decompressed with total microscopic tumor removal. Decompression of spinal canal and absence of the tumor was shown by MRI and CT scan after the operation. RESULTS Complete resolution of the patient's complaints was achieved. Histopathological analysis was consistent with a diagnosis of PVNS. CONCLUSIONS The principle of surgical management of spinal lesions causing neurologic deficit is early surgical decompression. It is also important to totally remove the synovium, the origin of PVNS, to prevent the recurrence.
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Affiliation(s)
- Ahmet Murat Müslüman
- Neurosurgery Clinic, Sişli Etfal Education and Research Hospital, Istanbul, Turkey
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Arnold PM, Dunlay RP, Haynes NG, Tawfik O, Hodges J. Pigmented villonodular synovitis of the thoracic spine: case report and review of the literature. COLUNA/COLUMNA 2009. [DOI: 10.1590/s1808-18512009000100019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pigmented Villonodular Synovitis (PVNS), a lesion of the synovial tissues, is rarely found in the spine. We present a 73-year-old male with increasing lower extremity weakness and paresthesias. MRI scans revealed disc herniation and spinal cord compression at the T11-T12 and T12- L1 levels. Intraoperative exploration revealed an epidural mass originating in the T12 lamina, compressing the spinal cord at T11-T12. Pathologic examination was consistent with pigmented villonodular synovitis.
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