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Ipponi E, Ruinato AD, Lombardi L, Cordoni M, Franco SD, D’Arienzo A, Andreani L. Outcomes of Surgical Treatment for Localized Tenosynovial Giant-Cell Tumor of the Foot and Ankle: A Case Series. Acta Med Litu 2023; 30:163-170. [PMID: 38516519 PMCID: PMC10952426 DOI: 10.15388/amed.2023.30.2.8] [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: 04/02/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 03/23/2024] Open
Abstract
Background Giant cell tumor of the tendon sheath (GCTTS), also termed Tenosynovial giant cell tumor (TGCT), is a locally aggressive tumor which originates from tendon sheaths or bursas. Around 3-5% of these tumors arise from foot and ankle. Localized lesions in this area are often manifested as firm masses or nodules with slow but continuous progression through months and years. Pain associated with weight-bearing, as well as limitations in joint motions, may be reported, depending on tumor's location. Surgery is the treatment of choice for the definitive removal of GCTTSs with the aim to eradicate the neoplasm and restore the lower limb's functionality. Methods Thirteen cases suffering from GCTTS of the foot and ankle underwent surgical resection at our institution between 2017 and 2022. For each case we recorded pre-operative and post-operative symptoms, as well as their pre-operative and post-operative functional status according to both MSTS and AOFAS scores. Eventual complications and local recurrences were reported. Results Each patient experienced an at least mild pain before surgical treatment. The mean pre-operative MSTS and AOFAS scores were 22.8 and 70.7, respectively. The mean tumor size was 17.7 mm. Each patient received a resection with wide margins. Two cases (15.4%) had local recurrences. None had major complications at their latest follow-up. After the surgery, the mean post-operative MSTS and AOFAS scores increased to 28.3 and 92.2, respectively. Conclusion Resection with wide margins for foot and ankle GCTTS is effective in restoring the patients' lower limb functionality and is associated with reasonable local recurrence rates.
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Affiliation(s)
- Edoardo Ipponi
- Department of Orthopedics and Trauma surgery, University of Pisa, Italy
| | | | - Leonardo Lombardi
- Department of Orthopedics and Trauma surgery, University of Pisa, Italy
| | - Martina Cordoni
- Department of Orthopedics and Trauma surgery, University of Pisa, Italy
| | - Silvia De Franco
- Department of Orthopedics and Trauma surgery, University of Pisa, Italy
| | - Antonio D’Arienzo
- Department of Orthopedics and Trauma surgery, University of Pisa, Italy
| | - Lorenzo Andreani
- Department of Orthopedics and Trauma surgery, University of Pisa, Italy
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Ikuta Y, Nakasa T, Sumii J, Nekomoto A, Kawabata S, Adachi N. Distraction Arthroplasty Combined with Autologous Bone Grafting for Diffuse-type Tenosynovial Giant Cell Tumour with Articular Cartilage Defect and Subchondral Bone Cysts: A Case Report. Mod Rheumatol Case Rep 2022:rxac092. [PMID: 36484489 DOI: 10.1093/mrcr/rxac092] [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: 05/12/2022] [Revised: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
Tenosynovial giant cell tumour encompasses a group of lesions that present with synovial differentiation and most commonly occur in the joint synovium, bursae, and tendon sheaths. Diffuse-type tenosynovial giant cell tumour, previously known as pigmented villonodular synovitis, is one of the most common benign soft tissue tumours of the foot and ankle and usually affects young adults. The differential diagnosis of diffuse-type tenosynovial giant cell tumours remains a clinical problem because its clinical symptoms are similar to those of inflammatory arthritis, including rheumatoid arthritis. Moreover, persistent diffuse-type tenosynovial giant cell tumours can lead to articular deterioration, including osseous erosions and subchondral bone cysts. Joint-preserving procedures are considered optimal for treating younger patients with ankle osteoarthritis because the indication of ankle arthrodesis and total ankle arthroplasty is limited. Thus, ankle distraction arthroplasty could be an alternative for treating diffuse-type tenosynovial giant cell tumour with articular deterioration in young patients. Here, we report about a woman in her early 30s who presented with ankle pain owing to a diffuse-type tenosynovial giant cell tumour with an articular cartilage defect and subchondral bone cysts. We performed ankle distraction arthroplasty combined with an autologous bone graft. A follow-up examination at 2 years revealed preservation of physical function and pain alleviation. These findings suggest that distraction arthroplasty is a viable treatment option for remedying the destruction of the articular cartilage and subchondral bone owing to diffuse-type tenosynovial giant cell tumours in young adults.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Rana R, Behera S, Jeetendra C. Pigmented Villonodular Synovitis of Flexor Hallusis Longus, Flexor Digitorum Longus, Tibialis Posterior: A Rare Case Report. Cureus 2022; 14:e24595. [PMID: 35664403 PMCID: PMC9148550 DOI: 10.7759/cureus.24595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/25/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a locally aggressive benign tumour of the synovial membrane and tendon sheath. The unique presentation of this tumour is hemosiderin deposition with synovial proliferation. Depending on the situation, surgical excision is always the first line of treatment with adjuvant radiotherapy. Arthroscopic excision is preferred in some intraarticular nodular PVNS cases. This is a rare pigmented villonodular synovitis involving flexor hallusis longus, flexor digitorum longus, and tibialis posterior (TP). The tumour was entirely extra-articular without any joint involvement. The tumour was the diffuse type of PVNS and was treated by excision followed by radiotherapy. There is no recurrence till nine months of follow-up.
