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Lubis AMT, Sahala MA. Recurrent diffuse tenosynovial giant cell tumor of the knee treated with adjuvant radiotherapy: A case report. Int J Surg Case Rep 2023; 110:108604. [PMID: 37591190 PMCID: PMC10457542 DOI: 10.1016/j.ijscr.2023.108604] [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: 06/22/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION TGCT (tenosynovial giant cell tumor) is a mono-articular proliferative condition that begins in the synovial membranes. Diffuse TGCT (DTGCT) has more prominent symptoms with high risks of recurrency. CASE PRESENTATION In this case, we presented a 32-year-old male with recurrent case of DTGCT. The patient has been treated with arthroscopic synovectomy with the recurrence of disease. The patient was finally treated by open synovectomy combined with arthroscopy followed by adjuvant radiotherapy. DISCUSSION The aim of this case is to report the success of open synovectomy combined with arthroscopy followed by 31 cycle of adjuvant radiotherapy in the recurrent case of DTGCT. CONCLUSION Open synovectomy combined with arthroscopic synovectomy followed by adjuvant RT is a promising treatment modality in patient with DTGCT.
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Affiliation(s)
- Andri M T Lubis
- Department of Orthopaedics and Traumatology, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | - Mohamad Almer Sahala
- Department of Orthopaedics and Traumatology, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Lavignac P, Herraudet P, Baudelle F, Commeil P, Legallois Y, Fabre T. Arthroscopic treatment of diffuse pigmented villonodular synovitis of the elbow. Orthop Traumatol Surg Res 2023; 109:103493. [PMID: 36455866 DOI: 10.1016/j.otsr.2022.103493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pigmented villonodular synovitis (PVNS) is a rare pathology of the elbow, but presents a risk of progression with cartilage destruction. Surgical treatment consists in synovectomy, as complete as possible. Arthroscopy is an excellent tool for the exploration and treatment of intra-articular lesions in the elbow, but the results in PVNS of the elbow have never been evaluated. The aim of this study was to assess the recurrence rate of PVNS of the elbow after arthroscopic synovectomy, and secondarily to assess pain, joint range of motion, functional scores and complication rate. MATERIAL AND METHODS We performed a retrospective study of a continuous series of 8 patients operated on between February 2012 and February 2019, with a mean age of 43.7 years. The operated side was the dominant side in 75% of cases. Surgery consisted in the most complete synovectomy possible, performed arthroscopically. Recurrence, clinical evaluation, with pain at rest and on mpvement on visual analogue scale (VAS) and joint range of motion, functional MEPS and DASH scores, and any complications were collected. RESULTS At a mean 66.4 months' follow-up, 2 patients required revision surgery for recurrence. At the last follow-up, VAS for pain at rest was 0.9 and 1.9 for pain on movement. MEPS score was 85.6 and DASH score 82.2. No neurological, vascular or infectious complications of arthroscopic synovectomy were found in our series. DISCUSSION Arthroscopic synovectomy in the treatment of PVNS of the elbow was a reliable and safe therapeutic alternative, with a low complications rate and 2 cases of recurrence (25%) in our study. This was the first study to report the results of arthroscopic surgical treatment of elbow PVNS. LEVEL OF EVIDENCE IV Retrospective study without control group.
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Affiliation(s)
- Pierre Lavignac
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Paul Herraudet
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Fabien Baudelle
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Paul Commeil
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Yohan Legallois
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Thierry Fabre
- Service de chirurgie orthopédique, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Koutalos AA, Ragias D, Rizniotopoulos E, Tsanadis K, Xydias E, Tsoukalas N, Charalampakis N, Trogkanis N, Ioannou M, Malizos KN, Tolia M. Diffuse pigmented villonodular synovitis of the knee joint: 3-year follow-up of a case report. Radiat Oncol J 2022; 40:270-275. [PMID: 36606304 PMCID: PMC9830041 DOI: 10.3857/roj.2022.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/06/2022] [Indexed: 12/27/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a proliferative, recurrent and locally invasive disease of the synovium. The symptoms of the disorder are not typical and thus it is very often misdiagnosed. Most of the times, magnetic resonance imaging presents the nodular model of development and sets the basis for the diagnosis. The final diagnosis will be set by the pathological evaluation of the lesion's biopsy. PVNS may be localized (nodule with a clear boundary with/without presence of single pedicle) or diffuse (extensive involvement of the adjacent nerves and vessels). Depending on the extension of the PVNS, a different management approach is performed, lesion excision vs. resection, followed by radiotherapy respectively. We report a case of diffuse PVNS in the knee joint, treated with surgical excision and adjuvant radiotherapy as well as follow-up imaging after a time period of 3 years.
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Affiliation(s)
- Antonios A. Koutalos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Dimitrios Ragias
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece,Correspondence: Dimitrios Ragias Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110, Larissa, Greece. Tel: +306934373163 E-mail: ,
| | | | | | - Emmanouil Xydias
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Nikolaos Tsoukalas
- Department of Oncology, 401 General Military Hospital of Athens, Athens, Greece
| | | | - Nikolaos Trogkanis
- Department of Radiation Oncology, Attikon General University Hospital, Athens, Greece
| | - Maria Ioannou
- Department of Pathology, Medical School, University of Thessaly, Larissa, Greece
| | - Konstantinos N. Malizos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Maria Tolia
- Department of Radiotherapy, Faculty of Medicine, University of Crete, Heraklion, Greece
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Baniel C, Yoo CH, Jiang A, von Eyben R, Mohler DG, Ganjoo K, Bui N, Donaldson SS, Million L, van de Rijn M, Oh JM, Hiniker SM. Long-term Outcomes of Diffuse or Recurrent Tenosynovial Giant Cell Tumor Treated with Postoperative External Beam Radiation Therapy. Pract Radiat Oncol 2022; 13:e301-e307. [PMID: 36460182 DOI: 10.1016/j.prro.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Tenosynovial giant cell tumor (TGCT) is a rare proliferative disorder of synovial membrane that previously was known as pigmented villonodular synovitis. Primary treatment involves surgical resection; however, complete removal of all disease involvement is difficult to achieve. Radiation may be useful to reduce the risk of recurrence. We report and update our institutional experience treating diffuse and recurrent TGCT with postsurgical external beam radiation therapy. METHODS AND MATERIALS We performed a retrospective chart review of 30 patients with TGCT from 2003 to 2019 treated with radiation therapy. Each patient was evaluated for demographics, radiation treatment parameters, surgical management, complications, and outcome. RESULTS With mean follow-up of 82 months (range, 3-211), 24 patients (80%) who underwent surgery followed by radiation therapy did not experience any further relapse, and all 30 patients achieved local control (100%) with additional salvage therapy after radiation therapy. The most common site of disease was the knee (n = 22, 73%), followed by the ankle (n = 5, 16%) and the hand (n = 3, 10%). Seven patients (24%) presented at time of initial diagnosis and 23 (76%) presented with recurrent disease after surgical resection, with an average of 2.6 surgical procedures before radiation therapy. After resection, 18 of 30 patients (67%) demonstrated residual TGCT by imaging. The median radiation therapy dose delivered was 36 Gy (range, 34-36 Gy) in 1.8 to 2.5 Gy/fractions for 4 weeks. In the assessment of posttreatment joint function, 26 sites (86%) exhibited excellent or good function, 2 (7%) fair, and 2 poor (7%) as determined by our scoring system. There were no cases of radiation-associated malignancy. CONCLUSIONS Among patients with diffuse or recurrent TGCT, postsurgical external beam radiation therapy provided excellent local control and good functional status, with minimal treatment-related complications. Postsurgical radiation therapy is a well-tolerated noninvasive treatment that should be considered after maximal cytoreductive resection to prevent disease progression and recurrence.
