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Benard C, Le Loarer F, Gomez-Mascard A, Azmani R, Garcia J, Perret R, de Pinieux G, Miquelestorena-Standley E, Weingertner N, Karanian M, Meurgey A, Michot A, Tirode F, Truffaux N, Macagno N, Bouvier C. Comprehensive Molecular Characterization of a Large Series of Calcified Chondroid Mesenchymal Neoplasms Widening Their Morphologic Spectrum. Am J Surg Pathol 2024; 48:991-1004. [PMID: 39016330 DOI: 10.1097/pas.0000000000002260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Recently, FN1 fusions to receptor tyrosine kinase genes have been identified in soft tissue tumors with calcified chondroid matrix named calcifying chondroid mesenchymal neoplasms (CCMNs). We collected 33 cases of CCMN from the French network for soft tissue and bone tumors. We performed whole-exome RNA sequencing, expression analysis, and genome-wide DNA methylation profiling in 33, 30, and 20 cases of CCMN compared with a control group of tumors, including noncalcified tenosynovial giant cell tumor (TGCT). Among them, 15 cases showed morphologic overlap with soft tissue chondroma, 8 cases with tophaceous pseudogout, and 10 cases with chondroid TGCT. RNA-sequencing revealed a fusion of FN1 in 76% of cases (25/33) with different 5' partners, including most frequently FGFR2 (14 cases), TEK or FGFR1. Among CCMN associated with FGFR1 fusions, 2 cases had overexpression of FGF23 without tumor-induced osteomalacia. Four CCMN had PDGFRA::USP8 fusions; 3 of which had histologic features of TGCT and were located in the hip, foot, and temporomandibular joint (TMJ). All cases with FN1::TEK fusion were located at TMJ and had histologic features of TGCT with or without chondroid matrix. They formed a distinct cluster on unsupervised clustering analyses based on whole transcriptome and genome-wide methylome data. Our study confirms the high prevalence of FN1 fusions in CCMN. In addition, through transcriptome and methylome analyses, we have identified a novel subgroup of tumors located at the TMJ, exhibiting TGCT-like features and FN1::TEK fusions.
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Affiliation(s)
- Clément Benard
- Department of Pathology, Timone University Hospital, Marseille
| | - François Le Loarer
- Department of Biopathology, Bergonié Institute, Regional Comprehensive Cancer Center
- UMR1312, University of Bordeaux, Inserm, BRIC, BoRdeaux Institute of Oncology
| | | | | | - Jeremy Garcia
- Department of Pathology, Timone University Hospital, Marseille
| | - Raul Perret
- Department of Biopathology, Bergonié Institute, Regional Comprehensive Cancer Center
- UMR1312, University of Bordeaux, Inserm, BRIC, BoRdeaux Institute of Oncology
| | | | | | | | | | | | - Audrey Michot
- UMR1312, University of Bordeaux, Inserm, BRIC, BoRdeaux Institute of Oncology
- Department of Surgery, Bergonié Institute, Bordeaux
| | | | - Nathalene Truffaux
- UMR1312, University of Bordeaux, Inserm, BRIC, BoRdeaux Institute of Oncology
| | - Nicolas Macagno
- UMR1251, Aix Marseille Univ, MMG, Marmara Institute, Timone University Hospital
| | - Corinne Bouvier
- Department of Pathology, Timone University Hospital, Marseille
- UMR7051, INP, Equipe 8 GlioME - Gliomagenèse et MicroEnvironnement, Aix Marseille Univ, Marseille, France
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2
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Abed Alharbi W, Mohammed Alshareef H, Hennawi YB, Munshi AA, Khalid Alzahrani A. Giant Cell Tumor in Tarsal Midfoot Bones: A Case Report. Cureus 2024; 16:e56215. [PMID: 38623116 PMCID: PMC11017238 DOI: 10.7759/cureus.56215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
Diffuse tenosynovial giant cell tumor (D-TGCT), previously known as pigmented villonodular synovitis (PVNS), is a benign, aggressive, and distracting proliferative synovial lesion. D-TGCT is commonly seen in large joints such as the knee and hip. We present the case of a 57-year-old female who initially presented with swelling on the left midfoot that increased over four years. Clinically, a ganglion was suspected on the left midfoot and an MRI showed a heterogeneous lobulated soft tissue mass on the superior aspect of the tarsal midfoot measuring 5.8 x 2.4 x 4.2 cm. The mass causing remodeling and bony erosion was more appreciated at the medial aspect of the talus bone and extended to the sinus tarsi and talocalcaneal joint space. Surgical excision of the mass was performed, and pathology reports found lobulated soft tissue lesions composed of mononuclear cells, multinucleated giant cells, sheets of foamy macrophages, inflammatory cells, and hemosiderin-laden macrophages. This case represents D-TGCT without atypia or malignancy based on the findings.