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Lukosius E, Chopra A, Parekh S. Anterior Capsule Reconstruction in the Setting of PVNS. Foot Ankle Spec 2022:19386400221088456. [PMID: 35416081 DOI: 10.1177/19386400221088456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a benign proliferative disease affecting tendon sheaths and synovial tissue. Pigmented villonodular synovitis in the foot and ankle has a high rate of recurrence, which can be destructive if incompletely removed. This case series analyzes functional outcomes after PVNS operative resection with an anterior ankle capsular reconstruction, using a novel technique. METHODS Three patients with PVNS underwent surgery between 2010 and 2020. The operative technique involved a posterior, midline approach for PVNS resection of the affected ankle joint, followed by a standard anterior approach for capsular excision. Subsequent anterior capsular reconstruction was performed with a regenerative tissue matrix and a bioresorbable anchoring system. Preoperative and postoperative range of motion for the ankle and subtalar joints, visual analog scale (VAS) for pain, and return to daily activities was assessed along with appropriate radiographs and magnetic resonance imaging (MRI) imaging. RESULTS All 3 surgeries had a mean follow-up period of 52.3 (range, 4-123) months and resulted in successful recovery as assessed by the VAS and self-reported activity. Preoperative ankle dorsiflexion and plantarflexion along with subtalar inversion and eversion range of motion were all normal. Postoperative ankle motion and subtalar motion were not statistically different. No complications or recurrence of PVNS was observed. CONCLUSION Further investigation is warranted to better understand the clinical outcomes of this technique designed to successfully eliminate PVNS recurrence. LEVEL OF EVIDENCE IV- Retrospective case series.
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Affiliation(s)
- Eric Lukosius
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Aman Chopra
- Georgetown University School of Medicine, Washington, DC
| | - Selene Parekh
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Guiffre D, Brien E, Shon W, Geffner ME. A Rare Case of Diffuse-type Tenosynovial Giant Cell Tumor in a Teenager With Noonan Syndrome. J Pediatr Hematol Oncol 2022; 44:e557-e560. [PMID: 34133387 DOI: 10.1097/mph.0000000000002233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Abstract
Noonan syndrome is a common autosomal dominant disorder associated with an increased risk of malignancy. We report a 16-year-old female with Noonan syndrome (KRAS gene variant, Q22R) and diffuse-type tenosynovial giant cell tumor, a proliferative disorder that has been rarely reported in this population. These tumors may represent a complication of the dysregulated RAS/MAPK signaling pathway that underlies Noonan syndrome. They lack typical clinical features, causing misdiagnosis and delays in management, which could lead to osseous invasion requiring more complicated surgical procedures. Increased awareness of this association will improve the clinical outcomes of patients with Noonan syndrome who develop diffuse-type tenosynovial giant cell tumors.
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Affiliation(s)
- Danielle Guiffre
- Center For Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles (CHLA), Keck School of Medicine of USC
| | - Earl Brien
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Wonwoo Shon
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mitchell E Geffner
- Center For Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles (CHLA), Keck School of Medicine of USC.,Saban Research Institute, Keck School of Medicine of USC
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Siegel M, Bode L, Südkamp N, Kühle J, Zwingmann J, Schmal H, Herget GW. Treatment, recurrence rates and follow-up of Tenosynovial Giant Cell Tumor (TGCT) of the foot and ankle-A systematic review and meta-analysis. PLoS One 2021; 16:e0260795. [PMID: 34855875 PMCID: PMC8638888 DOI: 10.1371/journal.pone.0260795] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/16/2021] [Indexed: 01/07/2023] Open
Abstract
Background The tenosynovial giant cell tumor (TGCT) is a usually benign lesion which arises from the synovium. It affects joints, tendon sheaths and bursae. The clinical course is often unpredictable, and local recurrences frequently occur. The aim of this study was to describe different treatment options, surgical complications, and to develop a follow-up regime based on a systematic literature review and meta-analysis of foot and ankle lesions. Methods and results 1284 studies published between 01/1966 and 06/2021 were identified. 25 met the inclusion criteria, with a total of 382 patients. Of these, 212 patients had a diffuse (dTGCT) and 170 a localized (lTGCT) TGCT. Patients with a dTGCT had a mean age of 36.6±8.2 years, and 55% were female. The overall complication rate was 24% in dTGCT, irrespective of the therapeutic procedure; the mean follow-up was 37.9±27.4 months with a recurrence rate of 21%, and recurrences occurred between 3 and 144 months, the vast majority (86%) within the first 5 years following intervention. Patients with a lTGCT had a mean age of 31.2±5.7 years, and 53% were female. Complications occurred in 12%. The mean follow-up was 51.1±24.6 months, the recurrence rate was 7%, and recurrence occurred between 1 and 244 months after intervention. Conclusion Diffuse TGCTs of the foot and ankle region have a remarkable recurrence rate irrespective of therapeutic procedures, and most lesions reoccurred within 5, with more than half of these in the first 2 years. The lTGCTs are well treatable lesions, with a low recurrence and a moderate complication rate. Based on these findings, we propose a follow-up regime for the dTGCT including a clinical survey and MR imaging 3 months after surgical intervention (baseline), followed by twice-yearly intervals for the first 2 years, yearly intervals up to the fifth year, and further individual follow-up due to the fact that recurrences can even occur for years later. For the lTGCT a clinical survey and MRT is proposed after 3–6 months after intervention (baseline), followed by annual clinical examination for 3 years, and in case of symptoms MR-imaging. Larger prospective multi-center studies are necessary to confirm these results and recommendations.