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Affiliation(s)
- Claire Baniel
- Departments of Radiation Oncology, Stanford University, Stanford, California
| | - Christopher H Yoo
- Departments of Radiation Oncology, Stanford University, Stanford, California
| | - Alice Jiang
- Departments of Radiation Oncology, Stanford University, Stanford, California
| | - Rie von Eyben
- Departments of Radiation Oncology, Stanford University, Stanford, California
| | - David G Mohler
- Departments of Orthopaedic, Stanford University, Stanford, California
| | - Kristen Ganjoo
- Departments of Medicine (Oncology), Stanford University, Stanford, California
| | - Nam Bui
- Departments of Medicine (Oncology), Stanford University, Stanford, California
| | - Sarah S Donaldson
- Departments of Radiation Oncology, Stanford University, Stanford, California
| | - Lynn Million
- Departments of Radiation Oncology, Stanford University, Stanford, California
| | - Matt van de Rijn
- Departments of Pathology, Stanford University, Stanford, California
| | - Justin Moon Oh
- Departments of Radiation Oncology, Stanford University, Stanford, California
| | - Susan M Hiniker
- Departments of Radiation Oncology, Stanford University, Stanford, California.
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Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Elbow. Case Rep Orthop 2022; 2022:7956167. [PMID: 36277026 PMCID: PMC9584726 DOI: 10.1155/2022/7956167] [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: 06/27/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of synovium that surrounds the joints, tendon sheaths, and bursae. The elbow is rarely affected, making it difficult to establish treatment guidelines. This article relates on a case of a male patient who presented with elbow pain and decreased range of motion. Diagnosis was established with magnetic resonance imaging (MRI) and biopsy, followed by arthroscopic removal and synovectomy. The patient was pain free shortly after surgery and gained free range of motion after six weeks. At the most recent follow-up after six months, he remained clinically well. The most recent MRI did not reveal any recurrence.
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Sun H, Ju XD, Huang HJ, Zhang X, Wang JQ. Clinical outcomes of endoscopic synovectomy with adjuvant radiotherapy of pigmented villonodular synovitis of the hip: a case series of single center. BMC Musculoskelet Disord 2022; 23:192. [PMID: 35236301 PMCID: PMC8889717 DOI: 10.1186/s12891-022-05141-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Though radiotherapy has been widely used for knee pigmented villonodular synovitis (PVNS), there is few literatures about radiotherapy for the treatment of PVNS hip. Thus, the purpose of this study was to analyze the clinical outcomes of endoscopic synovectomy with/without radiotherapy postoperatively of PVNS hip. Methods We performed a retrospective study of patients who underwent endoscopy in our hospital from November 2010 to January 2021. Inclusion criteria was patients with magnetic resonance image (MRI) signs, endoscopic findings and/or histological evidence of PVNS. Exclusion criteria was patients lost follow-up. All patients underwent synovectomy endoscopically and were divided into two groups depending on receiving postoperative radiotherapy or not. The primary outcome measurements were the recurrence of PVNS, receiving revision, and/or converting to total hip arthroplasty (THA). The secondary outcome measurements were the patient-reported outcome (PRO) collected at pre- and post-operation, which consist of Hip Outcome Score Activities of Daily Living (HOS-ADL), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (IHOT-12), Non-arthritic Hip Scale (NAHS), and visual analog scale (VAS). Results In a case series of 16 patients (8 cases of male, 50%), 4 (25%) cases were localized type and 12 (75%) cases were diffuse type. The average follow-up was 44.8 ± 38.2 months (range,3 to 110). 8 (50%) cases (6 diffuse cases and 2 localized cases) received radiotherapy postoperatively, and the rest (6 diffuse cases and 2 localized cases) received endoscopic treatment alone. At the latest follow-up, 3 (18.75%) cases (2 diffuse cases and 1 localized case) who did not receive radiotherapy converted to arthroplasty. The preoperative HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of remaining 13 patients were 63.1 ± 19.1 (range,32.0 to 98.8), 54.8 ± 20.1 (range, 10.0 to 77.0), 50.9 ± 15.4 (range, 31.0 to 76.6),51.6 ± 15.9 (range, 20.0 to 84.4), 6.0 ± 1.4 (range,4.0 to 8.0) points, respectively. The latest HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of the 13 patients were 79.7 ± 10.8 (range, 58.0 to 97.6), 78.6 ± 9.1 (range,55.0 to 87.0), 74.7 ± 9.7 (range, 55.6 to 91.0), 78.9 ± 18.7 (range,20.0 to 92.5), 3.1 ± 1.2 (range,2.0 to 6.0) points respectively. Conclusion Endoscopic synovectomy can achieve satisfactory PRO in PVNS hip patients. Besides, postoperative adjuvant radiotherapy can achieve higher hip survivability than synovectomy alone in this present study.
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Affiliation(s)
- Hao Sun
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China
| | - Xiao-Dong Ju
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China.
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, 49 North Garden Rd, Haidian District, 100191, Beijing, PR China.
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Hip Tenosynovial Giant Cell Tumor without Recurrence in a 9-Year Follow-Up. Case Rep Orthop 2022; 2022:1797218. [PMID: 35154840 PMCID: PMC8837448 DOI: 10.1155/2022/1797218] [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: 04/30/2021] [Revised: 12/02/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Tenosynovial giant cell tumors are a benign but rare condition with potentially aggressive tumor-like traits which should be considered in young patients with monoarticular joint involvement. Case Presentation. This report presents a 31-year-old otherwise healthy woman with a right hip pain. Clinical and histopathological investigations revealed the diagnosis of diffuse-type tenosynovial giant cell tumor of the hip (the diffuse intra-articular form of PVNS). Open synovectomy and tumor resection and surgical dislocation of the hip were performed. She was free of symptoms and recurrence within a 9-year-follow-up period. Conclusion. Open synovectomy and tumor resection through surgical dislocation of the hip without adjutant radiotherapy could be a reliable choice for the localization of the hip.
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Vaynrub A, Healey JH, Tap W, Vaynrub M. Pexidartinib in the Management of Advanced Tenosynovial Giant Cell Tumor: Focus on Patient Selection and Special Considerations. Onco Targets Ther 2022; 15:53-66. [PMID: 35046667 PMCID: PMC8763255 DOI: 10.2147/ott.s345878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/27/2021] [Indexed: 12/16/2022] Open
Abstract
Tenosynovial giant cell tumor (TGCT) is a neoplasm of the joint synovium that can have severe impacts on joint mobility, function, and quality of life. Traditionally, treatment modalities included partial or complete surgical synovectomy, radiotherapy (typically as an adjunct to surgery), and watchful monitoring (no medical or surgical intervention). However, these approaches have been met with varying degrees of success and high recurrence rates, as well as onerous complications and clinical sequelae. Pexidartinib, a colony-stimulating factor 1 receptor (CSF1R) inhibitor, presents a promising molecular approach that targets a neoplastic driver of TGCT. While the introduction of pexidartinib allows clinicians to avoid the significant morbidity associated with traditional treatment options, there are also defined risks associated with pexidartinib treatment. Therefore, patient selection is critical in optimizing treatment modalities in TGCT. The purpose of this literature review is to identify the TGCT patient population that would derive maximal benefit with minimal risk from pexidartinib, and to determine the specific indications and contraindications for selecting pexidartinib over other therapeutic approaches. Specifically, this paper compares the efficacy and safety profile of pexidartinib across clinical and preclinical studies to that of surgery, radiotherapy, and watchful monitoring. Rates of improvement in joint mobility, pain, and recurrence-free survival across studies of pexidartinib have been encouraging. The most common adverse events are mild (hypopigmentation of the hair) or reversible (transient aminotransferase elevation). Severe or permanent adverse events (notably cholestatic hepatotoxicity) are rare. While the optimal treatment strategy remains highly dependent on a patient's clinical circumstances and treatment goals, pexidartinib has surfaced as a promising therapeutic in cases where the morbidity of surgery or radiotherapy outweighs the benefits.