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Han W, Luo H, Zhao Y, He Z, Guo C, Meng J. Retrospective study of synovial chondromatosis of the temporomandibular joint: clinical and histopathologic analysis and the early-stage imaging features. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:215-223. [PMID: 38158268 DOI: 10.1016/j.oooo.2023.09.006] [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: 08/14/2023] [Revised: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Herein, we aimed to study the clinical, radiographical, and histopathologic features of synovial chondromatosis in the temporomandibular joint (SC in TMJ) and provide references for early diagnosis and treatment prognosis. STUDY DESIGN The medical records and imaging examinations of patients with SC in TMJ, diagnosed using postoperative histopathologic examination, were reviewed and analyzed. Among them, 18 cases who lacked calcified loose bodies on spiral computed tomography or cone beam computed tomography (SCT/CBCT) were selected for further study. Descriptive statistical methods were used to analyze the clinical characteristics of patients. RESULTS The study included 100 patients with SC in TMJ, who were predominantly female (male to female: 1:3), and were aged from 21 to 77 years (median, 47). Radiopaque calcified lesions on SCT/CBCT were missing in 18 cases, but cartilaginous nodules were observed during surgery. The cases lacking calcification had a relatively shorter disease course, suggesting they were in the early stages of SC. CONCLUSION In the early stage of SC, although calcified loose bodies cannot be detected on SCT/CBCT, attention should be paid to the widening of the posterior superior joint space and sclerosis or slight erosion of the joint fossa. Magnetic resonance imaging would be helpful to detect the early-stage SC in TMJ.
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Affiliation(s)
- Weihua Han
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Haiyan Luo
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yanping Zhao
- Department of Oral Radiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zonghan He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Juanhong Meng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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4
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Kao EY, Chen EY. Calcified Chondroid Mesenchymal Neoplasms. Surg Pathol Clin 2024; 17:77-82. [PMID: 38278609 DOI: 10.1016/j.path.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Calcified chondroid mesenchymal neoplasms (CCMN) represent a morphologic spectrum of related tumors. Historically, chondroid matrix or chondroblastoma-like features have been described in soft tissue chondroma, tenosynovial giant cell tumors (especially of the temporomandibular joint (TMJ) region), and in a subset of tophaceous pseudogout. Recently, these tumors have been found to share FN1-receptor tyrosine kinase (RTK) fusions. This review discusses the clinical, morphologic, immunohistochemical, and molecular genetic features of CCMN. The distinction from morphologic mimics is also discussed.
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Affiliation(s)
- Erica Y Kao
- Department of Pathology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Building 3600, 4th Floor, Room 447-6, San Antonio, TX 78234, USA
| | - Eleanor Y Chen
- Department of Laboratory Medicine and Pathology, University of Washington, 1959 Northeast Pacific Street, Box 357705, HSB Room K072A, Seattle, WA 98195-7705, USA.
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5
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Cheah AL, Brown W, Bonar SF. Pathology of intra-articular tumours and tumour-like lesions: pearls, pitfalls and rarities from a general surgical pathology practice. Skeletal Radiol 2024:10.1007/s00256-024-04615-5. [PMID: 38363417 DOI: 10.1007/s00256-024-04615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Intra-articular tumours are uncommonly encountered in routine practice and may present diagnostic challenges to pathologists. Challenges unique to this site include distinction from more common reactive synovial conditions, which are far more common; histologic variability; superimposed reactive changes; and often, lack of provided clinicoradiological context. This article reviews the pathology of the synovial tumours and tumour-like lesions, including diagnostic pearls, pitfalls and rare entities.
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Affiliation(s)
- Alison L Cheah
- Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW, 2113, Australia.
| | - Wendy Brown
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - S Fiona Bonar
- Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW, 2113, Australia
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6
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Hild V, Mellert K, Möller P, Barth TFE. Giant Cells of Various Lesions Are Characterised by Different Expression Patterns of HLA-Molecules and Molecules Involved in the Cell Cycle, Bone Metabolism, and Lineage Affiliation: An Immunohistochemical Study with a Review of the Literature. Cancers (Basel) 2023; 15:3702. [PMID: 37509363 PMCID: PMC10377796 DOI: 10.3390/cancers15143702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Giant cells (GCs) are thought to originate from the fusion of monocytic lineage cells and arise amid multiple backgrounds. To compare GCs of different origins, we immunohistochemically characterised the GCs of reactive and neoplastic lesions (n = 47). We studied the expression of 15 molecules including HLA class II molecules those relevant to the cell cycle, bone metabolism and lineage affiliation. HLA-DR was detectable in the GCs of sarcoidosis, sarcoid-like lesions, tuberculosis, and foreign body granuloma. Cyclin D1 was expressed by the GCs of neoplastic lesions as well as the GCs of bony callus, fibroid epulis, and brown tumours. While cyclin E was detected in the GCs of all lesions, p16 and p21 showed a heterogeneous expression pattern. RANK was expressed by the GCs of all lesions except sarcoid-like lesions and xanthogranuloma. All GCs were RANK-L-negative, and the GCs of all lesions were osteoprotegerin-positive. Osteonectin was limited to the GCs of chondroblastoma. Osteopontin and TRAP were detected in the GCs of all lesions except xanthogranuloma. RUNX2 was heterogeneously expressed in the reactive and neoplastic cohort. The GCs of all lesions except foreign body granuloma expressed CD68, and all GCs were CD163- and langerin-negative. This profiling points to a functional diversity of GCs despite their similar morphology.