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Affiliation(s)
- M. Siegel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre–University of Freiburg, Freiburg, Germany
- * E-mail:
| | - L. Bode
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre–University of Freiburg, Freiburg, Germany
| | - N. Südkamp
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre–University of Freiburg, Freiburg, Germany
| | - J. Kühle
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre–University of Freiburg, Freiburg, Germany
| | - J. Zwingmann
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre–University of Freiburg, Freiburg, Germany
- Department of Orthopaedic Surgery and Traumatology, St. Elisabeth Hospital, Ravensburg, Germany
| | - H. Schmal
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre–University of Freiburg, Freiburg, Germany
- Department of Orthopaedic Surgery, University Hospital Odense, Odense C, Denmark
| | - G. W. Herget
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre–University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg CCCF, Faculty of Medicine, Medical Centre—University of Freiburg, Freiburg, Germany
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Ota T, Nishida Y, Ikuta K, Tsukushi S, Yamada K, Kozawa E, Urakawa H, Imagama S. Tumor location and type affect local recurrence and joint damage in tenosynovial giant cell tumor: a multi-center study. Sci Rep 2021; 11:17384. [PMID: 34462509 PMCID: PMC8405684 DOI: 10.1038/s41598-021-96795-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022] Open
Abstract
Osteochondral destruction and a high recurrence rate after surgery are major concerns that make difficult the treatment course of tenosynovial giant cell tumor. The aims of this study were to elucidate rates of postoperative local recurrence and osteochondral destruction, as correlated with various demographic factors. Eighty surgically treated patients with intra-articular tumors (knee: 49, ankle and foot: 12, hip: 10, others: 9) were included in this study. Factors including age, disease type (diffuse/localized), location, existence of osteochondral destruction were correlated with local recurrence or development/progression of osteochondral destruction. The 5-year local recurrence free survival rate was 71.4%. Diffuse type (n = 59, localized: n = 21) (P = 0.023) and knee location (P = 0.002) were independent risk factors for local recurrence. Diffuse type (P = 0.009) was a significant risk factor, and knee location (P = 0.001) was a negative factor for osteochondral destruction at the initial examination. Progression of osteochondral destruction was observed more often in cases with local recurrence (P = 0.040) and findings of osteochondral destruction at the initial examination (P = 0.029). Diffuse type is a factor that should be noted for both local recurrence and osteochondral destruction, while local recurrence occurs but osteochondral destruction is less observed in the knee.
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Affiliation(s)
- Takehiro Ota
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Department of Orthopaedic Surgery, Nagoya Memorial Hospital, Nagoya, Aichi, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. .,Department of Rehabilitation Medicine, Nagoya University Hospital, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan.
| | - Kunihiro Ikuta
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Tsukushi
- Department of Orthopaedic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Kenji Yamada
- Department of Orthopaedic Surgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Eiji Kozawa
- Department of Orthopaedic Surgery, Nagoya Memorial Hospital, Nagoya, Aichi, Japan
| | - Hiroshi Urakawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Córdoba-Fernández A, Sánchez-Robles LJ, Lobo-Martín A. Tenosynovial Giant Cell Tumor in the Forefoot: Two Case Reports and Literature Review. J Am Podiatr Med Assoc 2021; 111:466712. [PMID: 34144588 DOI: 10.7547/20-089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tenosynovial giant cell tumor is the common term used to describe a group of soft-tissue tumors that share a common etiologic link. These tumors are relatively infrequent in the foot and ankle, and occasionally they may be the cause of destruction of the adjacent bone structures. We report the imaging appearance and pathologic findings of two patients with localized tenosynovial giant cell tumor of the forefoot. Both of these patients underwent surgical gross total resection. However, one of the patients experienced a recurrence. Their clinical, radiologic, and pathologic features, with their treatment protocol, are summarized retrospectively, and related literature is reviewed in an attempt to enhance the understanding of these tumor lesions. Clinicians should perform a careful preoperative and postoperative examination and complete tumor surgical resection with the aim of reducing local recurrence.
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Williams RD, Honeycutt MW, Manci EA, Nimityongskul P. Pediatric Tenosynovial Giant Cell Tumor of the Flexor Hallucis Longus Tendon Sheath: A Case Report. JBJS Case Connect 2021; 10:e0519. [PMID: 32649117 DOI: 10.2106/jbjs.cc.19.00519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE An otherwise healthy 13-year-old girl presented with a firm nodule on the plantar right forefoot that was tender after cheerleading. Initial workup was unremarkable, but magnetic resonance imaging revealed a multilobulated mass surrounding the flexor hallucis longus tendon. Surgical resection revealed a tenosynovial mass without tendon infiltration. Pathologic examination was consistent with tenosynovial giant cell tumor. The patient resumed cheerleading and remained asymptomatic after 1 year. CONCLUSION As far as we know, this is the first report of a tenosynovial giant cell tumor of the flexor hallucis longus in a pediatric patient; it illustrates the importance of considering this lesion when diagnosing a pediatric plantar mass.
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Affiliation(s)
- Richard D Williams
- 1Department of Orthopaedic Surgery, University of South Alabama, Mobile, Alabama 2Department of Pathology, University of South Alabama, Mobile, Alabama
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Endoscopic resection of a localized tenosynovial giant cell tumor causing posterior ankle impingement in a 15-year-old athlete: A case report. Jt Dis Relat Surg 2021; 32:234-238. [PMID: 33463443 PMCID: PMC8073462 DOI: 10.5606/ehc.2021.77699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Tenosynovial giant cell tumor (TGCT) is a systematically benign but locally aggressive lesion arising from the synovium, tendon sheath or joint bursae. Even in athletes, soft tissue tumors may be the underlying reason or a component of posterior ankle impingement, although the most common mechanism is forceful and repetitive plantar flexion. In this article, we present a case of localized TGCT in a 15-year-old female patient presenting with symptoms of posterior ankle impingement. The preferred technique for treatment was complete local resection via posterior ankle endoscopy. The patient returned to sports at three months and no recurrence was observed on the last follow-up at the first postoperative year. Although rare, soft tissue tumors should be taken into consideration in posterior ankle impingement in athletes. Such benign soft tissue tumors in the posterior ankle can be treated safely and effectively via two-portal posterior endoscopic approach.
