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Zeoli T, Mathkour M, Scullen T, Carr C, Abou-Al-Shaar H, Wang L, Divagaran A, Dindial R, Tubbs RS, Bui CJ, Maulucci CM. Spinal pigmented villonodular synovitis and tenosynovial giant cell tumor: A report of two cases and a comprehensive systematic review. Clin Neurol Neurosurg 2021; 202:106489. [PMID: 33596487 DOI: 10.1016/j.clineuro.2021.106489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/07/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Pigmented villonodular synovitis (PVNS) is a lesion of uncertain etiology that involves the synovial membranes of joints or tendon sheaths, representing a diffuse and non-encapsulated form of the more common giant cell tumors of the synovium (GCTTS). PVNS was reclassified to denote a diffuse form of synovial giant cell tumor (TSGCT), while 'giant cell tumor of the tendon sheath (GCTTS)' was used for localized lesions. These pathologies rarely affect the axial skeleton. We provide an unprecedented and extensive systematic review of both lesions highlighting presentation, diagnostic considerations, treatment, prognosis, and outcomes, and we report a short case-series. METHOD We describe two-cases and conduct a systematic review in accordance with PRISMA guidelines. RESULT PVNS was identified in most of the cases reviewed (91.6 %), manifesting predominantly in the cervical spine (40 %). Patients commonly presented with neck pain (59 %), back pain (53 %), and lower back pain (81.2 %) for cervical, thoracic, and lumbar lesions, respectively. GTR occurred at rates of 94 %, 80 %, and 87.5 %. Recurrence was most common in the lumbar region (30.7 %). GCTTS cases (8%) manifested in the cervical and thoracic spine at the same frequency. We reported first case of GCTTS in the lumbosacral region. Both poses high rate of facet and epidural involvements. CONCLUSION Spinal PVNS and GCTTS are rare. These lesions manifest most commonly as PVNS within the cervical spine. Both types have a high rate of facet and epidural involvement, while PVNS has the highest rate of recurrence within the lumbar spine. The clinical and radiological features of these lesions make them difficult to differentiate from others with similar histogenesis, necessitating tissue diagnosis. Proper management via GTR resolves the lesion, with low rates of recurrence.
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Affiliation(s)
- Tyler Zeoli
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - Mansour Mathkour
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Saudi Arabia.
| | - Tyler Scullen
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
| | - Christopher Carr
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Leon Wang
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - Adhira Divagaran
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - Rishawn Dindial
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
| | - Cuong J Bui
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
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Cho JM, Chang JH, Kim SH, Lee KS. Pediatric giant cell tumor of the tendon sheath of the craniocervical junction involving the occipital condyle. Childs Nerv Syst 2016. [PMID: 26210493 DOI: 10.1007/s00381-015-2820-5] [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] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Giant cell tumor of the tendon sheath (GCTTS), also called pigmented villonodular synovitis, is a common lesion of the synovial membrane of the hand joint, but it uncommonly involves the axial skeleton, especially in pediatric populations. Furthermore, GCTTS originating from the occipital condyle has not been reported previously. CASE REPORT A 15-year-old girl presented with a palpable neck mass for 1 year, and imaging studies revealed a less demarcated and heterogeneously enhanced mass in the suboccipital region. The tumor was originating from the occipital condyle that eroded the skull and atlas, and it was completely resected via a far lateral transcondylar approach followed by transarticular screw fixation. After the resection, we performed occipitocervical fusion to prevent spinal instability. The patient made an uneventful recovery after surgery. Recurrence has not been observed after 5 years of follow-up. DISCUSSION We report this rare case and briefly review the general features and unusual locations of GCTTS with recommendations for treatment modalities.