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Affiliation(s)
- Vivien Hild
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
| | - Kevin Mellert
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
| | - Peter Möller
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
| | - Thomas F E Barth
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
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7
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Kallen ME, Michal M, Meyer A, Suster DI, Olson NJ, Charville GW, Perret R, Gross JM. Calcified Chondroid Mesenchymal Neoplasm: Exploring the Morphologic and Clinical Features of an Emergent Entity With a Series of 33 Cases. Am J Surg Pathol 2023; 47:725-737. [PMID: 37102574 DOI: 10.1097/pas.0000000000002044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Calcified chondroid mesenchymal neoplasm is a term proposed for tumors with a spectrum of morphologic features, including cartilage/chondroid matrix formation, that frequently harbor FN1 gene fusions. We report a series of 33 cases of putative calcified chondroid mesenchymal neoplasms, mostly referred for expert consultation out of concern for malignancy. Patients included 17 males and 16 females, with a mean age of 51.3 years. Anatomic locations include the hands and fingers, feet and toes, head and neck, and temporomandibular joint; 1 patient presented with multifocal disease. Radiologic review showed soft tissue masses with variable internal calcification, which occasionally scalloped bone but in all cases appeared indolent/benign. Tumors had a mean gross size of 2.1 cm and a homogenous rubbery to fibrous/gritty tan-white cut surface. Histology demonstrated multinodular architecture with a prominent chondroid matrix and increased cellularity towards the periphery of the nodules. The tumor cells were polygonal with eccentric nuclei and bland cytologic features and showed a variable amount of increased spindled / fibroblastic forms in the perinodular septa. The majority of cases had notable grungy and/or lacy calcifications. A subset of cases demonstrated at least focal areas of increased cellularity and osteoclast-like giant cells. Herein, we confirm the distinct morphologic and clinicopathologic features associated with this entity with the largest series to date, with a focus on practical diagnostic separation from similar chondroid neoplasms. Awareness of these features is critical in avoiding pitfalls, including a malignant diagnosis of chondrosarcoma.
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Affiliation(s)
- Michael E Kallen
- Department of Pathology, University of Maryland School of Medicine
| | | | - Anders Meyer
- Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - David I Suster
- Department of Pathology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School, Rutgers, NJ
| | - Nicholas J Olson
- Physicians Laboratory
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | | | - Raul Perret
- Institut Bergonié / Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - John M Gross
- Department of Pathology, Johns Hopkins Medicine, Baltimore, MD
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8
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Kanbour A, Hurrell M, Ricciardo P. Management of tenosynovial giant cell tumour of the temporomandibular joint: a systematic review. ANZ J Surg 2022; 93:869-875. [PMID: 37052058 DOI: 10.1111/ans.18186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
Diffuse type tenosynovial giant cell tumour of the temporomandibular joint (D-TGCT-TMJ) is a rare proliferative disorder. The aim of this study was to perform a systematic review of the literature to summarize D-TGCT-TMJ management regimes and recurrence rates with at least 12 months of follow-up. Our secondary aim was to propose a minimum period of post-operative follow-up. A medline search for any D-TGCT-TMJ case detailing treatment, follow-up of at least 12 months, and presence of recurrence was undertaken. The following variables were extracted from the studies: patient's age and sex, presence of middle cranial fossa invasion, treatment undertaken, total length of follow-up, and presence of recurrence. All studies were assessed for bias as per the Joanna Briggs Institute systematic reviews appraisal tool. There were 63 cases reviewed and were predominantly managed with total resection (60.3%). Other modalities included: arthroplasty, subtotal resection with or without postoperative radiotherapy, medical therapy and surveillance. The recurrence rate was 9.52% and the longest follow-up period where recurrence was observed was at 60 months. Total resection and arthroplasty are common D-TGCT-TMJ management regimes. Patients with D-TGCT-TMJ should be followed up annually for at least 5 years postoperatively to assess for recurrence.
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Affiliation(s)
- Abdullah Kanbour
- Department of Oral and Maxillofacial Surgery Royal Perth Hospital Perth Western Australia Australia
| | - Michael Hurrell
- Department of Oral and Maxillofacial Surgery Royal Perth Hospital Perth Western Australia Australia
| | - Peter Ricciardo
- Department of Oral and Maxillofacial Surgery Royal Perth Hospital Perth Western Australia Australia
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9
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Hamel-Lemaire S, Fortin M, Avon SL. Pigmented villonodular synovitis of the temporomandibular joint: case report and literature review. J Oral Maxillofac Surg 2022; 80:1691-1704. [DOI: 10.1016/j.joms.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022]
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10
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Liu YJ, Wang W, Yeh J, Wu Y, Mantilla JG, Fletcher CDM, Ricciotti RW, Chen EY. Calcified chondroid mesenchymal neoplasms with FN1-receptor tyrosine kinase gene fusions including FGFR2, FGFR1, MERTK, NTRK1, and TEK: a molecular and clinicopathologic analysis. Mod Pathol 2021; 34:1373-1383. [PMID: 33727696 DOI: 10.1038/s41379-021-00786-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
Translocations involving FN1 have been described in a variety of neoplasms that share the presence of a cartilage matrix and may also contain a variable extent of calcification. Fusions of FN1 to FGFR1 or FGFR2 have been reported in nine soft tissue chondromas, mostly demonstrated indirectly by FISH analysis. Delineation of FN1 fusions with various partner genes will facilitate our understanding of the pathogenesis and diagnostic classification of these neoplasms. In this study, we present molecular, clinical, and pathologic features of 12 cartilaginous soft tissue neoplasms showing a predilection for the TMJ region and the distal extremities. We analyzed for gene fusions with precise breakpoints using targeted RNA-seq with a 115-gene panel. We detected gene fusions in ten cases, including three novel fusions, FN1-MERTK, FN1-NTRK1, and FN1-TEK, each in one case, recurrent FN1-FGFR2 fusion in five cases, FN1-FGFR1 in one case, and FGFR1-PLAG1 in one case. The breakpoints in the 5' partner gene FN1 ranged from exons 11-48, retaining the domains of a signal peptide, FN1, FN2, and/or FN3, while the 3' partner genes retained the transmembrane domain, tyrosine kinase (TK) domains, and/or Ig domain. The tumors are generally characterized by nodular/lobular growth of polygonal to stellate cells within a chondroid matrix, often accompanied by various patterns of calcification, resembling those described for the chondroblastoma-like variant of soft tissue chondroma. Additional histologic findings include extensive calcium pyrophosphate dihydrate deposition in two cases and features resembling tenosynovial giant cell tumor (TGCT). Overall, while the tumors from our series show significant morphologic overlap with chondroblastoma-like soft tissue chondroma, we describe findings that expand the morphologic spectrum of these neoplasms and therefore refer to them as "calcified chondroid mesenchymal neoplasms." These neoplasms represent a spectrum of chondroid/cartilage matrix-forming tumors harboring FN1-receptor TK fusions that include those classified as soft tissue chondroma as well as chondroid TGCT.
