Tenosynovial giant-cell tumor arising from the anterior cruciate ligament of the knee

A Rare Case of Giant Cell Tumour of Tendon Sheath and Its Arthroscopic In Toto Excision

The aim of this study is to bring attention to a unique occurrence in an uncommon location and to describe our approach to treatment in this context. We describe a case of a 36-year-old male who presented with complaints of pain in his left knee for three months, with a restricted range of motion, without a prior history of trauma. A thorough knee examination was performed, which was unremarkable except for a restricted range of motion and tenderness along the medial joint line. A plain radiograph of the knee revealed no bony injury. MRI was done to assess the extension and it confirmed a soft tissue mass beneath the patella. The patient was taken up for surgery after a pre-anesthetic checkup and the mass was removed arthroscopically in toto using a higher accessory antero-medial portal. The mass was removed with the help of a spatula without damaging it and sent for histopathological analysis. Histopathology confirmed that it was a giant cell tumour of the tendon sheath. The procedure was uneventful, and the patient achieved a full range of motion post-operatively.

Tenosynovial giant cell tumor of cruciate ligament: A case report and review

Introduction

Tenosynovial giant cell tumor (TSGCT) is a slow-growing soft tissue tumor that develops from the synovial tissue of tendon sheaths, joints, or bursae. In the knee, this type of tumor is uncommon. Giant cell tumors of the cruciate ligaments' tendon sheath are far more infrequent. Only 16 localized TSGCTs of the cruciate ligaments have been recorded in the literature to our knowledge, with 9 involving the anterior cruciate ligament (ACL) and 7 involving the posterior cruciate ligament (PCL).

Case presentation

We present a rare case of localized TSGCT arising from the PCL's femoral insertion in a 44-year-old male, as well as a literature review on localized TSGCT of cruciate ligaments in the knee. The diagnosis of tumor's presence was made using MRI while the definitive diagnosis was obtained through intraoperative evaluation and postoperative pathology.

Conclusion

Arthroscopic tumor resection was an effective and safe treatment option based on the available data.

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Giant cell tumors of the cruciate ligaments are extremely uncommon.

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The most typical clinical presentations are pain and decreased range of motion of the knee without a history of trauma.

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MRI helps confirm the presence of a tumor but not its original location or type.

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Based on available data, arthroscopic tumor removal is an effective and safe treatment option.

Tenosynovial giant cell tumor of the pes anserinus bursa with secondary involvement of a reconstructed autologous anterior cruciate ligament - A case report

Tenosynovial giant cell tumor (TGCT) is defined by the World Health Organization (WHO) as a family of lesions most often arising from the synovium of joints, bursae and tendon sheaths. It is composed of synovial- like mononuclear cells, admixed with multinucleate giant cells, foam cells, siderophages and inflammatory cells (1). It can have various clinical manifestations, and is therefore subdivided in a diffuse and a localized/ nodular subtype. Furthermore, the lesions can have an intra- or extra-articular location. The purpose of this paper is to present the case of a 41-year-old male suffering from multifocal extra- and intra-articular TGCT of the right knee, with involvement of the pes anserinus bursa and an anterior cruciate ligament (ACL) autograft respectively. The ACL reconstruction was performed 11 years prior to the diagnosis of the TGCT, using tendons harvested from the pes anserinus. Our case illustrates the risk of transferring TGCT from an extra- to intra-articular location during ACL reconstruction, when using tendons of a pes anserinus prone to develop this condition. To our knowledge, no similar case was published in the literature so far.

Intra-articular leiomyoma of the knee mimicking a ganglion cyst in a child: A case report and review of literature

INTRODUCTION AND IMPORTANCE

Angioleiomyoma is a rare benign soft tissue tumor of smooth muscle getting its origin from the muscular layer of vessel walls. The localized type of leiomyoma occurs on the skin, deep soft tissues, in the genitourinary, gastrointestinal, and respiratory tracts.

CASE PRESENTATION

We report a case of a 16-year-old patient who presented with an intra-articular leiomyoma developed in the anterior cruciate ligament and treated with arthroscopy.

CLINICAL DISCUSSION

Angioleiomyoma can occur anywhere in the body and is most often seen in the extremities, particularly the lower limbs, but is very rare in the knee joint. Angioleiomyoma should be included in the differential diagnosis of nodular lesions mimicking loose body, such as lipomas, inclusion cysts, ganglion, pigmented villonodular synovitis (PVNS), fibroma, nodular synovitis, hemangioma, synovial sarcoma, myopericytoma, leiomyosarcomas, glomus tumor.