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Affiliation(s)
- Jin Mo Cho
- Department of Neurosurgery, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center and Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Ho Kim
- Department of Neurosurgery, Brain Tumor Center and Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Sung Lee
- Department of Neurosurgery, Brain Tumor Center and Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Oh SW, Lee MH, Eoh W. Pigmented villonodular synovitis on lumbar spine : a case report and literature review. J Korean Neurosurg Soc 2014; 56:272-7. [PMID: 25368775 PMCID: PMC4217069 DOI: 10.3340/jkns.2014.56.3.272] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/06/2014] [Accepted: 08/14/2014] [Indexed: 12/29/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a benign proliferative joint disease with an uncertain etiology that uncommonly involves the spine. We present a case of PVNS involving the lumbar spine. A 38-year-old male developed back pain and pain in both legs caused by a mass in the L4 region of the right lamina. After gross total tumor removal, the symptoms improved. The pathological finding was synovial hyperplasia with accumulation of hemosiderin-laden macrophages. He was diagnosed with PVNS and experienced no recurrence for up to 2 years after surgery. In this report, we review the previous literature and discuss etiology, clinical manifestations, diagnosis, and treatment.
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Affiliation(s)
- Sung Woon Oh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whan Eoh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Pigmented villonodular synovitis of the thoracic spine. J Clin Neurosci 2014; 21:1679-85. [PMID: 24938389 DOI: 10.1016/j.jocn.2014.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/30/2014] [Indexed: 12/18/2022]
Abstract
Pigmented villonodular synovitis (PVNS) is a proliferative lesion of the synovial membranes. Knees, hips, and other large weight-bearing joints are most commonly affected. PVNS rarely presents in the spine, in particular the thoracic segments. We present a patient with PVNS in the thoracic spine and describe its clinical presentation, radiographic findings, pathologic features, and treatment as well as providing the first comprehensive meta-analysis and review of the literature on this topic, to our knowledge. A total of 28 publications reporting 56 patients were found. The lumbar and cervical spine were most frequently involved (40% and 36% of patients, respectively) with infrequent involvement of the thoracic spine (24% of patients). PVNS affects a wide range of ages, but has a particular predilection for the thoracic spine in younger patients. The mean age in the thoracic group was 22.8 years and was significantly lower than the cervical and lumbar groups (42.4 and 48.6 years, respectively; p=0.0001). PVNS should be included in the differential diagnosis of osteodestructive lesions of the spine, especially because of its potential for local recurrence. The goal of treatment should be complete surgical excision. Although the pathogenesis is not clear, mechanical strain may play an important role, especially in cervical and lumbar PVNS. The association of thoracic lesions and younger age suggests that other factors, such as neoplasia, derangement of lipid metabolism, perturbations of humoral and cellular immunity, and other undefined patient factors, play a role in the development of thoracic PVNS.
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Siribumrungwong K, Tangtrakulwanich B, Nitiruangjaras A. Unusual presentation of giant cell tumor originating from a facet joint of the thoracic spine in a child: a case report and review of the literature. J Med Case Rep 2013; 7:178. [PMID: 23830026 PMCID: PMC3711725 DOI: 10.1186/1752-1947-7-178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/24/2013] [Indexed: 02/07/2023] Open
Abstract
Introduction Giant cell tumor of the synovium is a common benign lesion that frequently occurs at the tendon sheaths in the hand; it is usually found in adults over 30 years old. It is related to pigmented villonodular synovitis. Giant cell tumor of the synovium or pigmented villonodular synovitis has been described rarely in the axial skeleton especially in the thoracic vertebrae of a child. Case presentation A previously healthy 7-year-old Thai girl presented with back pain and progressive paraparesis and was unable to walk for 1 month. She had weakness and hyperreflexia of both lower extremities. Magnetic resonance imaging showed a well-defined homogeneously and intensely enhanced extradural mass with cord compression at T4 to T7 levels. The patient underwent laminectomy at T4 through to T7 and total tumor removal. Permanent histopathologic sections and immunostains revealed a giant cell tumor of the synovium. Postoperative neurological status recovered to grade V. Magnetic resonance imaging at the 1-year follow-up showed no recurrence and there was no clinical recurrence at the 2-year follow-up. Conclusion We report an extremely rare case of giant cell tumor in the epidural space that extended from a thoracic facet joint. The tumor was removed successfully through laminectomies. Although giant cell tumor of a facet joint of the thoracic spine is very rare, it must be considered in the differential diagnosis for masses occurring in the epidural space in a child. Total tumor removal is the best treatment. Careful monitoring of recurrence can achieve a good clinical outcome.
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Affiliation(s)
- Koopong Siribumrungwong
- Department of Orthopedic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90110, Thailand.