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Affiliation(s)
- Yajuan J Liu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States.
| | - Wenjing Wang
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Jeffrey Yeh
- Department of Biology, University of Washington, Seattle, WA, United States
| | - Yu Wu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Jose G Mantilla
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Christopher D M Fletcher
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Robert W Ricciotti
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Eleanor Y Chen
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States.
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11
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Zhao W, Ruan Y, Zhang W, Yang F. Synovial chondromatosis of the temporomandibular joint with 400 loose bodies: a case report and literature review. J Int Med Res 2021; 49:3000605211000526. [PMID: 33752510 PMCID: PMC7995452 DOI: 10.1177/03000605211000526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Synovial chondromatosis (SC) is a benign condition characterized by the formation of metaplastic cartilage in the synovial membrane of the joint, resulting in numerous attached and unattached osteocartilaginous bodies. SC mostly affects the large synovial joints, especially the knee, hip, elbow, and ankle, whereas involvement of the temporomandibular joint (TMJ) is rare. Approximately 240 cases of SC of the TMJ have been reported in the English-language literature to date. The number of loose bodies varies among patients but usually ranges from the dozens to around 100. We herein report a case of SC of the TMJ accompanied by approximately 400 loose bodies in a healthy 53-year-old woman. Such a high number of loose bodies within a small space is extremely rare. We also include a brief discussion about the differential diagnoses and current diagnostic approaches to SC of the TMJ. Notably, delayed diagnosis or misdiagnosis is common because of the nonspecific nature of the presenting complaints.
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Affiliation(s)
- Wenyan Zhao
- Graduate Department, BengBu Medical College, Bengbu, Anhui, China
| | - Yan Ruan
- Graduate Department, BengBu Medical College, Bengbu, Anhui, China
| | - Wentao Zhang
- Department of Stomatology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Fan Yang
- Department of Stomatology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
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12
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Papke DJ, Hung YP, Schaefer IM, Bredella MA, Charville GW, Reith JD, Fletcher CDM, Nielsen GP, Hornick JL. Clinicopathologic characterization of malignant chondroblastoma: a neoplasm with locally aggressive behavior and metastatic potential that closely mimics chondroblastoma-like osteosarcoma. Mod Pathol 2020; 33:2295-2306. [PMID: 32601382 PMCID: PMC8007083 DOI: 10.1038/s41379-020-0604-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022]
Abstract
Chondroblastoma is currently classified as a benign neoplasm; however, chondroblastoma and chondroblastoma-like osteosarcoma have morphologic overlap, raising the possibility that some tumors diagnosed as chondroblastoma-like osteosarcoma might actually represent malignant chondroblastoma. The H3F3B K36M point mutation, which has not been reported in osteosarcoma, is identified in 95% of chondroblastomas and is reliably detectable by immunohistochemistry (IHC). We reviewed 11 tumors diagnosed as atypical chondroblastoma, malignant chondroblastoma, or chondroblastoma-like osteosarcoma (median follow-up: 8.8 years; range: 4 months-26.4 years). Seven chondroblastomas with cytologic atypia and permeative growth were designated "malignant chondroblastoma"; six were H3K36M-positive by IHC. Relative to conventional chondroblastoma, malignant chondroblastoma occurred in older individuals (median: 52 years; range: 29-57 years) and arose at unusual sites. Three of four tumors with long-term follow-up recurred, and one patient died of widespread metastases. One was found to have chromosomal copy number alter4ations and a SETD2 mutation in addition to H3F3B K36M. The four remaining tumors were classified as chondroblastoma-like osteosarcoma. Chondroblastoma-like osteosarcoma occurred in younger patients (median: 21 years; range: 19-40 years) than malignant chondroblastoma. In contrast to malignant chondroblastoma, all had regions of malignant cells forming bone. Two of three patients with long-term follow-up developed recurrences, and two died of disease, one with widespread metastases. No mutations in H3F3A/H3F3B were detected by Sanger sequencing. While malignant chondroblastoma and chondroblastoma-like osteosarcoma show significant morphologic overlap, they have distinct clinical presentations and genetic findings. When considering this challenging differential diagnosis, IHC using histone H3 mutation-specific antibodies is a critical diagnostic adjunct.