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Management of Tenosynovial Giant Cell Tumor: A Neoplastic and Inflammatory Disease. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00028. [PMID: 33156160 PMCID: PMC7643913 DOI: 10.5435/jaaosglobal-d-20-00028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Patients with diffuse tenosynovial giant cell tumor (TGCT) face a high risk of recurrence, progression, and disability. This systematic review assesses the recent evidence of surgical, adjuvant, and systemic treatments for TGCT. Methods: We searched PubMed and Ovid with the terms “Giant cell tumor of tendon sheath” OR “pigmented villonodular synovitis” OR “tenosynovial giant cell” AND “treatment” OR “surgery.” Inclusion criteria: published 2013 to present; prospective or retrospective design; English language; > 20 patients with histopathological confirmed diagnosis of TGCT; and ≥ 1 efficacy and/or safety outcome from surgery, systemic drug therapy, or adjuvant 90yttrium radiosynoviorthesis. Results: Of the 434 studies identified, 25 met the inclusion criteria. Of 11 studies in patients with disease in the knee, nine examined surgical treatment approaches, and two evaluated adjuvant 90yttrium radiosynoviorthesis. Of 11 studies in patients with mixed sites of disease, six assessed surgical treatment approaches, and five evaluated systemic drug therapies. Three studies assessed surgery in patients with TGCT in the hand, hip, and ankle or foot. Discussion: The high rates of recurrence and risks associated with surgery emphasize the need for novel treatments in patients with symptomatic, advanced TGCT. Systemic therapy may be valuable as part of a multidisciplinary approach.
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Tsukamoto S, Zucchini R, Staals EL, Mavrogenis AF, Akahane M, Palmerini E, Errani C, Tanaka Y. Incomplete resection increases the risk of local recurrence and negatively affects functional outcome in patients with tenosynovial giant cell tumor of the hindfoot. Foot Ankle Surg 2020; 26:822-827. [PMID: 31839476 DOI: 10.1016/j.fas.2019.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/26/2019] [Accepted: 10/29/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diffuse tenosynovial giant cell tumors (TGCT) are more likely to occur in the hindfoot and tend to recur after surgical excision. We performed a pooled analysis of hindfoot TGCT cases to identify factors associated with local recurrence and functional outcomes. METHODS We retrospectively reviewed medical records of 33 patients diagnosed with TGCT (15, localized cases; 18 diffused cases) of the hindfoot between 1998 and 2017. Median follow-up was 32 months. Multivariable Cox proportional hazards regression analysis was conducted to estimate the hazard ratios for risk factors for local failure. Generalized linear regression models were used to assess whether resection status, tumor size, tumor type or bone involvement correlated with the Musculoskeletal Tumor Society (MSTS) score. RESULTS Local failure was reported in 30% (10/33) patients. Multivariable analysis showed that macroscopically incomplete resection was the only independent prognostic factor for poor local failure-free survival (P=.001). Incomplete resection significantly decreased MSTS score and negatively affected functional outcome (P=.047). CONCLUSIONS Incomplete resection increases the risk of local recurrence and negatively affects functional outcome in patients with TGCT of the hindfoot.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan.
| | - Riccardo Zucchini
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Eric L Staals
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562 Holargos, Athens, Greece
| | - Manabu Akahane
- Department of Public Health, Health Management and Policy, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Emanuela Palmerini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara, Nara 634-8521, Japan
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13
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Çevik HB, Kayahan S, Eceviz E, Gümüştaş SA. Tenosynovial giant cell tumor in the foot and ankle. Foot Ankle Surg 2020; 26:712-716. [PMID: 31526689 DOI: 10.1016/j.fas.2019.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/28/2019] [Accepted: 08/28/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tenosynovial giant cell tumor (TSGCT) originates from the synovial cells of the tendon sheath and is the most common soft tissue tumor of the foot and ankle. Due to the lack of clinical data about TSGCT in the foot and ankle, this study was performed with the aim of investigating the clinical characteristics, and surgical outcomes that might predict the likelihood of recurrence. METHODS Clinical data, obtained from the pathology records and the clinic files, along with the tumor subtype, local recurrence, and patient functional status among 26 cases of TSGCT were evaluated with the mean 73 months follow-up period. RESULTS There were 26 patients including 16 males and 10 females with a mean age of 40 years, who underwent surgery. There were 15 localised TSGCT and 11 diffuse TSGCT. The diffuse TSGCT was more likely to be in the hindfoot dorsum (54,5%, 6/11). The localised TSGCT was mostly located in the forefoot (80%, 12/15). The recurrence rate in the diffuse TSGCT was 27,3% (3/11). In the localised TSGCT, recurrence was seen in 6,6% of patients (1/15). The mean AOFAS score was 79. CONCLUSION Diffuse TSGCT is more likely to occur in the hindfoot and localised TSGCT is more common in the forefoot. Excision with clear margins is an effective treatment for TSGCT, with good oncological and clinical outcomes. But the orthopaedic surgeons should consider the equilibrium between surgical margins and the functional status of the patient.