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Müslüman AM, Cavuşoğlu H, Yilmaz A, Dalkiliç T, Tanik C, Aydin Y. Pigmented villonodular synovitis of a lumbar intervertebral facet joint. Spine J 2009; 9:e6-9. [PMID: 19303820 DOI: 10.1016/j.spinee.2008.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 11/07/2008] [Accepted: 12/04/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pigmented villonodular synovitis (PVNS) is a slowly progressive lesion of uncertain etiology that involves the synovial membrane of joints or tendon sheaths. Only rarely does PVNS affect the axial skeleton, where it arises from the vertebral articular facet joint. Its treatment and prognosis remains limited. PURPOSE To describe our management in a patient with PVNS and to review previously published cases. STUDY DESIGN Case report. METHODS This is a case report of a 59-year-old woman who presented left sciatica. Computed tomography (CT) imaging revealed a mixed sclerotic and lucent lesion affecting the left L4-L5 facet joint. Magnetic resonance imaging (MRI) demonstrated a diffusely infiltrative process that originated from the left inferior articular process of L4 vertebra with extension into the spinal canal. A total synovectomy with left L4 hemilaminectomy was performed. Left L5 root was decompressed with total microscopic tumor removal. Decompression of spinal canal and absence of the tumor was shown by MRI and CT scan after the operation. RESULTS Complete resolution of the patient's complaints was achieved. Histopathological analysis was consistent with a diagnosis of PVNS. CONCLUSIONS The principle of surgical management of spinal lesions causing neurologic deficit is early surgical decompression. It is also important to totally remove the synovium, the origin of PVNS, to prevent the recurrence.
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Affiliation(s)
- Ahmet Murat Müslüman
- Neurosurgery Clinic, Sişli Etfal Education and Research Hospital, Istanbul, Turkey
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Orhan Z, Oktas B, Yildirim U. An unusual presentation of peroneal neuropathy secondary to pigmented villonodular synovitis: a case report. Knee Surg Sports Traumatol Arthrosc 2009; 17:518-20. [PMID: 19205665 DOI: 10.1007/s00167-009-0720-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 01/05/2009] [Indexed: 11/25/2022]
Abstract
Pigmented villonodular synovitis (PVS) is a benign proliferative disorder of unknown origin that affects synovial joints, most commonly the knee. The joint knee can be affected by localized or diffuse form. Diffuse PVS, the aggressive form of the disease is much more problematic, especially when it extends extra-articularly, and is associated with high recurrence rates. Although this disease is categorized as an inflammatory process rather than a neoplasm, it may be locally destructive and involve muscles, tendons, bone and skin. Neural involvement of the disease is rather rare, and only limited knowledge about neuropathy due to PVS we have yet. The presentation of the disease in our patient is a peroneal neuropathy which is the first reported case in English language literature of PVS of the knee seen with extra-articular tissue involvement.
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Affiliation(s)
- Zafer Orhan
- Department of Orthopedics and Traumatology, Duzce Medical Faculty, Duzce University, Duzce, Turkey.
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Gupta R, Jambhekar N, Sanghvi D. Giant-cell tumour of the synovium in a facet joint in the thoracic spine of a child. ACTA ACUST UNITED AC 2008; 90:236-9. [DOI: 10.1302/0301-620x.90b2.19616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Giant-cell tumour of the synovium is known to affect the fingers or toes of adults. It has seldom been described in the spine and rarely in the thoracic vertebrae or in a child. The lesions of giant-cell tumour of the synovium have a classical radiological appearance, but require a high index of suspicion for correct recognition. Unlike giant-cell tumour of the synovium at other well-known sites, spinal lesions lack the characteristic papillary architecture, thereby raising other diagnostic possibilities. We describe a giant-cell tumour of the synovium of the left facet joint of a thoracic vertebra in a nine-year-old girl. The tumour was treated successfully by surgical excision.
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Affiliation(s)
- R. Gupta
- Department of Pathology, Tata Memorial Hospital, Ernest Borges Road, Lower Parel, Mumbai, 400012 India
| | - N. Jambhekar
- Department of Pathology, Tata Memorial Hospital, Ernest Borges Road, Lower Parel, Mumbai, 400012 India
| | - D. Sanghvi
- Department of Radiology, King Edward Memorial, Hospital and Seth GS Medical College, Parel, Mumbai, 400012 India
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