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Affiliation(s)
- David J. Papke
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Yin P. Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Inga-Marie Schaefer
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory W. Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - John D. Reith
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - G. Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jason L. Hornick
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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13
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Lee JC, Huang HY. Soft Tissue Special Issue: Giant Cell-Rich Lesions of the Head and Neck Region. Head Neck Pathol 2020; 14:97-108. [PMID: 31950466 PMCID: PMC7021864 DOI: 10.1007/s12105-019-01086-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
Giant cell-rich lesions represent a heterogeneous group of tumors and non-neoplastic lesions, usually arising in bone, which harbor varying number of reactive osteoclastic-type multinucleate giant cells as a common feature. Among these entities, some are confined to the head and neck region (e.g., central giant cell granuloma and mimicking lesions, i.e., peripheral giant cell granuloma and cherubism) or show a relative predilection for this region (e.g., aneurysmal bone cyst and brown tumor of hyperparathyroidism), while others are rare but associated with distinct underlying disease (e.g., giant cell tumor of bone) or histology (e.g., tenosynovial giant cell tumor of the temporomandibular joint and phosphaturic mesenchymal tumor of the jaws) when occurring in the head and neck. Collectively, these lesions pose great challenge in the pathologic diagnosis, which often requires combinatory assessment from the clinical, histopathologic, and/or molecular aspects. This review provides a summary of pertinent clinical and pathologic features and an update of recent molecular and genetic findings of these entities. The considerations in differential diagnosis as well as the effects of the emerging therapeutic RANKL-antagonizing antibody denosumab will also be addressed.
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Affiliation(s)
- Jen-Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsuan-Ying Huang
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833 Taiwan
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14
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Nagase M, Araki A, Ishikawa N, Nagano N, Fujimoto M, Biyajima K, Yamagami N, Yamamoto S, Maruyama R. Tenosynovial Giant Cell Tumor, Localized Type With Extensive Chondroid Metaplasia: A Case Report With Immunohistochemical and Molecular Genetic Analysis. Int J Surg Pathol 2019; 28:447-453. [PMID: 31771368 DOI: 10.1177/1066896919889672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tenosynovial giant cell tumor (TSGCT) of localized type is a common disease occurring mostly in the hands. Diagnosis of this tumor is relatively easy to render with hematoxylin-eosin-stained sections as compared with that of TSGCT of diffuse type. However, very rare cases with chondroid metaplasia that have recently been reported mainly in diffuse type can make pathological differentiation from soft tissue cartilaginous tumors extremely difficult. In this article, the authors present the second reported case of TSGCT of localized type showing extensive chondroid metaplasia. Pathological interpretation was difficult without utilizing immunohistochemistry and fluorescence in situ hybridization. One must be careful not to misdiagnose this lesion as cartilaginous tumors of soft tissue, and we suspect at least some chondroblastoma-like chondroma could be reclassified as TSGCT of localized type with extensive chondroid metaplasia. Morphological, immunohistochemical, and molecular genetic characteristics are presented and discussed.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Riruke Maruyama
- Shimane University, Izumo, Shimane, Japan.,Shimane University Hospital, Izumo, Shimane, Japan
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Brant JA, Kaufman AC, Luu N, Grady SM, O Apos Malley BW, Ruckenstein MJ. Pigmented Villonodular Synovitis Presenting as Unilateral Hearing Loss: Review of the Literature and Case Report. ORL J Otorhinolaryngol Relat Spec 2019; 81:171-182. [PMID: 31242479 DOI: 10.1159/000499473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To review the existing literature on pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ) and report a rare case of PVNS of the TMJ presenting with unilateral hearing loss. METHODS Review of the existing literature and a description of personal experience with PVNS of the TMJ presenting with unilateral hearing loss. RESULTS Review of the existing literature revealed 76 reported cases of PVNS of the TMJ. The most common presenting symptom was of a slowly enlarging mass or swelling of the preauricular area, with dysfunctional TMJ also frequently reported. All patients underwent surgical excision with some pursuing radiation as adjuvant therapy. Presented Patient: A 46-year-old man presented with several months of unilateral subjective hearing loss and aural fullness. Imaging revealed a mass centered along the superior TMJ with expansion through the squamous temporal bone and extra-axial intracranial extension into the middle cranial fossa. Imaging characteristics and fine-needle aspiration biopsy were consistent with PVNS. INTERVENTION The patient underwent near-total excision of the mass via frontotemporal craniectomy and lateral temporal bone resection. FOLLOW-UP At the 16-month follow-up there was no evidence of disease recurrence. CONCLUSION PVNS of the TMJ represents a rare entity that can present with a variety of symptoms including unilateral hearing loss.
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Affiliation(s)
- Jason A Brant
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam C Kaufman
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Neil Luu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sean M Grady
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bert W O Apos Malley
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Shetty SK, Hegde U, Agarwal G, Sreeshyla HS. Chondroid Tenosynovial Giant Cell Tumor of Temporomandibular Joint. Ann Maxillofac Surg 2019; 8:327-329. [PMID: 30693256 PMCID: PMC6327827 DOI: 10.4103/ams.ams_161_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tenosynovial giant cell tumor (TGCT), a benign proliferative lesion arising from the synovial membrane of the joints, is rarely seen in the temporomandibular joint. It frequently presents as a painful, preauricular swelling and affects the jaw functions. Two types of TGCT seen are diffuse TGCT (TGCT-D) and localized TGCT. A case of TGCT-D is described here, the highlight of the case being extensive areas of chondroid metaplasia which mimicked chondroid lesions, but was ruled out based on negative immunohistochemical findings within the tumor cells.