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Affiliation(s)
- Anna Vaynrub
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - John H Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Max Vaynrub
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Tenosynovial Giant-Cell Tumor Presenting as Septic Arthritis of the Knee. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202104000-00002. [PMID: 33830088 PMCID: PMC8032351 DOI: 10.5435/jaaosglobal-d-20-00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tenosynovial giant-cell tumor (TGCT) is an intraarticular giant-cell tumor of the synovial tissue and tendon sheaths which often mimics multiple conditions on presentation. This case report describes a previously asymptomatic 67-year-old man with preliminary clinical and laboratory evaluation suggestive of septic arthritis; however, arthroscopy revealed diffuse synovitis, and biopsy confirmed TGCT. To our knowledge, this is the first report of TGCT presenting as septic arthritis in an adult patient. This diagnosis should be considered in evaluation of acute, atraumatic knee pain with associated inflammatory marker elevation.
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Chien JC, Wei YP, Chen CY, Hsiang WH, Wang YY, Liu WS, Yang SW. Long-term functional outcomes of diffuse pigmented villonodular synovitis of knee: The role of adjuvant radiotherapy. Medicine (Baltimore) 2021; 100:e23794. [PMID: 33761628 PMCID: PMC9281910 DOI: 10.1097/md.0000000000023794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/15/2020] [Indexed: 01/05/2023] Open
Abstract
Diffuse pigmented villonodular synovitis (PVNS) of knee is a rare benign disease that has a destructive clinical course. Synovectomy and adjuvant radiotherapy (RT) have been reported as treatment options but literatures reporting functional outcomes were sparse. This study aimed to evaluate the long-term functional outcomes and disease control among treatment modalities through the 22 years of experience.A single-center database was searched for patients who received synovectomy of knee with the pathologic diagnosis of PVNS. General data, treatment modalities, and recurrent status were retrospectively collected from medical records. Functional outcomes were evaluated by Western Ontario and McMaster Universities Osteoarthritis Index through phone interviews by an independent orthopedist.From January 1995 to December 2017, 24 patients with diffuse PVNS of knee were identified, including 19 receiving open synovectomy (OP) and 5 undergoing arthroscopic surgery. Adjuvant RT was performed on 14 patients with a median dose of 35 Gy (range 20-40 Gy). After median follow up of 6 years, recurrences were recorded in 10 cases. The recurrence rate was significantly lower in the OP + RT group than the OP group (8.3% vs 57.1%, P = .038). Among those with preserved knee joints, there was no significant difference in the Western Ontario and McMaster Universities Osteoarthritis Index score and stiffness score between patients in the OP + RT and OP groups.For patients with diffuse PVNS of knee, the addition of moderate-dose adjuvant RT following OP provided excellent local control while maintaining good joint function with limited treatment-related morbidity. Our study emphasized the importance of moderate dose RT in diffuse PVNS of knee joint.
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Affiliation(s)
| | - Yi Ping Wei
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Chun Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Wei Hsin Hsiang
- Departement of Pharmacy, Tri-Service General Hospital Penghu Branch, Magong City, Penghu
| | - Yuan You Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | - Shan Wei Yang
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung
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Zhao WQ, Zhao B, Li WS, Assan I. Subtalar joint pigmented villonodular synovitis misdiagnosed at the first visit: A case report. World J Clin Cases 2021; 9:1379-1385. [PMID: 33644205 PMCID: PMC7896681 DOI: 10.12998/wjcc.v9.i6.1379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is an uncommon disease that usually occurs in large joints, and involvement of the subtalar joint is rare. The lack of comprehensive knowledge of subtalar joint PVNS could lead to misdiagnosis.
CASE SUMMARY We present a 64-year-old woman who, at her first visit, complained of discomfort in the right ankle when she walked. Based on the physical signs and X-ray report, the physician failed to make the suspected diagnosis of PVNS. Eighteen months later, the patient returned with a complaint of a mass in her right lateral malleolus with intermittent blunt pain. The X-ray presented an osteophyte formation and soft tissue calcification at the margin of the subtalar joint. The laboratory tests were normal, whereas magnetic resonance imaging (MRI) showed a low-intensity area on both T1- and T2-weighted images. A suspected diagnosis of PVNS was made and later confirmed by postoperative pathology. Subsequently, the patient received radiotherapy with 32 Gy in 16 fractions. At 6 mo postoperatively, the patient only complained of discomfort after walking three blocks. The American Orthopedic Foot and Ankle Society Ankle–Hindfoot score was 97.
CONCLUSION MRI is necessary for the diagnosis of PVNS. Early soft tissue calcification and painless joint swelling should be of concern.
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Affiliation(s)
- Wen-Qian Zhao
- Department of Traditional Chinese Medicine, The People's Hospital of Shouguang City, Shouguang 262700, Shandong Province, China
| | - Bin Zhao
- Department of Orthopedics, Shouguang Hospital of Traditional Chinese Medicine, Shouguang 262700, Shandong Province, China
| | - Wan-Sheng Li
- Department of General Surgery, Shouguang Hospital of Traditional Chinese Medicine, Shouguang 262700, Shandong Province, China
| | - Isaac Assan
- School of International Education, Weifang Medical University, Weifang 261053, Shandong Province, China
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Palmerini E, Longhi A, Donati DM, Staals EL. Pexidartinib for the treatment of adult patients with symptomatic tenosynovial giant cell tumor: safety and efficacy. Expert Rev Anticancer Ther 2020; 20:441-445. [PMID: 32297819 DOI: 10.1080/14737140.2020.1757441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Tenosynovial giant cell tumor (TGCT) is a benign clonal neoplastic proliferation arising from the synovium often causing pain, swelling, joint stiffness, and reduced quality of life. The optimal treatment strategy in patients with diffuse-type TGCT (dt-TGCT) is evolving. Surgery is the main treatment, with a high recurrence rate and surgery-related morbidity. Radiotherapy is associated with important side effects. TGCT cells overexpress colony-stimulating factor 1 (CSF1). Pexidartinib (Turalio™) is a selective CSF1 R inhibitor, which was recently approved by the FDA for the treatment of TGCT. AREAS COVERED This article reviews the pharmacological properties, clinical efficacy, and safety of pexidartinib. EXPERT OPINION Pexidartinib was effective with an acceptable safety profile for advanced TGCT in phase I-III studies. The phase III trial (ENLIVEN) in unresectable TGCT met its primary endpoints of overall response rate. These results led to FDA approval for this TGCT population. Mixed or cholestatic hepatotoxicity was observed in rare cases. For this reason, pexidartinib is currently available only through a Risk Evaluation and Mitigation Strategy (REMS) Program in the USA. TGCT significantly impairs patients' quality of life. The approval of pexidartinib has changed the therapeutic armamentarium for this condition. However, strict monitoring of liver function is warranted.
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Affiliation(s)
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli , Bologna, Italy
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Yang X, Sun Y, Yu W, Fu J. Pigmented villonodular synovitis of the temporomandibular joint: case report and the literature review for postoperative radiotherapy. J Radiol Case Rep 2019; 13:31-39. [PMID: 31558968 DOI: 10.3941/jrcr.v13i8.3661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of the synovium that usually involves joints, tendon sheaths, and bursae. It presents rarely, however, in the temporomandibular joints (TMJs). This paper reports a 59-year-old female patient with PVNS of the TMJ and its clinico-pathologic features are discussed. The patient was treated with surgery and postoperative radiotherapy (PORT). Follow-up was conducted, and there were no recurrences, metastases, skin changes or joint stiffness noted. The main treatment of PVNS is surgical resection. However, postoperative radiotherapy is important for local control of extensive tumors or positive margins. We conducted a literature review for postoperative radiotherapy case reports related to PVNS of the TMJ.