CONCLUSION

Angioleiomyoma related to the cruciate ligaments of the knee should be considered in the differential diagnosis of a painful knee especially when associated with a decreased of range of motion of knee. The arthroscopic debridement should be considered the treatment of choice in order to reliably restore active ROM.

A rare localized giant cell tumor of the tendon sheath originating from the ligamentum mucosum: A case report

Giant cell tumor of the tendon sheath (GCTTS) occurs most often in the hand and rarely in the feet, and as an extremely uncommon presentation in the knee joint. Case reports involving GCTTS in the knee joint generally describe it originating from the nearby anterior cruciate ligament, posterior cruciate ligament, patellar tendon, and medial plica. To the best of our knowledge, there are no previously reported case reports involving GCTTS originating in the ligamentum mucosum. In this article, we describe a 27-year-old male patient who was admitted to the orthopedic emergency room with a painful locked knee. He had severe pain that was worse with activity and a decreased range of motion. Magnetic resonance imaging (MRI) indicated massive swelling and a well- circumscribed lobulated intraarticular mass at the distal one third of the ligamentum mucosum. The mass was removed successfully with arthroscopic-assisted mini-open excision, and histological analysis subsequently diagnosed it as a localized type of GCSTT. The patient remained asymptomatic and a follow-up MRI two years after surgery did not show any recurrence of the lesion.

Arthroscopic Resection of a Tenosynovial Giant Cell Tumor in the Wrist: A Case Report

The treatment for giant cell tumors of the tendon sheath is surgical therapy, but surgical recurrence rates were reported to be as high as 50% in some cases. Therefore, complete radical excision of the lesion is the treatment of choice. If the tumor originates from the joint, it is important to perform capsulotomy. Here, the authors report the first case of successful treatment of a localized intra-articular giant cell tumor in the wrist by arthroscopic resection.A 28-year-old right-handed woman visited the clinic because of left wrist ulnar-side pain, which had been aggravated during the previous 15 days. Vague ulnar-side wrist pain had begun 2 years ago. When the authors examined the patient, the wrist showed mild swelling on the volo-ulnar aspect and the distal radioulnar joint, as well as volar joint line tenderness. She showed a positive result on the ulnocarpal stress test and displayed limited range of motion. Magnetic resonance imaging revealed an intra-articular mass with synovitis in the ulnocarpal joint. Wrist arthroscopy was performed using standard portals under regional anesthesia. The arthroscopic findings revealed a large, well-encapsulated, yellow lobulated soft-tissue mass that was attached to the volar side of the ulnocarpal ligament and connected to the extra-articular side. The mass was completely excised piece by piece with a grasping forceps. Histopathologic examination revealed that the lesion was an intra-articular localized form of a tenosynovial giant cell tumor.At 24-month follow-up, the patient was completely asymptomatic and had full range of motion in her left wrist, and no recurrence was found in magnetic resonance imaging follow-up evaluations.The authors suggest that the arthroscopic excision of intra-articular giant cell tumors, as in this case, may be an alternative method to open excisions, with many advantages.

Giant Cell Tumor of the Patella Tendon Sheath Presenting as a Painful Locked Knee

Patient: Male, 26

Final Diagnosis: Giant cell tumor of the patella tendon seath

Symptoms: Efusion • locking knee • pain

Medication: None

Clinical Procedure: Arthroscopy and open resection of the tumor

Specialty: Orthopedics and Traumatology

A rare case of giant cell tumour arising from anterior cruciate ligament: Its diagnosis and management

Tenosynovial giant cell tumour is a locally aggressive tumour arising from the synovia of the fibrous tissue surrounding the joints, tendon sheaths and tendons. Areas of predilection are the hand, and in the case of synovial joints, the knee joint is particularly affected. We describe a rare case of an intra-articular localized tenosynovial giant cell tumour arising from the anterior cruciate ligament (ACL) in a 27 year male who presented with pain and giving way of his left knee without prior history of any trauma. Tests for internal derangement of knee were negative. MRI reported an ACL tear with a heterogeneous fibrous mass attached to the distal part, most probably an organized haematoma. It was decided to do a diagnostic arthroscopy before proceeding for ACL reconstruction. Arthroscopy revealed a purple coloured mass attached to distal part of ACL. The mass was removed piecemeal using an additional posterolateral portal. ACL was found intact. Histopathology reported it to be tenosynovial giant cell tumour. The patient was asymptomatic at each subsequent follow up. It is a rare diagnosis which presented as an ACL tear; in such suspected cases it is prudent to perform a diagnostic arthroscopy before going for ACL reconstruction.