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Affiliation(s)
- Sujeeth Kumar Shetty
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysuru, Karnataka, India
| | - Usha Hegde
- Department of Oral Pathology and Microbiology, JSS Dental College and Hospital, Mysuru, Karnataka, India
| | - Garima Agarwal
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysuru, Karnataka, India
| | - H S Sreeshyla
- Department of Oral Pathology and Microbiology, JSS Dental College and Hospital, Mysuru, Karnataka, India
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17
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Nakamura T, Hagi T, Asanuma K, Sudo A. Intra-articular synovial sarcoma in the ankle joint: A case report. Mol Clin Oncol 2018; 9:464-466. [PMID: 30233799 DOI: 10.3892/mco.2018.1702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/26/2018] [Indexed: 11/06/2022] Open
Abstract
Intra-articular primary soft tissue sarcomas are extremely rare. The present case report describes a case of intra-articular synovial sarcoma of the ankle joint. A 51-year-old man presented with complaints of swelling and progressive pain in the right ankle. Lateral radiographs of the ankle revealed lytic invasion of the anterior and posterior parts of the talus. Computed tomography imaging revealed a low-density lesion with calcifications around the ankle joint. Magnetic resonance imaging revealed that the diffuse lesion was isointense on T1-weighted images and hypointense to hyperintense on T2-weighted images. The final diagnosis was synovial sarcoma. The foot could not be salvaged as the sarcoma was diffusely spread throughout the ankle joint; thus, the patient underwent below-the-knee amputation with neoadjuvant and adjuvant chemotherapy. He succumbed from fatal arrhythmia 2 years following the initial diagnosis. Although intra-articular primary soft tissue sarcomas are extremely rare, the possibility of malignancy should be considered.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Tomohito Hagi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
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18
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Anbinder AL, Geraldo BMC, Guimarães R, Pereira DL, Almeida OPD, Carvalho YR. Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A Rare Case Report. Braz Dent J 2018; 28:647-652. [PMID: 29215692 DOI: 10.1590/0103-6440201701371] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 06/20/2017] [Indexed: 12/17/2022] Open
Abstract
Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.
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Affiliation(s)
- Ana Lia Anbinder
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP - Univ Estadual Paulista, São José dos Campos, SP, Brazil
| | - Barbara Maria Corrêa Geraldo
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP - Univ Estadual Paulista, São José dos Campos, SP, Brazil
| | - Rubens Guimarães
- Department of Dentistry, UNITAU - Universidade de Taubaté, Taubaté, SP, Brazil
| | - Débora Lima Pereira
- Department of Oral Diagnosis, Piracicaba Dental School, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Yasmin Rodarte Carvalho
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, UNESP - Univ Estadual Paulista, São José dos Campos, SP, Brazil
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Abstract
Giant cell rich lesions of the temporal bone encompass a wide spectrum of disease that includes infectious, reactive, and neoplastic processes. When dealing with any lesion that can potentially involve bone, it is important to understand both the clinical presentation and to correlate the histologic findings with the radiologic imaging. This review discusses the clinical, the pathologic features including the differential diagnosis, and the treatment of some of the more commonly encountered giant cell rich entities in this region.
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20
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Jeyaraj PE, Sharma V. Synovial Osteochondromatosis of the Temporomandibular Joint Manifesting as a Large Infratemporal Space Occupying Lesion. J Maxillofac Oral Surg 2017; 16:387-391. [DOI: 10.1007/s12663-016-0974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022] Open
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21
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Xiao Y, Qian Z, Ning G, Junyu L, Haoman N, Yu C. [The diffuse giant cell tumor of tendon sheath with chondroid metaplasia in right temporomandibular joint: a case report]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2017; 35:223-226. [PMID: 28682558 DOI: 10.7518/hxkq.2017.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A case diagnosed as diffuse giant cell tumor of tendon sheath with chondroid metaplasia in right temporomandibular joint was reported. The clinicopathological features, diagnosis, and treatment were discussed with the literature review.