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Affiliation(s)
- Xiaojing Yang
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Sun
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weiwei Yu
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jie Fu
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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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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Palmerini E, Longhi A, Donati D, Staals EL. Advances in treatment for tenosynovial giant cell tumors. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1549481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Orthopaedic Surgery, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric L. Staals
- Orthopaedic Surgery, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Stephan SR, Shallop B, Lackman R, Kim TWB, Mulcahey MK. Pigmented Villonodular Synovitis: A Comprehensive Review and Proposed Treatment Algorithm. JBJS Rev 2018; 4:01874474-201607000-00003. [PMID: 27509331 DOI: 10.2106/jbjs.rvw.15.00086] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Evidence now exists suggesting a neoplastic origin for pigmented villonodular synovitis, including a thorough description of the translocations involved. Arthroscopic excision for localized pigmented villonodular synovitis allows for both minimal recurrence and morbidity when compared with open excision; however, open excision still plays an important role in treating posterior compartment nodules. The optimal surgical treatment for diffuse pigmented villonodular synovitis is still a matter for debate, with combined anterior arthroscopic and open posterior excision being considered the preferred method. Radiation therapy has re-emerged as an additional treatment method for pigmented villonodular synovitis; however, the potential for serious toxicity makes it a questionable option, especially for such a benign condition. Small molecule and monoclonal antibody targeted therapies are being investigated as novel treatment methods for pigmented villonodular synovitis, with promising results.
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Affiliation(s)
- Stephen R Stephan
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Brandon Shallop
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | | | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Duan Y, Qian J, Chen K, Zhang Z. Necessity of adjuvant postoperative radiotherapy for diffuse pigmented villonodular synovitis of the knee: A case report and literature review. Medicine (Baltimore) 2018; 97:e9637. [PMID: 29504995 PMCID: PMC5779764 DOI: 10.1097/md.0000000000009637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pigmented villonodular synovitis (PVNS) is an idiopathic, proliferative disorder lesion of synovial tissue, which is regarded as a benign disease, but has a local invasion. Up to now, these are no consensus about the etiology and pathogenesis of PVNS. Because of the lack of typical clinical features, misdiagnosis and delayed diagnosis are not uncommon, magnetic resonance imaging (MRI) can assist diagnosis and histopathological examination is recognized as the gold standard for the final diagnosis. Because this disease is so rare, there is no standard treatment. Surgical resection of the lesion is considered the preferred treatment, but postoperative recurrence is a problem that cannot be ignored. Postoperative radiotherapy is necessary, especially for patients with diffuse PVNS of the knee. PATIENT CONCERNS A 27-year-old female teacher presented with 3 years chronic pain of the right knee, and progressive swelling aggravated for 1 week. The range of motion of the knee was limited. DIAGNOSES Clinical and laboratory examination failed to provide definitive diagnosis. Imaging can assist in diagnosis, and pathology is the gold standard. Erythrocyte sedimentation rate (ESR), antihemolytic streptococcus O (ASO), and rheumatoid factors (RF) were all negative. Joint puncture revealed giant cell tumor of the synovial membrane. PVNS was confirmed by postoperative pathology. The characteristic T2 weighted low signal of MRI suggests the recurrence of PVNS. INTERVENTIONS The patient underwent 2 stages of treatment: open synovectomy was performed in the first place and postoperative external radiotherapy was not considered. After 2 years of disease-free remission, she was diagnosed with a recurrence of the disease by MRI. Further, arthroscopic total synovectomy of the right knee was performed and external beam radiotherapy was carried out after the operation. OUTCOMES Up to now, the patient was followed up for 3 years without any sign of recurrence. LESSONS Adjuvant postoperative radiotherapy can improve the local control rate, it is a reliable treatment method for diffused PVNS.
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Affiliation(s)
| | | | | | - Zhuo Zhang
- Department of Oncology Radiotherapy, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China
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Prewett S, Horan G, Hatcher H, Ajithkumar T. Borderline Sarcomas and Smooth Muscle Tumours of Uncertain Malignant Potential. Clin Oncol (R Coll Radiol) 2017; 29:528-537. [PMID: 28595873 DOI: 10.1016/j.clon.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 12/22/2022]
Abstract
Borderline sarcomas and smooth muscle tumours of uncertain malignant potential (STUMP) have an unpredictable clinical behaviour with frequent local recurrences and rarely, metastases. We review the current management of common subtypes of borderline sarcomas and STUMP.
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Affiliation(s)
- S Prewett
- Cambridge University Hospital, Cambridge, UK
| | - G Horan
- Cambridge University Hospital, Cambridge, UK
| | - H Hatcher
- Cambridge University Hospital, Cambridge, UK
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Abstract
Pigmented villonodular synovitis (PVNS) is a rare disease that can affect any joint, bursa or tendon sheath.The hip is less frequently affected than the knee, and hence is less discussed in scientific journals.PVNS of the hip mainly occurs in young adults, requiring early diagnosis and adequate treatment to obtain good results.There is no consensus on the management of PVNS of the hip in current literature.We will discuss the options for surgical intervention in hip PVNS using a literature review of clinical, biological, etiological, histological and radiographic aspects of the disease. Cite this article: Steinmetz S, Rougemont A-L, Peter R. Pigmented villonodular synovitis of the hip. EFORT Open Rev 2016;1:260-266. DOI: 10.1302/2058-5241.1.000021.
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Affiliation(s)
| | | | - Robin Peter
- Geneva University Hospitals, Geneva, Switzerland
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Levine BD, Motamedi K, Seeger LL. Synovial Tumors and Proliferative Diseases. Rheum Dis Clin North Am 2016; 42:753-768. [DOI: 10.1016/j.rdc.2016.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mazonakis M, Tzedakis A, Lyraraki E, Damilakis J. Organ-specific radiation-induced cancer risk estimates due to radiotherapy for benign pigmented villonodular synovitis. Phys Med Biol 2016; 61:6400-12. [DOI: 10.1088/0031-9155/61/17/6400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Diffuse-type tenosynovial giant cell tumour: Current treatment concepts and future perspectives. Eur J Cancer 2016; 63:34-40. [DOI: 10.1016/j.ejca.2016.04.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/18/2016] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
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Mollon B, Griffin AM, Ferguson PC, Wunder JS, Theodoropoulos J. Combined arthroscopic and open synovectomy for diffuse pigmented villonodular synovitis of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24:260-6. [PMID: 25308157 DOI: 10.1007/s00167-014-3375-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 10/01/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE There are few reports detailing recurrence rates or functional outcomes after combined arthroscopic and open synovectomy to treat diffuse pigmented villonodular synovitis (DPVNS) of the knee. METHODS Patients with DPVNS of the knee treated with combined synovectomy, followed for a minimum of 12 months at a tertiary orthopaedic oncology centre, were identified. We extracted data pertaining to demographics, complications, clinical outcomes and recurrence. Functional status was evaluated prospectively using the Toronto Extremity Salvage Score (TESS) and the Musculoskeletal Tumor Society (MSTS) 1987 and 1993 surveys. Data were reported descriptively as mean (SD) unless otherwise specified. RESULTS Fifteen patients [80% female; mean age 38.9 (SD 14.2) years] representing 15 knees were treated with combined synovectomies and followed for 81 (SD 55) months. Posterior arthroscopy was utilized in 73% of patients. External beam radiation was utilized post-operatively in 73% of patients. Two patients (13%) experienced symptomatic disease recurrence. The mean post-operative knee range of motion was 1° (range 0-10°) to 115° (range 90-135°). TESS and MSTS 1987/1993 scores all suggested excellent patient function. Post-operative complications included one posterior wound dehiscence, one case of femoral condyle avascular necrosis and one patient with lymphedema. CONCLUSIONS Combined synovectomy resulted in a low rate of symptomatic disease recurrence and good to excellent functional outcomes for diffuse PVNS of the knee. A literature review identified this as largest case series focusing on combined synovectomies for DPVNS of the knee and the only one describing functional outcomes or the use of external beam radiotherapy. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Brent Mollon
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Orthopaedic Surgery, Mt. Sinai Hospital, Toronto, ON, Canada.
| | - Anthony M Griffin
- Division of Orthopaedic Surgery, Mt. Sinai Hospital, Toronto, ON, Canada.
| | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Orthopaedic Surgery, Mt. Sinai Hospital, Toronto, ON, Canada.