A tenosynovial giant cell tumor arising from femoral attachment of the anterior cruciate ligament

The localized type of tenosynovial giant cell tumor usually occurs on the palmar side of fingers and toes. Tenosynovial giant cell tumors of the tendon sheath are rarely intra-articular. We report a giant cell tumor of the tendon sheath arising from femoral attachment of the anterior cruciate ligament and its treatment with arthroscopy in a 28-year-old man.

Localized pigmented villonodular synovitis of the anterior cruciate ligament of the knee: an exceptional presentation of a rare disease with neoplastic and inflammatory features

Pigmented villonodular synovitis (PVNS) is a rare condition, most commonly involving the knee joint. PVNS is locally aggressive and can invade and destroy surrounding soft tissue and bone, leading to anatomical and functional deterioration of the affected joint. Localized PVNS is an unusual presentation of the disease, generally consisting of a nodular lesion protruding into the articular cavity. Localized PVNS of the knee can mimic other joint disorders which may pose a challenge for a correct diagnosis. Given the locally aggressive behavior of PVNS, prompt identification and excision of the lesion are instrumental to avoid complications. Here, we report a rare case of localized cystic PVNS involving the anterior cruciate ligament of the knee in a 32-year-old woman with persistent knee pain, in whom magnetic resonance imaging was inconclusive. The diagnosis was achieved via arthroscopy and histology. We also present a concise review of the literature on this pathological entity as well as a discussion on the differential diagnosis between localized PVNS and other intra-articular cystic lesions.

Primary sarcoma of the anterior cruciate ligament - a case report

Clear cell sarcoma of tendons and aponeuroses (CCSTA) is a rare, aggressive soft tissue malignancy, which is found in intimate association with tendon, aponeurosis or fascia. It has not previously been reported in association with intraarticular ligaments. We report the first case of an intraarticular CCSTA, in this case of the anterior cruciate ligament and describe the diagnostic and treatment challenges of intraarticular tumours of the knee.

Tumour and tumour-like lesions of the intercondylar notch of the knee: a pictorial review

A variety of tumours and tumour-like lesions are found in the intercondylar notch of the knee. MR imaging is the technique of choice in evaluating these conditions. Correlation with radiographs is important to identify those lesions containing calcification. This review article discusses the imaging features of tumour and tumour-like lesions involving the intercondylar notch with an emphasis on MR imaging features that suggest a specific diagnosis.

Localized nodular synovitis of the knee presenting as anterior knee pain: a case report

The localized nodular synovitis is a benign proliferative synovial tumor manifesting as an intra-articular solitary nodule. We report a case of localized nodular synovitis at the infrapatellar fat pad of the knee which presented as a vague symptom of anterior knee pain. An arthroscopic excision of the lesion relieved the anterior knee pain and there has been no evidence of recurrence. Although the localized nodular synovitis shares some common histologic features with the pigmented villonodular synovitis without villous fronds, hemorrhage, or hemosiderin deposit, it is important to make a distinction between the two entities because their clinical presentations differ greatly, as do their responses to treatment. This rare tumorous lesion should be included in the differential diagnosis of common clinical symptom of anterior knee pain.

Pigmented villonodular synovitis of the knee: disease of the popliteus tendon and posterolateral compartment

The knee joint is the most frequent location for pigmented villonodular synovitis (PVNS). Within the knee, localized PVNS is most commonly situated within the anterior compartment and is rarely found in the posterior compartment. Preoperative diagnosis is often elusive but can be improved with magnetic resonance imaging. We present a case of localized PVNS within the posterolateral compartment of the knee originating from the popliteus tendon that was not found on preoperative examination or radiological imaging.

Differential diagnosis of tumours and tumour-like lesions of the infrapatellar (Hoffa?s) fat pad: pictorial review with an emphasis on MR imaging

A variety of intrinsic and extrinsic tumours and tumour-like conditions may affect the infrapatellar (Hoffa's) fat pad (IFP). MR imaging is the technique of choice in evaluating these conditions, but correlation with radiographs is important to identify those lesions producing mineralization. This pictorial review illustrates the spectrum of mass-like lesions that can affect the IFP, emphasizing the radiographic and MR findings that suggest a specific diagnosis.

Arthroscopic excision of juxta-articular giant-cell tumor arising from the patellar tendon sheath

Most giant-cell tumors of the tendon sheath are found on the flexor surface of the hand, in the fingers, wrist, or palm. The isolated discrete lesion involving tendon sheaths (localized giant-cell tumor of the tendon sheath) is rarely located intra-articularly, especially in the knee joint. To the best of my knowledge, this is the first reported case of a large, localized, juxta-articular giant-cell tumor of the patellar tendon sheath that was treated successfully with arthroscopic excision.