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Affiliation(s)
- Yang Xiao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zhang Qian
- Dept. of Oral and Maxillofacial Surgery, Yibin Second People's Hospital, Yibin 644000, China
| | - Geng Ning
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Liu Junyu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Niu Haoman
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chen Yu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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22
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Carlson ML, Osetinsky LM, Alon EE, Inwards CY, Lane JI, Moore EJ. Tenosynovial giant cell tumors of the temporomandibular joint and lateral skull base: Review of 11 cases. Laryngoscope 2016; 127:2340-2346. [PMID: 27888510 DOI: 10.1002/lary.26435] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/19/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To elucidate the clinical behavior, treatment, and outcomes of tenosynovial giant cell tumors (TGCT) involving the temporomandibular joint (TMJ) and adjacent temporal bone. STUDY DESIGN Retrospective case series with histopathologic review. METHODS A retrospective chart review was performed identifying and collecting data from all cases of TGCT involving the TMJ and adjacent temporal bone that were treated at the authors' center between January 1960 and December 2015. RESULTS Eleven histopathologically confirmed cases met inclusion criteria. The median age at diagnosis was 49 years, eight patients were men, and the median follow-up was 116 months. Computed tomographic (CT) imaging revealed a lytic expansile mass centered on the TMJ. Magnetic resonance imaging (MRI) most commonly exhibited hypointense signal on precontrast T1- and T2-weighted sequences and variable postcontrast enhancement. The median delay in diagnosis was 24 months, and the most common presenting symptoms were hearing loss and pain. All patients underwent surgical resection, eight receiving gross total removal, one receiving near total removal, and two patients from early in the series receiving subtotal resection with neoadjuvant or adjuvant radiation. Histopathological review of surgical specimens revealed chondroid metaplasia in seven tumors. Eight of nine cases receiving gross total or near total resection have no evidence of recurrence to date. CONCLUSIONS TGCT of the TMJ and temporal bone are rare and locally aggressive tumors that commonly present with nonspecific symptoms. A careful review of CT and MRI followed by early biopsy is critical in establishing an accurate diagnosis and facilitating appropriate treatment. TGCT of the TMJ more commonly contain chondroid metaplasia when compared to TGCT at other anatomic locations. Gross total resection is achievable in most cases and offers long-term cure. Radiation may be considered for recurrent disease or adjuvant therapy following subtotal resection. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2340-2346, 2017.
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Affiliation(s)
- Matthew L Carlson
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - L Mariel Osetinsky
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - Eran E Alon
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center at Tel Hashomer, Tel Aviv, Israel
| | - Carrie Y Inwards
- Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - John I Lane
- Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
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23
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Liu X, Huang Z, Zhu W, Liang P, Tao Q. Clinical and Imaging Findings of Temporomandibular Joint Synovial Chondromatosis: An Analysis of 10 Cases and Literature Review. J Oral Maxillofac Surg 2016; 74:2159-2168. [DOI: 10.1016/j.joms.2016.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/23/2016] [Accepted: 04/23/2016] [Indexed: 01/04/2023]
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24
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Abdou AG, Aiad H, Youssef Asaad N. Fine Needle Aspiration Cytology of Chondroid Tenosynovial Giant Cell Tumor of the Hand. Rare Tumors 2015; 7:5814. [PMID: 26266013 PMCID: PMC4508644 DOI: 10.4081/rt.2015.5814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/24/2015] [Accepted: 04/01/2015] [Indexed: 12/21/2022] Open
Abstract
Giant cell tumor (GCT) of tendon sheath is a localized form of tenosynovial GCT, which preferentially affects the joints of hands and feet. Chondroid metaplasia is a rare phenomenon in tenosynovial GCT either in localized or diffuse types. The current case investigates the cytological and histopathological features of chondroid GCT of tendon sheath in a 22-year-old female presenting with wrist swelling.
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Affiliation(s)
| | - Hayam Aiad
- Department of Pathology, Menofiya University , Shebein Elkom, Egypt
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25
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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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26
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Safaee M, Oh T, Sun MZ, Parsa AT, McDermott MW, El-Sayed IH, Bloch O. Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: A case series and systematic review. Head Neck 2014; 37:1213-24. [PMID: 24764167 DOI: 10.1002/hed.23717] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/15/2014] [Accepted: 04/21/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovial membrane. PVNS generally affects large joints but occasionally involves the temporomandibular joint (TMJ), with occasional extension into the middle cranial fossa. The purpose of this study was to report our experience with PVNS along with a focused literature review. METHODS Patients with PVNS of the TMJ treated at the University of California - San Francisco from 2007 to 2013 were reviewed. A PubMed search was performed to identify additional cases. RESULTS Five patients underwent surgical resection, with 1 recurrence at 61 months. A literature review identified 58 patients, 19 of which had intracranial involvement. Interestingly, intracranial extension was more common in men. Intracranial extension was not associated with an increased rate of recurrence. CONCLUSION PVNS of the TMJ is a rare entity associated with excellent outcomes, even with intracranial extension. Management should consist of maximal resection, with radiotherapy reserved for extensive or recurrent lesions.
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Affiliation(s)
- Michael Safaee
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Z Sun
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Michael W McDermott
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Ivan H El-Sayed
- Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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27
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Son SM, Lee YM, Shin HM, Chung JG, Chung J, Lee OJ. Chondroid tenosynovial giant cell tumor of the toe: A case report. J Biomed Res 2014. [DOI: 10.12729/jbr.2014.15.1.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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29
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Black J, Coffin CM, Dehner LP. Fibrohistiocytic tumors and related neoplasms in children and adolescents. Pediatr Dev Pathol 2012; 15:181-210. [PMID: 22420728 DOI: 10.2350/11-03-1001-pb.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fibrohistiocytic tumors (FHTs) in children and adolescents range from the benign fibrous histiocytoma, or dermatofibroma, to a variety of intermediate and malignant neoplasms, such as dermatofibrosarcoma protruberans and high-grade undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma). Those tumors as a group are comprised of fibroblasts, myofibroblasts, and histiocytes-dendritic cells with a variably prominent inflammatory infiltrate consisting of lymphocytes and eosinophils. Dendritic cells are also a major constituent of another group of neoplasms that include Langerhans cell histiocytosis, follicular and interdigitating cell sarcomas, and juvenile xanthogranuloma. These latter tumors are considered in this discussion for the sake of differential diagnosis and their possible histogenetic relationship to FHTs. Recent studies have suggested that the relationship between the fibroblast and histiocyte in the FHTs may reflect the intrinsic capacity to transdifferentiate from one to the other morphologic and functional state. The so-called "facultative fibroblast," as a cell with fibroblastic and histiocytic properties, was discussed in the context of the fibrous xanthoma 50 years ago. Possibly the entire histogenetic concept of FHTs should be reconsidered in light of current studies.