- University Musculoskeletal Oncology Unit, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Jay S Wunder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Orthopaedic Surgery, Mt. Sinai Hospital, Toronto, ON, Canada.
- University Musculoskeletal Oncology Unit, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.
| | - John Theodoropoulos
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Orthopaedic Surgery, Mt. Sinai Hospital, Toronto, ON, Canada.
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, Toronto, ON, Canada.
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Mollon B, Lee A, Busse JW, Griffin AM, Ferguson PC, Wunder JS, Theodoropoulos J. The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee. Bone Joint J 2015; 97-B:550-7. [PMID: 25820897 DOI: 10.1302/0301-620x.97b4.34907] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pigmented villonodular synovitis (PVNS) is a rare proliferative process of the synovium which most commonly affects the knee and occurs in either a localised (LPVNS) or a diffuse form (DPVNS). The effect of different methods of surgical synovectomy and adjuvant radiotherapy on the rate of recurrence is unclear. We conducted a systematic review and identified 35 observational studies in English which reported the use of surgical synovectomy to treat PVNS of the knee. A meta-analysis included 630 patients, 137 (21.8%) of whom had a recurrence after synovectomy. For patients with DPVNS, low-quality evidence found that the rate of recurrence was reduced by both open synovectomy (odds ration (OR) = 0.47; 95% CI 0.25 to 0.90; p = 0.024) and combined open and arthroscopic synovectomy (OR = 0.19, 95% CI = 0.06 to 0.58; p = 0.003) compared with arthroscopic surgery. Very low-quality evidence found that the rate of recurrence of DPVNS was reduced by peri-operative radiotherapy (OR = 0.31, 95% CI 0.14 to 0.70; p = 0.01). Very low-quality evidence suggested that the rate of recurrence of LPVNS was not related to the surgical approach. This meta-analysis suggests that open synovectomy or synovectomy combined with peri-operative radiotherapy for DPVNS is associated with a reduced rate of recurrence. Large long-term prospective multicentre observational studies, with a focus on both rate of recurrence and function, are required to confirm these findings. Cite this article: Bone Joint J 2015;97-B:550–7.
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Affiliation(s)
- B. Mollon
- University of Toronto, 149
College Street, Room 508A, Toronto, Ontario, M5T
1P5, Canada
| | - A. Lee
- University of Toronto, 149
College Street, Room 508A, Toronto, Ontario, M5T
1P5, Canada
| | - J. W. Busse
- McMaster University , Room
HSC 2V9, 1280 Main St West, Hamilton
Ontario, L8S 4K1, Canada
| | - A. M. Griffin
- Mount Sinai Hospital, 600
University Avenue, Toronto, Ontario, Canada
| | - P. C. Ferguson
- Mount Sinai Hospital, 600
University Avenue, Toronto, Ontario, Canada
| | - J. S. Wunder
- Mount Sinai Hospital, 600
University Avenue, Toronto, Ontario, Canada
| | - J. Theodoropoulos
- Mount Sinai Hospital, 600
University Avenue, Toronto, Ontario, Canada
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Joshi K, Huang B, Scanga L, Buchman C, Chera BS. Postoperative radiotherapy for diffuse pigmented villonodular synovitis of the temporomandibular joint. Am J Otolaryngol 2015; 36:106-13. [PMID: 25459320 DOI: 10.1016/j.amjoto.2014.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare/benign condition of the synovial joint lining. It most commonly presents in the knee but has also been reported to occur in the temporomandibular joint (TMJ). Although there are several series reporting the use of postoperative radiotherapy (PORT) for extremity PVNS, there is scant literature on the use of PORT for PVNS of the TMJ. METHODS We conducted a literature review for case reports related to PVNS of the TMJ and discuss two additional cases treated with surgery and PORT. RESULTS 71 cases were found in the literature. 89% were the diffuse subtype. 92% had primary surgery and 7% had PORT. 68% were locally controlled. Both patients treated at our institution are locally controlled. CONCLUSIONS PVNS of the TMJ is a rare entity. Surgery is the mainstay of treatment but PORT may be useful for local control of extensive tumors or positive margins.
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Affiliation(s)
| | - Benjamin Huang
- Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Lori Scanga
- Department of Pathology, University of North Carolina, Chapel Hill, NC
| | - Craig Buchman
- Department of Otolaryngology, Head and Neck Surgery, University of North Carolina, Chapel Hill, NC
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Linebeger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
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Aurégan JC, Klouche S, Bohu Y, Lefèvre N, Herman S, Hardy P. Treatment of pigmented villonodular synovitis of the knee. Arthroscopy 2014; 30:1327-41. [PMID: 24999007 DOI: 10.1016/j.arthro.2014.04.101] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/07/2014] [Accepted: 04/22/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to determine the rate of local recurrence, the rate of postoperative complications, and the functional outcome at final follow-up of surgical and nonsurgical treatment approaches for pigmented villonodular synovitis (PVNS) of the knee. METHODS Medline, Embase, and the Cochrane Library were systematically searched for studies that reported the results of treatment for any type of PVNS between January 1, 1950, and August 1, 2013. Two authors extracted the data independently using predefined data fields including study quality indicators. RESULTS Sixty studies (1,019 patients) met the inclusion criteria. Thirty-five presented data on the treatment of localized pigmented villonodular synovitis (LPVNS), 40 on diffuse pigmented villonodular synovitis (DPVNS), 1 on extra-articular LPVNS, and 7 on DPVNS with extra-articular involvement. Many therapeutic options were reported. Depending on these options, DPVNS recurred in 8% to 70% of the series and LPVNS recurred in 0% to 8% of the series. For LPVNS, the 2 most-reported options were open localized synovectomy and arthroscopic local synovectomy. Between these 2 courses of treatment, no difference was found in terms of local recurrence (8.7% for open synovectomy and 6.9% for arthroscopic synovectomy) and postoperative complications (<1% for open synovectomy and 0% for arthroscopic synovectomy). For DPVNS, the 2 most-reported options were open total synovectomy and arthroscopic total synovectomy. Between these 2 courses of treatment, no difference was found in terms of local recurrence (22.6% for open synovectomy and 16.1% for arthroscopic synovectomy). However, we found a lower rate of reported complications between open synovectomy (19.3%) and arthroscopic synovectomy (0%). Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy seemed to decrease the rate of local recurrence in DPVNS cases with a high risk of recurrence. Finally, we found a great heterogeneity in the way the functional results were reported, and no valid conclusion could be made based on the data we extracted. CONCLUSIONS We found no difference in local recurrence rates after open or arthroscopic surgery for either LPVNS or DPVNS. However, a lower rate of postoperative complications was reported after arthroscopic surgery for DPVNS. LEVEL OF EVIDENCE Level IV, systematic review of Level IV therapeutic studies.