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Affiliation(s)
- Hüseyin Bilgehan Çevik
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Research and Training Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
| | - Sibel Kayahan
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Research and Training Hospital, Department of Pathology, İstanbul Turkey
| | - Engin Eceviz
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Research and Training Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Seyit Ali Gümüştaş
- University of Health Sciences, Kartal Dr. Lütfi Kırdar Research and Training Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
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Radiosynoviorthesis after Surgery in the Treatment of Patients with Ankle Pigmented Villonodular Synovitis: A Case Series. J Clin Med 2020; 9:jcm9020597. [PMID: 32098290 PMCID: PMC7073893 DOI: 10.3390/jcm9020597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) of the ankle is a very rare, locally aggressive, proliferative disorder. Although surgical excision represents the standard curative treatment, the PVNS relapse rate is high. We present our study of five young athletes (range 20–36 years) with a histopathological diagnosis of PVNS of the ankle, who were treated by surgery and adjuvant radiosynoviorthesis (RSO). The operation involved either arthroscopic (four patients) or open (one patient) debridement, followed by intraarticular RSO with the radiopharmaceutical erbium-169 (169Er). They were evaluated with the Foot Function Index (FFI) and a visual analog scale (VAS) for pain. At a median follow up period of 47 months (range 36–54 months), all five patients reported marked pain relief with improvements in their daily activities. In particular, the median FFI decreased from 77% (range 71.0%–84.5%) pre-treatment, to 0.5% (range 0%–6%) after treatment. The median VAS score decreased from 4 (range 3–7) to 0 (range 0–1), respectively. Throughout the follow-up period, there were no major complications regarding either therapeutic intervention (arthroscopic or open debridement, RSO). Based on these results, it can be concluded that adjuvant RSO with 169Er following surgical excision is effective and safe in the treatment of PVNS of the ankle.
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Yen YA, Wu LC, Lu NM, Lee CH. Pigmented villous nodular synovitis mimicking metastases on 18F-FDG PET/CT in a patient with rectal mucosal melanoma: a case report. BMC Musculoskelet Disord 2020; 21:13. [PMID: 31914975 PMCID: PMC6950986 DOI: 10.1186/s12891-019-3034-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mucosal melanomas are rare and have a high potential for metastasizing. Surgical resection is the treatment of choice for single distant metastases. Malignant melanoma usually shows the highest uptake of fluorine-18 fluorodeoxyglucose (18F-FDG). 18F- FDG positron emission tomography /computed tomography (PET/CT) is usually used for melanoma staging. An extensive literature review revealed only 4 published case reports and an original paper involving 8 cases (12 cases in total) of patients with skin melanomas in whom pigmented villous nodular synovitis (PVNS) mimicked metastatic melanoma, however, none of the melanomas reported were of rectal mucosal origin. CASE PRESENTATION A 60-year-old woman presented with recent diagnosis of rectal mucosal melanoma, two additional 18F-FDG-avid lesions in the left ankle and left foot were detected on 18F-FDG PET/CT. Metastases were initially suspected; however, the final diagnosis was PVNS. CONCLUSIONS This is the first report of PVNS mimicking metastases on 18F-FDG PET/CT in a patient with rectal mucosal melanoma. Although high 18F-FDG-avid lesions in patients with rectal mucosal melanoma are highly suspected to be metastasis and warrant an meticulous examination, the present case is a reminder that in such patients, not all lesions with high 18F-FDG uptake, especially those near a joint, are metastases and that more extensive resection is unnecessary.
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Affiliation(s)
- Yu-An Yen
- Department of Nuclear Medicine, Chi Mei Medical Center, 901, Zhonghua Rd., Yongkang Dist, Tainan City, 710, Taiwan
| | - Li-Chun Wu
- Department of Nuclear Medicine, Chi Mei Medical Center, 901, Zhonghua Rd., Yongkang Dist, Tainan City, 710, Taiwan
| | - Na-Mi Lu
- Department of Pathology, Liouying Chi Mei Hospital, Tainan, Taiwan
| | - Chiang Hsuan Lee
- Department of Nuclear Medicine, Chi Mei Medical Center, 901, Zhonghua Rd., Yongkang Dist, Tainan City, 710, Taiwan.
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Burgess C, Petrone B, Matai P, Cohn R, Bitterman A. Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419900882. [PMID: 35097363 PMCID: PMC8697194 DOI: 10.1177/2473011419900882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Routine submission of pathologic specimens for histologic analysis following orthopedic surgery is a common and often required practice in the United States. Prior orthopedic studies have determined that these histologic examinations are of limited cost effectiveness and low clinical value because rarely do the pathology findings alter patient management. The purpose of this study was to evaluate the cost effectiveness and clinical significance of routine histologic examination of tissue specimens removed during ankle arthroscopy. Methods: Between 2014 and 2018, 408 patients underwent ankle arthroscopy at a multi-center hospital system by 16 different orthopedic surgeons. The available pathology reports from these cases were retrospectively reviewed to determine if the routine histologic examination altered patient care. We compared the preoperative diagnosis to both the postoperative and histologic diagnoses. The total cost for these histologic examinations was estimated using 2017 Medicare physician fees released by the College of American Pathologists. Cost-effectiveness was estimated in 2017 US dollars by cost per discrepant and discordant diagnosis. Results: Of the 408 patients who underwent ankle arthroscopy, 361 pathology reports were available for review. The prevalence of concordant diagnosis was 98.9% (357/361); the prevalence of discrepant diagnoses was 1.0% (4/361). There were no cases identified with a discordant diagnosis. Total estimated cost for all pathology specimens was $46 381 in 2017 US dollars. Cost per discrepant diagnosis was $11 595. Conclusion: In our study, histologic examination of surgical specimens following ankle arthroscopy had no effect on patient management, yet it increased costs. Routine examination of these pathologic specimens had a low rate of discrepant and/or discordant diagnoses. Based on our results, routine pathologic examination of ankle arthroscopy tissue specimens should be sent solely at the discretion of the orthopedic surgeon as opposed to being a mandated policy. Level of Evidence: Level IV, case series.