Localized pigmented villonodular synovitis of the knee

Eight patients with localized pigmented villonodular synovitis (LPVNS) of the knee were treated with arthroscopic and open techniques, with diagnosis confirmed by histological examination. Average patient age was 29 years (range: 13-50 years). At arthroscopy, all lesions except one were in the anterior compartment of the involved knee. Treatment consisted of complete local excision with partial synovectomy. This procedure was completed arthroscopically in seven patients. No recurrence was reported at average 24-month follow-up (range: 12-33 months). Arthroscopy is a valuable tool in the diagnosis and treatment of LPVNS.

Localized nodular synovitis of the knee: MR imaging appearance and clinical correlates in 21 patients

OBJECTIVE

Localized nodular synovitis of the knee and pigmented villonodular synovitis are similar histologically. The purpose of this study was to evaluate the MR imaging appearance and clinical findings of localized nodular synovitis of the knee and to differentiate this condition from pigmented villonodular synovitis.

MATERIALS AND METHODS

A retrospective review of MR imaging of the knee was performed in 21 patients with histologically confirmed localized nodular synovitis. Surgical excision of the lesion was performed in all patients. The MR imaging appearances of the lesions were defined, and the clinical and surgical findings were reviewed.

RESULTS

All lesions presented as a solitary intraarticular mass. The mass originated from the synovial lining in different locations including the infrapatellar fat pad (n = 14), suprapatellar pouch (n = 5), and posterior aspect of the intercondylar notch (n = 2). A small (2.0-3.5 cm; mean diameter, 2.7 cm) ovoid mass (n = 13) was more common than a large (5.0-9.0 cm; mean diameter, 6.5 cm) polylobulated mass (n = 8). At surgery, a long pedicle attached the mass to the adjacent synovium in two patients, but this was observed on MR imaging in only one patient. The lesions showed intermediate (n = 15) or hyperintense (n = 6) signal intensity on T1-weighted images and heterogeneously high (n = 13) or low (n = 8) signal intensity with variable circular foci of low signal intensity on T2-weighted images. On T2-weighted images, linear regions of high signal intensity within the mass were seen in seven lesions. Prominent enhancement of the lesion with IV contrast administration was shown in all patients who were given contrast material (n = 10). Knee pain, joint swelling, and a palpable mass were the most frequent clinical manifestations. An acutely painful knee was noted in one patient who presented with torsion of an infrapatellar pedicle. Five patients complained of locking of the knee, but at physical examination, restricted terminal knee extension was noted in nine patients.

CONCLUSION

Localized nodular synovitis of the knee predominantly involves the infrapatellar fat pad. It may produce symptoms related to mechanical derangement of the knee. Although there is no typical MR appearance for this lesion, many features help to differentiate it from pigmented villonodular synovitis.

Localized pigmented villonodular synovitis attached to the posterior cruciate ligament of the knee

Localized pigmented villonodular synovitis (PVNS) of the knee joint is a rare pathological entity characterized by a limited involvement of the synovium. We report on a case of localized PVNS which was attached to the posterior cruciate ligament and presented pain without mechanical symptoms. The lesion did not reach dimensions sufficient to interfere with joint function. After arthroscopic removal of the tumor, the patient has maintained asymptomatic status during the 2 year follow-up period.

Giant-cell tumor of the tendon sheath arising from the posterior cruciate ligament of the knee: a case report and review of the literature

The localized form of a giant-cell tumor of the tendon sheath is uncommon and rarely intraarticular. While the sonographic findings are nonspecific, the magnetic resonance (MR) findings can be diagnostic. Relatively homogeneous iso- or marginal hyperintensity on T2-weighted sequences, lack of susceptibility effects due to hemosiderin, the demonstration of a fibrous capsule and the absence of adjacent joint involvement may help to differentiate localized and diffuse forms of giant-cell tumors of tendon sheaths and pigmented villonodular synovitis.

Localized pigmented villonodular synovitis: a rare cause of locking of the knee

A 34-year-old woman presented with a history of recurrent episodes of knee locking and swelling. Arthroscopy revealed characteristic brown colored pedunculated lesions in the intercondylar notch region. These were clearly causing interference to joint motion. The lesions were resected arthroscopically with prompt resolution in symptoms. Histological examination confirmed pigmented villonodular synovitis.