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Affiliation(s)
- Jean-Charles Aurégan
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Université de Versailles Saint-Quentin-en-Yvelines, nité de Formation et de Recherche des Sciences de la Santé, Versailles, France.
| | - Shahnaz Klouche
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Institut de l'Appareil Locomoteur Nollet, Paris, France; Clinique du Sport Paris V, Paris, France
| | - Yoann Bohu
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Institut de l'Appareil Locomoteur Nollet, Paris, France; Clinique du Sport Paris V, Paris, France
| | | | - Serge Herman
- Institut de l'Appareil Locomoteur Nollet, Paris, France; Clinique du Sport Paris V, Paris, France
| | - Philippe Hardy
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Université de Versailles Saint-Quentin-en-Yvelines, nité de Formation et de Recherche des Sciences de la Santé, Versailles, France
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Tosun HB, Uludağ A, Serbest S, Gümüştaş S, Erdoğdu IH. A rare case of extensive diffuse nonpigmented villonodular synovitis as a cause of total knee arthroplasty failure. Int J Surg Case Rep 2014; 5:419-23. [PMID: 24892248 PMCID: PMC4064475 DOI: 10.1016/j.ijscr.2014.04.031] [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: 11/08/2013] [Revised: 04/08/2014] [Accepted: 04/28/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Nonpigmented villonodular synovitis (non-PVNS) is a benign proliferative disease involving the synovium. It is a rare condition that is little recognized. Non-PVNS has been reported as a cause of total knee replacement failure. PRESENTATION OF CASE We report a case of extensive diffuse non-PVNS in a patient with tibial component loosening after total knee replacement and review the related literature. DISCUSSION It is reported that pigmented villonodular synovitis (PVNS) occurs less frequently than non-PVNS after knee replacement. However, there are many more case reports of PVNS than non-PVNS after knee arthroplasty in the English-language literature. CONCLUSION Previously, there were no reported cases of extensive diffuse non-PVNS after total knee arthroplasty (TKA). This case study highlights an unusual case of non-PVNS as a cause of TKA failure. We propose that non-PVNS should be considered as a differential diagnosis in patients after TKA who present with recurrent pain and effusion/hemarthrosis of the knee, and that it is one of the causes of implant loosening after TKA.
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Affiliation(s)
- Hacı Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
| | - Abuzer Uludağ
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Sancar Serbest
- Department of Orthopaedic Surgery, Kırklareli State Hospital, Kırklareli, Turkey
| | - Seyitali Gümüştaş
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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Verspoor FGM, van der Geest ICM, Vegt E, Veth RPH, van der Graaf WT, Schreuder HWB. Pigmented villonodular synovitis: current concepts about diagnosis and management. Future Oncol 2013; 9:1515-31. [DOI: 10.2217/fon.13.124] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
At present, the treatment strategies in patients with localized and diffuse forms of pigmented villonodular synovitis have more or less been standardized. However, these strategies are not optimal because high recurrence rates persist and studies with a sufficient level of evidence are lacking. This systematic review article describes all known treatment options for intra-articular pigmented villonodular synovitis and their clinical results. Based on this research, we provide guidelines to support physicians in making the optimal treatment decisions. Given the rarity of the disease, randomized studies are not to be expected, but an international registry through existing networks would offer the benefit of getting a better insight into the outcome of this disease. Therefore, we propose a basic set of data to be investigated and ideally to be reported on in such a registry.
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Affiliation(s)
- Floortje GM Verspoor
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Ingrid CM van der Geest
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Rene PH Veth
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Winette T van der Graaf
- Department of Medical Oncology Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - HW Bart Schreuder
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Bruns J, Ewerbeck V, Dominkus M, Windhager R, Hassenpflug J, Windhagen H, Hovy L, Loehr J, Krauspe R, Duerr HR. Pigmented villo-nodular synovitis and giant-cell tumor of tendon sheaths: a binational retrospective study. Arch Orthop Trauma Surg 2013; 133:1047-53. [PMID: 23681468 DOI: 10.1007/s00402-013-1770-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Indexed: 11/26/2022]
Abstract
AIM Pigmented villonodular synovitis is rare. Thus, we initiated a retrospective multi-center study regarding symptoms, location, type of disease, type of surgery, number of recurrences, use of adjuvant therapies and functional outcome. RESULTS Ten centers contributed. Data from 173 patients were sampled. The disease was seen predominantly in joints, less frequently in tendon sheaths and bursae. Patients with articular lesions suffered mainly from the diffuse type. In tendon sheaths, the relation "diffuse versus nodular" was nearly 50 % each, in bursae most often the nodular type was found. Anatomically, mostly the knee was affected. Institutions with more than 20 patients had a lower rate of recurrence than those with less than 20 cases. Regarding the knee, there were less recurrences in joints treated with open synovectomy than in those treated arthroscopically. CONCLUSIONS Since the rate of recurrence has been rather high, the use of adjuvant treatments (radiosynoviorthesis or radiotherapy) is recommended. In our study, the rate of their application was quite low. Patients who received an adjuvant therapy after primary surgery did not show any recurrence. In 14 % of patients in whom an adjuvant therapy had been used, after at least one recurrence, further recurrences were observed. Functional results were excellent in 84 % of patients. LEVEL OF EVIDENCE Prognostic multi-center study, Level III.
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Affiliation(s)
- Juergen Bruns
- Diakonieklinikum Hamburg, Hohe Weide 17, 20259, Hamburg, Germany.
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A Low Recurrence Rate is Possible With a Combination of Surgery and Radiosynovectomy for Diffuse Pigmented Villonodular Synovitis of the Knee. Clin Nucl Med 2013; 38:608-15. [DOI: 10.1097/rlu.0b013e318292efdf] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van der Heijden L, Gibbons CLMH, Dijkstra PDS, Kroep JR, van Rijswijk CSP, Nout RA, Bradley KM, Athanasou NA, Hogendoorn PCW, van de Sande MAJ. The management of diffuse-type giant cell tumour (pigmented villonodular synovitis) and giant cell tumour of tendon sheath (nodular tenosynovitis). ACTA ACUST UNITED AC 2012; 94:882-8. [PMID: 22733940 DOI: 10.1302/0301-620x.94b7.28927] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Giant cell tumours (GCT) of the synovium and tendon sheath can be classified into two forms: localised (giant cell tumour of the tendon sheath, or nodular tenosynovitis) and diffuse (diffuse-type giant cell tumour or pigmented villonodular synovitis). The former principally affects the small joints. It presents as a solitary slow-growing tumour with a characteristic appearance on MRI and is treated by surgical excision. There is a significant risk of multiple recurrences with aggressive diffuse disease. A multidisciplinary approach with dedicated MRI, histological assessment and planned surgery with either adjuvant radiotherapy or systemic targeted therapy is required to improve outcomes in recurrent and refractory diffuse-type GCT. Although arthroscopic synovectomy through several portals has been advocated as an alternative to arthrotomy, there is a significant risk of inadequate excision and recurrence, particularly in the posterior compartment of the knee. For local disease partial arthroscopic synovectomy may be sufficient, at the risk of recurrence. For both local and diffuse intra-articular disease open surgery is advised for recurrent disease. Marginal excision with focal disease will suffice, not dissimilar to the treatment of GCT of tendon sheath. For recurrent and extra-articular soft-tissue disease adjuvant therapy, including intra-articular radioactive colloid or moderate-dose external beam radiotherapy, should be considered.
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Affiliation(s)
- L van der Heijden
- Leiden University Medical Center, Department of Orthopedic Surgery, Postzone J11-70, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Long-term success in the treatment of diffuse pigmented villonodular synovitis of the knee with subtotal synovectomy and radiotherapy. Arthroscopy 2012; 28:1271-4. [PMID: 22554472 DOI: 10.1016/j.arthro.2012.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to evaluate the effectiveness and long-term outcome of the treatment of patients with diffuse pigmented villonodular synovitis (PVNS) of the knee with subtotal arthroscopic and open synovectomy and subsequent external-beam radiotherapy. METHODS Eight patients diagnosed with diffuse PVNS by clinical and magnetic resonance imaging were treated surgically with subtotal arthroscopic synovectomy and an additional posterior incision for extra-articular lesions, followed by local adjuvant radiotherapy. These patients were followed up for a mean of 8.6 years to monitor remaining lesions and to detect new occurrences of the condition. RESULTS None of the patients presented with major postoperative complications or have had radiotherapeutic late effects. In no case was radiographic arthritis progression detected. Three patients exhibited late minor complications (peripatellar pain, articular effusion, and persistent quadricipital muscle atrophy). Only 1 patient (12.5%) presented with recurrence of the disease during the follow-up period. CONCLUSIONS On the basis of our limited study, subtotal arthroscopic and open synovectomy with subsequent local external-beam radiotherapy had a recurrence rate of 12.5% at 8.6 years of follow-up for the treatment of diffuse PVNS of the knee joint. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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van der Heijden L, Gibbons CLMH, Hassan AB, Kroep JR, Gelderblom H, van Rijswijk CSP, Nout RA, Bradley KM, Athanasou NA, Dijkstra PDS, Hogendoorn PCW, van de Sande MAJ. A multidisciplinary approach to giant cell tumors of tendon sheath and synovium--a critical appraisal of literature and treatment proposal. J Surg Oncol 2012; 107:433-45. [PMID: 22806927 DOI: 10.1002/jso.23220] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 06/19/2012] [Indexed: 02/04/2023]
Abstract
Giant cell tumors deriving from synovium are classified into a localized (GCT of tendon sheath; GCT-TS) and diffuse form (diffuse-type GCT, Dt-GCT). We propose a multidisciplinary management based upon a systematic review and authors' opinion. Open excision for GCT-TS and open synovectomy (plus excision) for Dt-GCT is advised to reduce the relatively high recurrence risk. External beam radiotherapy should be considered in severe cases, as Dt-GCT commonly extends extra-articular.