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Affiliation(s)
- Colin Burgess
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Plainview, New York, USA
| | - Brandon Petrone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Plainview, New York, USA
| | - Prashant Matai
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Plainview, New York, USA
| | - Randy Cohn
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Plainview, New York, USA
| | - Adam Bitterman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Plainview, New York, USA
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Fraser EJ, Sullivan M, Maclean F, Nesbitt A. Tenosynovial Giant-Cell Tumors of the Foot and Ankle: A Critical Analysis Review. JBJS Rev 2019; 5:01874474-201701000-00001. [PMID: 28135228 DOI: 10.2106/jbjs.rvw.16.00025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Ethan J Fraser
- 1Department of Orthopaedic Surgery, St Vincent's Clinic, Sydney, Australia2Foot and Ankle Clinic, North Shore Private Hospital, Sydney, Australia3Douglass Hanly Moir Pathology, Macquarie Park, Australia4Department of Orthopaedic Surgery, Cairns Hospital, Cairns, Australia
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Results and recurrence of pigmented villonodular synovitis of the ankle: does diffuse PVNS with extra-articular extension tend to recur more often? Knee Surg Sports Traumatol Arthrosc 2018; 26:3118-3123. [PMID: 28389877 DOI: 10.1007/s00167-017-4488-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 02/14/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to provide the outcomes and to analyze the recurrence of Pigmented Villonodular Synovitis (PVNS) of the ankle joint treated by surgical synovectomy. METHODS Thirty-one PVNS cases of the ankle, including 5 localized PVNS cases and 26 diffuse PVNS cases, were treated in our institute between 2004 and 2015. The median age was 35 (range 18-63) years. The 5 localized PVNS cases were treated with partial synovectomy (group I); 10 diffuse PVNS cases limited to intra-articular synovium received arthroscopic comprehensive synovectomy (group II); and 16 cases with diffuse PVNS spreading to extra-articular tendon sheaths underwent combined arthroscopic and open synovectomy (group III). Adjuvant radiotherapy was provided in groups II and III. The American Orthopaedic Foot and Ankle Society (AOFAS) score and subjective grading of procedure were used to evaluate the results. RESULTS Twenty-seven patients were followed with a median of 54 (range 15-108) months. In the three groups, the average AOFAS score improved from 75 (in all three groups) points preoperatively to 100 (group I), 97 (group II), and 90 points (group III) postoperatively. The rate of good-to-excellent result was 100% in group I and II and 73.3% in group III. Only in group III, recurrence occurred in five cases. CONCLUSIONS Diffuse PVNS of the ankle can be successfully managed with surgical synovectomy and adjuvant radiotherapy. Radiotherapy is not needed for localized PVNS. The recurrence rate in PVNS patients with extra-articular extension is higher. LEVEL OF EVIDENCE IV.
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Muramatsu K, Iwanaga R, Tominaga Y, Hashimoto T, Taguchi T. Diffuse Pigmented Villonodular Synovitis Around the Ankle. J Am Podiatr Med Assoc 2018; 108:140-144. [PMID: 29634303 DOI: 10.7547/16-100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare disorder around the ankle joint. The optimal treatment for diffuse-type PVNS is still controversial because of the high incidence of recurrence. We present the clinical features of our patients and review the current diagnostic and treatment modalities. METHODS Five patients with PVNS located around the ankle were surgically treated. In three patients, diffuse PVNS arose from the ankle joint, and in the other two it arose from the calcaneocuboid and intercuneiform joints. The average follow-up time after surgery was 2.9 years (range, 2-4.6 years). RESULTS The average time between onset of pain and diagnosis of PVNS was 6.4 years (range, 4-10 years). Arthrotomic tumor resection was performed in all of the patients. In the three patients with ankle joint PVNS, both medial and lateral approaches were used. One patient experienced mild infection at the surgical site, but this healed conservatively. No tumor recurrences had occurred after minimum follow-up of 2 years, although mild pain persisted in the three patients with ankle PVNS. CONCLUSIONS Diagnosis of diffuse PVNS is frequently delayed due to vague symptoms and variable growth patterns. Orthopedic clinicians should be aware of the existence of this lesion, and it should be suspected in patients with persistent ankle swelling. To prevent tumor recurrence, accurate evaluation of tumor location and careful operative planning are mandatory. A combined surgical approach involving medial and lateral incision is necessary to expose the entire joint cavity.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Japan
| | - Ryuta Iwanaga
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Japan
| | - Yasuhiro Tominaga
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Japan
| | - Takahiro Hashimoto
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Japan
| | - Toshihiko Taguchi
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Japan
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20
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Kanatli U, Ataoğlu MB, Özer M, Yildirim A, Cetinkaya M. Arthroscopic treatment of intra-artricularly localised pigmented villonodular synovitis of the ankle: 4 cases with long-term follow-up. Foot Ankle Surg 2017; 23:e14-e19. [PMID: 29202997 DOI: 10.1016/j.fas.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 03/05/2017] [Accepted: 03/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND CONTEXT Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive benign proliferative pathology of synovial tissue. Lesions are classified regarding location as diffuse or localised which are same as histologically. Intra-articularly localised type is relatively rare, especially in the ankle joint. Because of the high recurrence rate and aggressive nature, localised lesions should be excised totally. PURPOSE We performed a retrospective study of 4 patients with intra-articularly localised PVNS in the ankle joint who were treated by total arthroscopic excision and evaluated for functional results and recurrence rate. STUDY DESIGN Case series. PATIENT SAMPLE The mean age of the patients was 27 (17-46) years at the time of arthroscopic surgery. The mean follow-up time was 33 (24-48) months. METHODS Functional evaluation according to the Musculoskeletal Tumour Society Score was performed, and patients were evaluated for recurrence by MR imaging. RESULTS In all patients, functional results were excellent and there was no recurrence. CONCLUSIONS This study demonstrates that the intra-articularly localised PVNS can be successfully treated with arthroscopic procedures without recurrence.