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Affiliation(s)
- Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Koca G, Ozsoy H, Atilgan HI, Demirel K, Dincel VE, Korkmaz M. Application of rhenium-186 radiosynovectomy in elbow diffuse pigmented villonodular synovitis. - a case report with multiple joint involvement. Nucl Med Mol Imaging 2012; 46:215-7. [PMID: 24900063 DOI: 10.1007/s13139-012-0152-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/19/2012] [Accepted: 06/20/2012] [Indexed: 11/24/2022] Open
Abstract
After surgical therapy of diffuse pigmented villonodular synovitis (DPVNS), recurrence is seen in almost half of the patients. The effectiveness of radiosynovectomy (RSV) in preventing recurrence and complaints of DPVNS is well known. Elbow involvement in DPVNS is a very rare condition; therefore, RSV in elbow hasn't been experienced widely. The aim of this case report is to show the effectiveness of RSV with rhenium-186 (Re-186) sulfide colloid. We applied Re-186 sulfide colloid to the elbow joint of DPVNS patients six weeks after arthroscopic synovectomy. As a result, the patient did not have any complaints, and our findings are compatible with residue or recurrence on magnetic resonance imaging (MRI) in sixth and twentieth month controls after administration. We concluded that Re-186 is an effective adjuvant therapy for the prevention of recurrence and complaints.
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Affiliation(s)
- Gokhan Koca
- Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hakan Ozsoy
- Department of Orthopedics and Traumatalogy, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hasan Ikbal Atilgan
- Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, Turkey
| | - Koray Demirel
- Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, Turkey
| | - Veysel Ercan Dincel
- Department of Orthopedics and Traumatalogy, Ankara Training and Research Hospital, Ankara, Turkey
| | - Meliha Korkmaz
- Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, Turkey
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Simultaneous anterior and posterior synovectomies for treating diffuse pigmented villonodular synovitis. Clin Orthop Relat Res 2012; 470:1755-62. [PMID: 22359272 PMCID: PMC3348323 DOI: 10.1007/s11999-012-2288-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 02/08/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The current treatment methods for diffuse intraarticular or extraarticular type pigmented villonodular synovitis (PVNS) include arthroscopic synovectomy or staged anterior and posterior open synovectomies. However, it is unclear whether simultaneous anterior and posterior synovectomies achieve local control and recovery of function. QUESTIONS/PURPOSES We therefore determined the recurrence rate and function in patients with diffuse PVNS treated with anterior and posterior synovectomies and adjuvant radiotherapy. METHODS We retrospectively reviewed all 19 patients with diffuse PVNS involving the knee treated with anterior and posterior synovectomies and adjuvant radiotherapy between January 2001 and November 2007. From the records, we determined local recurrence and Tegner-Lysholm scores. The minimum followup was 42 months (median, 98 months; range, 42-143 months). RESULTS Postoperative MRI revealed residual tumor in five of the 19 patients, although three had no disease progression during followup and had knee scores of 86 to 90. Two patients had recurrences at 6 and 9 months with knee scores of 88 at 42 months and 90 at 68 months. The mean Tegner-Lysholm knee score improved from 59 to 93 points. Mean maximum extension and flexion angles improved from 11° to 2° and from 76° to 127°, respectively. CONCLUSIONS Compared with the literature, simultaneous anterior and posterior synovectomies associated with postoperative radiotherapy provided rates of residual or recurrent tumor and knee function recovery comparable to that with staged synovectomies reported in the literature. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Park G, Kim YS, Kim JH, Lee SW, Song SY, Choi EK, Yi SY, Ahn SD. Low-dose external beam radiotherapy as a postoperative treatment for patients with diffuse pigmented villonodular synovitis of the knee: 4 recurrences in 23 patients followed for mean 9 years. Acta Orthop 2012; 83:256-60. [PMID: 22489888 PMCID: PMC3369151 DOI: 10.3109/17453674.2012.678803] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder involving synovial membranes, and patients with PVNS have a variable prognosis. We retrospectively analyzed clinical outcomes after synovectomy plus low-dose external beam radiotherapy for diffuse PVNS of the knee. METHODS We reviewed the medical records of 23 patients who underwent postoperative radiotherapy between 1998 and 2007. 19 patients had primary disease and 4 had recurrent disease with an average of 2.5 prior surgeries. After synovectomy (17 arthroscopic surgeries; 6 open), all 23 patients received 4-MV or 6-MV external beam radiotherapy with a median dose of 20 (12-34) Gy in 10 fractions. RESULTS At a median follow-up of 9 (0.8-12) years, 4 patients had recurrent disease, with a median disease-free interval of 5 years. Of these 4 patients, 3 received salvage synovectomy and regained local control. Univariate analysis showed that age, sex, history of trauma, and total dose of radiation were not predictive of local control. 22 patients reported excellent or good joint function, and 1 who refused salvage synovectomy had poor joint function. None of the patients experienced grade 3 or higher radiation-related toxicity or radiation-induced secondary malignancies. INTERPRETATION Postoperative external beam radiotherapy is an effective and acceptable modality to prevent local recurrence and preserve joint function in patients with diffuse PVNS of the knee. Low-dose (20 Gy) radiotherapy appears to be as effective as moderate-dose treatment (around 35 Gy).
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Affiliation(s)
- Geumju Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Jong Hoon Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Sang-wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seong Yoon Yi
- Division of Hematology-Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
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Long-term outcome of the treatment of high-risk tenosynovial giant cell tumor/pigmented villonodular synovitis with radiotherapy and surgery. Cancer 2012; 118:4901-9. [DOI: 10.1002/cncr.26529] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 11/07/2022]
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NISHIDA YOSHIHIRO, TSUKUSHI SATOSHI, NAKASHIMA HIROATSU, SUGIURA HIDESHI, YAMADA YOSHIHISA, URAKAWA HIROSHI, ARAI EISUKE, ISHIGURO NAOKI. Osteochondral Destruction in Pigmented Villonodular Synovitis During the Clinical Course. J Rheumatol 2011; 39:345-51. [DOI: 10.3899/jrheum.110730] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.In pigmented villonodular synovitis (PVNS), some cases recur and progress to osteochondral destruction. The aim of our study was to clarify the occurrence of osteochondral destruction according to the location of PVNS during the clinical course.Methods.Seventy-two patients with PVNS (43 female, 29 male) with a mean age of 40 years (range 3–87 yrs) had been referred to our institutions. Factors influencing the occurrence of osteochondral destruction were investigated.Results.Mean followup was 60 months (range 12–190 mo). Adjacent bone change occurred in 24 (42%) of 57 patients, who were evaluated at the time of the first consultation. Eight (89%) of 9 patients with hip lesions initially had bone lesions, significantly more frequently than those with other lesions (p = 0.038). Duration of symptoms was significantly correlated with the occurrence of bone lesions in diffuse knee lesions (p = 0.005). During followup, patients with location in the knee had a significantly higher incidence of osteoarthritic change (73%) compared to those with foot and ankle involvement (p = 0.027). Re-operation was more frequently required for knee lesions due to the high recurrence rate (32%). Patients who required re-operation had significantly more marked osteoarthritic change in knees (p = 0.001) during followup than those who did not.Conclusion.For PVNS arising in knees, repeated recurrences followed by re-operation resulted in the progression of osteoarthritic change. PVNS arising in hips, feet, and ankles developed bone lesions initially, probably due to the limited volume of these joints. The indications for re-operation for recurrent knee lesions require careful consideration regarding progression of osteoarthritic change.