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Affiliation(s)
- Ulunay Kanatli
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Turkey
| | - M Baybars Ataoğlu
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Turkey
| | - Mustafa Özer
- Department of Orthopaedics and Traumatology, Meram University Faculty of Medicine, Turkey
| | - Ahmet Yildirim
- Department of Orthopaedics and Traumatology, Selçuk University Faculty of Medicine, Turkey.
| | - Mehmet Cetinkaya
- Department of Orthopaedics and Traumatology, Erzincan University Mengucek Gazi Training and Research Hospital, Turkey
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21
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Li X, Xu Y, Zhu Y, Xu X. Surgical treatment for diffused-type giant cell tumor (pigmented villonodular synovitis) about the ankle joint. BMC Musculoskelet Disord 2017; 18:450. [PMID: 29137617 PMCID: PMC5686795 DOI: 10.1186/s12891-017-1824-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/09/2017] [Indexed: 12/30/2022] Open
Abstract
Background Diffused-type giant cell tumor(Dt-GCT) is a rare, aggressive disorder of the joint synovium, bursa and tendon sheaths. Osseous erosions and subchondral cysts may develop as the result of synovium infiltration in Dt-GCT. We present a retrospective study of a series of patients who are diagnosed with Dt-GCT about the ankle joint, there clinical outcome is evaluated in this study. Material and method Fifteen patients with radiologically and histologically confirmed Dt-GCT about the ankle joint were identified in our foot and ankle department. Patients were managed with open synovectomy for the tumor tissue and bone grafting for bony erosions. X-rays and MRI scans were used for evaluation of the tumor and bony erosions pre- and post-operatively. Pre- and post-operative ankle function was assessed using the American Orthopedic Foot and Ankle Society –Ankle and Hindfoot (AOFAS-AH) score and the Muscularskeletal Tumor Society (MSTS) score. Results The mean follow-up duration was 37.4 months (range 25 to 50 months). There were 6 males and 9 females, with a mean age of 35 years old (range 18 to 65 years). All patients had talar erosion with the average size of 10.1*9.1*8.2 mm, distal tibia was affected in 5 patients with the average size of 6.2*5.6*5.8 mm. 7 patients had tendon involvement, 2 patients had recurrence and progression of ankle osteoarthritis. Both of them underwent ankle fusion. At the time of last follow-up, the mean AOFAS-AH score increased from 49 to 80 points (p < 0.05), the MSTS score increased from 12 to 22 points (p < 0.05). Conclusion For Dt-GCT with bony erosions, open synovectomy combined with bone grafting seems to be a safe and effective operation for the salvage of ankle joint. Fusion is recommended for failed and severe cartilage destruction of the ankle joint.
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Affiliation(s)
- Xingchen Li
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Yang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Yuan Zhu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Xiangyang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China.
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22
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Arthroscopy in the treatment of pigmented villonodular synovitis of the ankle and subtalar joints: a technique guide and case series. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Giant cell tumor of tendon sheath: Open surgery or arthroscopic synovectomy? A systematic review of the literature. Orthop Traumatol Surg Res 2017; 103:809-814. [PMID: 28428036 DOI: 10.1016/j.otsr.2017.03.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/09/2017] [Accepted: 03/22/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Giant cell tumor of tendon sheath (GCTTS), formerly known as pigmented villonodular synovitis (PVNS), is a benign, locally aggressive, proliferative disorder of the synovium involving a joint, bursa, or tendon sheath. Treatment of GCTTS involves early surgical resection to limit articular destruction and the risk of recurrence. Synovectomy remains the treatment of choice for GCTTS, but without clear consensus to make an open or arthroscopic synovectomy and no certainty on the responsibility of surgery in the evolution towards the degenerative osteoarthritis. The aim of this study was to evaluate the long-term clinical outcomes and the rate of recurrence of open or arthroscopic excision of GCTTS of the four most frequently involved joints: the shoulder, hip, knee and ankle. METHODS We performed a systematic review of literature in September 2015. The keywords were "villonodular synovitis" AND "surgical treatment". The two authors analyzed 413 articles, according to title and abstract. Forty articles were selected, read entirely and references were analyzed. RESULTS Thirty-three articles were selected. CONCLUSION Our review of literature showed that arthroscopic excision is effective for localized type of GCTTS for all four joints. In diffuse type GCTTS, the efficacy of arthroscopic synovectomy has only been shown for the knee joint. In the other joints, early diagnosis can improve clinical outcomes, but we cannot certify that surgical treatment avoids osteoarthritis degradation. STUDY DESIGN Review of literature, level of evidence IV.