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Marengo MF, Suarez-Almazor ME, Lu H. Neoplastic and Paraneoplastic Synovitis. Rheum Dis Clin North Am 2011; 37:551-72. [DOI: 10.1016/j.rdc.2011.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Pigmented Villonodular Synovitis: A Retrospective Single-Center Study of 122 Cases and Review of the Literature. Semin Arthritis Rheum 2011; 40:539-46. [DOI: 10.1016/j.semarthrit.2010.07.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/02/2010] [Accepted: 07/13/2010] [Indexed: 11/21/2022]
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Intra-articular chromic phosphate (32P) in the treatment of diffuse pigmented villonodular synovitis. Brachytherapy 2011; 10:190-4. [DOI: 10.1016/j.brachy.2010.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 05/11/2010] [Accepted: 05/13/2010] [Indexed: 11/18/2022]
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Schnirring-Judge M, Lin B. Pigmented villonodular synovitis of the ankle-radiation therapy as a primary treatment to reduce recurrence: a case report with 8-year follow-up. J Foot Ankle Surg 2011; 50:108-16. [PMID: 21172644 DOI: 10.1053/j.jfas.2010.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Indexed: 02/03/2023]
Abstract
Pigmented villonodular synovitis (PVNS) is a rare, benign, idiopathic proliferative disorder of the synovium that results in villous and or nodular formations that have been reported to manifest within joints, tendon sheaths, and bursae. The overall incidence includes 2% to 10% that occur within the foot and ankle joints. PVNS has a high rate of recurrence and up to a 45% recurrence rate has been reported despite surgical intervention. Although traditional treatment for PVNS includes synovectomy with arthroplasty of the affected joint, radiation therapy is now suggested as an adjunctive therapy that is believed to reduce recurrence of the disease. We present a case of PVNS where the patient was treated in 2 stages: surgical resection of the tumor with arthroplasty of the ankle joint followed by radiation therapy. A retrospective review of the chart, radiographs, and MRIs was conducted for a 36-year-old, African American female who had been treated and followed for 8 years. Pathologic examination of the tumor confirmed the diagnosis of PVNS. No evidence of recurrent PVNS was identified in the long-term postoperative MRI examination. The fact that ancillary imaging examinations failed to reveal evidence of recurrence and that the patient expresses a very high patient satisfaction supports the potential benefit of adjunctive radiation therapy for this condition.
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Heyd R, Micke O, Berger B, Eich HT, Ackermann H, Seegenschmiedt MH. Radiation Therapy for Treatment of Pigmented Villonodular Synovitis: Results of a National Patterns of Care Study. Int J Radiat Oncol Biol Phys 2010; 78:199-204. [DOI: 10.1016/j.ijrobp.2009.07.1747] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 07/09/2009] [Indexed: 10/19/2022]
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Horoschak M, Tran PT, Bachireddy P, West RB, Mohler D, Beaulieu CF, Kapp DS, Donaldson SS. External Beam Radiation Therapy Enhances Local Control in Pigmented Villonodular Synovitis. Int J Radiat Oncol Biol Phys 2009; 75:183-7. [DOI: 10.1016/j.ijrobp.2008.10.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 10/19/2008] [Accepted: 10/21/2008] [Indexed: 10/21/2022]
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Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics 2008; 28:1493-518. [PMID: 18794322 DOI: 10.1148/rg.285085134] [Citation(s) in RCA: 252] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Pigmented villonodular synovitis (PVNS) represents an uncommon benign neoplastic process that may involve the synovium of the joint diffusely or focally (PVNS) or that may occur extraarticularly in a bursa (pigmented villonodular bursitis [PVNB]) or tendon sheath (pigmented villonodular tenosynovitis [PVNTS]). Pathologic specimens of the hypertrophic synovium may appear villous, nodular, or villonodular, and hemosiderin deposition, often prominent, is seen in most cases. The knee, followed by the hip, is the most common location for PVNS or PVNB, whereas PVNTS occurs most often in the hand and foot. PVNTS is also referred to as giant cell tumor of the tendon sheath (GCTTS). PVNTS is the most common form of this disease by a ratio of approximately 3:1. Radiographs reveal nonspecific features of a joint effusion in PVNS, a focal soft-tissue mass in PVNB or PVNTS, or a normal appearance. Extrinsic erosion of bone (on both sides of the joint) may also be seen and is most frequent with intraarticular involvement of the hip (>90% of cases). Cross-sectional imaging reveals diffuse involvement of the synovium (PVNS), an intimate relationship to the tendon (PVTNS), or a typical bursal location (PVNB), findings that suggest the diagnosis. However, the magnetic resonance (MR) imaging findings of prominent low signal intensity (seen with T2-weighting) and "blooming" artifact from the hemosiderin (seen with gradient-echo sequences) are nearly pathognomonic of this diagnosis. In addition, MR imaging is optimal for evaluating lesion extent. This information is crucial to guide treatment and to achieve complete surgical resection. Recurrence is more common with diffuse intraarticular disease and is difficult to distinguish, both pathologically and radiologically, from the rare complication of malignant PVNS. Recognizing the appearances of the various types of PVNS, which reflect their pathologic characteristics, improves radiologic assessment and is important for optimal patient management.
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Affiliation(s)
- Mark D Murphey
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 16th St NW, Washington, DC 20306, USA.
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Abstract
Collectively, benign synovial disorders are not uncommon, and they may be seen in general orthopaedic practices. Symptoms are nonspecific, often delaying diagnosis. In fact, synovial chondromatosis, pigmented villonodular synovitis, synovial hemangioma, and lipoma arborescens often mimic each other as well as other, more common joint disorders in presentation, making diagnosis extremely difficult. It is important to diagnose these disorders correctly in order to provide appropriate treatment and avoid secondary sequelae, such as bone erosion and cartilage degeneration.
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Bickels J, Isaakov J, Kollender Y, Meller I. Unacceptable complications following intra-articular injection of yttrium 90 in the ankle joint for diffuse pigmented villonodular synovitis. J Bone Joint Surg Am 2008; 90:326-8. [PMID: 18245592 DOI: 10.2106/jbjs.g.00441] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Simple resection of diffuse pigmented villonodular synovitis of the ankle joint is associated with local recurrence rates as high as 50%. Thus, adjuvant treatment modalities, such as radiation or intra-articular isotope injection, are sometimes used after tumor resection. Our initial and highly satisfactory experience with the injection of radioactive yttrium 90 to treat pigmented villonodular synovitis of the ankle joint eroded with time so much so that we discontinued its use in the ankle and believe that it is important to alert our colleagues to the complications that we observed. METHODS Between 1989 and 2006, we treated seven patients who had diffuse pigmented villonodular synovitis of the ankle joint with subtotal synovectomy followed by intra-articular injection of 15 mCi of yttrium 90. RESULTS Two of the study patients had full-thickness skin necrosis develop around the injection site, necessitating free muscle flap transfer within three months of treatment, and a third patient had development of a draining sinus that was associated with chronic severe pain. The other four patients reported pain after the injection that was reasonably controlled by the use of nonsteroidal anti-inflammatory drugs. At the most recent follow-up evaluation, no study patient had recurrent disease. CONCLUSIONS Because of the unacceptably high rate of serious complications associated with the injection of yttrium 90 into the ankle joint following subtotal synovectomy, we discontinued its use as a local adjuvant in the management of diffuse pigmented villonodular synovitis of the ankle.
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Affiliation(s)
- Jacob Bickels
- National Unit of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel.
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