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Cattelan M, Bonnomet F, Bierry G, Di Marco A, Brinkert D, Adam P, Ehlinger M. Villonodular synovitis of the ankle. Analysis of the risk of recurrence. Orthop Traumatol Surg Res 2016; 102:639-44. [PMID: 27197681 DOI: 10.1016/j.otsr.2016.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Villonodular synovitis (VNS) is a rare disease with an incidence of 1.8 per 1,000,000 inhabitants. VNS of the ankle has seldom been described and evaluated given its extreme rarity (2.5% of VNS cases). It presents an 11% recurrence rate. We report a continuous retrospective series with the main objective of clinically and radiologically evaluating these ankles searching for any risk factors of recurrence. At revision the study's main endpoint was the existence of local recurrence (radiological and clinical) and the secondary endpoint was the existence of tibiotalar osteoarthritis. The working hypothesis was that recurrence could be subclinical, warranting systematic imaging studies during follow-up. MATERIAL AND METHODS The study was retrospective, conducted on seven patients (six males) whose mean age was 42 years treated over a period of 9 years (two diffuse forms and five localized forms). The initial treatment consisted in synovectomy via the conventional approach. Four patients also received adjuvant isotopic synoviorthesis treatment. The revision was clinical (MMTS, AOFAS, and OMAS scores) and radiological (standard and MRI) to evaluate the joint after-effects and search for recurrence. RESULTS Six patients were seen at a mean 6.5 years of follow-up. One case of early recurrence (4 years) was noted, with a major clinical manifestation because it was associated with joint destruction requiring arthrodesis, and one case of late asymptomatic recurrence (9 years), diagnosed radiologically on the follow-up MRI. The functional results remained good at follow-up (MMTS 77%, AOFAS 71, OMAS 71). Five of the six patients returned to their daily activities. At revision, no sign of osteoarthritis was observed. No risk factor for recurrence was demonstrated. DISCUSSION/CONCLUSION The hypothesis was confirmed with the existence of asymptomatic recurrence at revision, underscoring the value of systematic MRI at follow-up. Other than major joint destruction, the prognosis remains good even in case of recurrence. The literature emphasizes the existence of an initial diffuse form and partial surgical resection as risk factors of recurrence. None of the reports in the literature has proven that adjuvant treatment, whose modalities do not meet with consensus, reduces this risk. LEVEL OF EVIDENCE Retrospective series, level IV.
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Affiliation(s)
- M Cattelan
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - F Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - G Bierry
- Service de Radiologie Ostéoarticulaire, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - A Di Marco
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - D Brinkert
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - P Adam
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - M Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Sharma P, Tiwari V, Khan SA, Rastogi S. An unusual case of Pigmented Villo-Nodular Synovitis of the second toe: A case report and review of literature. Foot (Edinb) 2016; 28:61-63. [PMID: 27720630 DOI: 10.1016/j.foot.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/10/2016] [Accepted: 08/02/2016] [Indexed: 02/04/2023]
Abstract
Pigmented villo-nodular synovitis (PVNS) is a common disease entity particularly in the knee joint but its incidence in the foot is quite rare. A case of PVNS of the second toe that presented at the outpatient department with an insidious onset and slowly progressive painful swelling of the toe associated with stiffness is presented. The mass was subsequently excised and the diagnosis confirmed by histo-pathology samples. The patient's symptoms improved significantly after the operation. This case is one of the very few reported cases of PVNS involvement of flexor tendon sheath of the foot. It also signifies the importance of clinical suspicions based on the symptoms and examination in reaching to the presumptive diagnosis of the foot pathology and its confirmation by histo-pathological evaluation.
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Affiliation(s)
- Pankaj Sharma
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Vivek Tiwari
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Shishir Rastogi
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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26
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Xie GP, Jiang N, Liang CX, Zeng JC, Chen ZY, Xu Q, Qi RZ, Chen YR, Yu B. Pigmented villonodular synovitis: a retrospective multicenter study of 237 cases. PLoS One 2015; 10:e0121451. [PMID: 25799575 PMCID: PMC4370558 DOI: 10.1371/journal.pone.0121451] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/01/2015] [Indexed: 12/13/2022] Open
Abstract
Purpose To review clinical characteristics of pigmented villonodular synovitis (PVNS) in China. Methods Electronic medical records (EMR) of four Chinese institutes were queried for patients with histologically proven PVNS between January 2005 and February 2014. Their data were collected including gender, age at diagnosis, clinical presentation, affected site, symptom duration, comorbidities, treatment strategy, recurrence and routine laboratories. Results A total of 237 patients with biopsy-proven PVNS were investigated. The gender ratio was 1.35 for a female predominance (101 males and 136 females). The average age was 36 years (range, 2 to 83 years). The median delay from initial clinical symptom to diagnosis was 18 months. Main affected areas were the knee (73.84%) and the hip (18.14%). Forty patients had a clear history of joint trauma. Six patients were concurrently diagnosed with PVNS and avascular necrosis (AVN). Five patients suffered from PVNS following implantation of orthopaedic devices including artificial prosthesis, plate and wire. One hundred and twenty-nine patients underwent arthroscopic synovectomy and 108 open synovectomy. Altogether 48 patients (26 males and 22 females) had recurrence of disease. The relapse rate was 24% (knee) and 6.98% (hip), 20.93% (open surgery) and 19.44% (arthroscopy), respectively. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) rate were elevated in 45.83% and 38.41% of the patients respectively. Conclusions To our knowledge, this study is the largest sample size of PVNS patients reported as well as the largest sample of PVNS with concurrent AVN reported to date. Our outcomes suggest that PVNS shows a female predominance, occurs mostly between 20–40 years and favors the knee and hip. Recurrence is frequent, particularly in the knee. Serum ESR and CRP may be elevated in some patients. Additionally, the present study supports the theory of an association between PVNS and orthopedic surgery, which is not limited to joint replacement.
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Affiliation(s)
- Guo-ping Xie
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- Key laboratory of Bone and Cartilage Regenerative Medicine of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Chang-xiang Liang
- Department of Orthopaedics, Guangdong General Hospital, Guangzhou, Guangdong, PR China
| | - Jian-chun Zeng
- Department of Third Orthopaedics, The First Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Zhi-yuan Chen
- Department of Overseas Chinese Patients, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, PR China
| | - Qian Xu
- Department of Health Statistics, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Rui-zhen Qi
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yi-rong Chen
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- Key laboratory of Bone and Cartilage Regenerative Medicine of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- * E-mail:
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