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Affiliation(s)
- Jennifer Black
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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30
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Nielsen GP, Rosenberg AE, O'Connell JX, Kattapuram SV, Schiller AL. Tumors and diseases of the joint. Semin Diagn Pathol 2011; 28:37-52. [PMID: 21675376 DOI: 10.1053/j.semdp.2011.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of different diseases affect the synovium, including infection, noninfectious immunologic inflammatory conditions, degenerative arthroses, crystal deposits, trauma, and tumors. Tumors of the synovium are relatively uncommon. Any mesenchymal tumor may arise in the synovium, but most recapitulate its normal counterpart including synoviocytes, blood vessels, fat, and fibrous tissue. These tumors can arise in any synovial lined structures both within joints and in extraarticular locations. Most synovial tumors are benign. Malignant tumors are rare but important to recognize because many are aggressive and must be treated appropriately. Among common nonneoplastic conditions that affect the synovium and surrounding structures are crystal deposits such as monosodium urate crystals, calcium pyrophosphate dihydrate crystals, and hydroxyapatite crystals. These crystal deposits may be asymptomatic or cause severe pain or chronic joint destruction. Their accurate identification is important to guide appropriate therapy.
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Affiliation(s)
- G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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31
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Pigmented villonodular synovitis of the temporomandibular joint: case report and review of the literature. ACTA ACUST UNITED AC 2011; 111:e17-28. [PMID: 21310347 DOI: 10.1016/j.tripleo.2010.11.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/31/2010] [Accepted: 11/26/2010] [Indexed: 02/06/2023]
Abstract
Pigmented villonodular synovitis (PVNS) is an aggressive proliferative lesion that usually involves the synovial tissues of big joints. To date, there are ∼52 cases of PVNS affecting the temporomandibular joint reported in the English-language literature, about one-third of them exhibiting intracranial involvement. We herein describe an additional case of PVNS of the temporomandibular joint with skull base invasion affecting a 26-year-old male patient and discuss its clinicopathologic features considering previously published cases. Histopathology and imaging evaluation are important for the diagnosis of PVNS, which should be included in the differential diagnosis of preauricular aggressive swellings.
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Malignant pigmented villonodular synovitis of the temporomandibular joint with lung metastasis: a case report and review of the literature. ACTA ACUST UNITED AC 2011; 111:e30-6. [PMID: 21444225 DOI: 10.1016/j.tripleo.2010.11.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 11/13/2010] [Accepted: 11/26/2010] [Indexed: 11/22/2022]
Abstract
Malignant pigmented villonodular synovitis (PVNS) is an extremely rare lesion. Approximately 30 cases of malignant PVNS have been reported to date and of these, only 1 case involved the temporomandibular joint. Owing to the rarity of well-documented cases and the heterogeneous histologic features of this group of tumors, there has been some confusion regarding its diagnosis. The heterogeneous features of the sarcomatous areas contain fibrosarcomatous, myxosarcomatous, malignant fibrous histiocytomalike or giant cell tumorlike patterns. However, despite the absence of frank sarcomatous change in the histopathogy of PVNS, there have been 3 reported cases of metastatic lesions in the lung or lymph nodes. Here we present an additional case of clinically malignant PVNS with pulmonary metastasis after recurrence. A 29-year-old man presented in our hospital with a recurrent swelling and pain in the right preauricular area, where benign tumor had been previously resected. MRI demonstrated a large mass with a low signal intensity that seemed to demonstrate a ferromagnetic effect. Surgical resection of the lesion was performed and the diagnosis of PVNS with focal atypical cells was made. Unfortunately, at 30 months post surgery, a thoracic CT found a metastatic nodule in the left lower lobe of the lung.
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Arthroscopic management of intra-articular pigmented villonodular synovitis of temporomandibular joint. Int J Oral Maxillofac Surg 2011; 40:150-4. [DOI: 10.1016/j.ijom.2010.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 07/05/2010] [Accepted: 09/13/2010] [Indexed: 11/23/2022]
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Hoch BL, Garcia RA, Smalberger GJ. Chondroid tenosynovial giant cell tumor: a clinicopathological and immunohistochemical analysis of 5 new cases. Int J Surg Pathol 2010; 19:180-7. [PMID: 21087985 DOI: 10.1177/1066896910381899] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tenosynovial giant cell tumor (TGCT) arises from the synovium of joints or tendon sheaths. Chondroid metaplasia in TGCT is rare with only 4 well-documented cases reported in the literature. The authors describe the morphological features and immunophenotype of 5 new cases of chondroid TGCT emphasizing a broader range of matrix patterns in these tumors and an expanded immunophenotype, specifically, staining for clusterin and podoplanin which have recently been found to be expressed in conventional TGCTs. Chondroid metaplasia was extensive in 3 cases. Matrix patterns included chondromyxoid, chondro-osseous, hyaline-like, and lace-like calcification similar to that seen in chondroblastoma. The authors conclude that chondroid TGCT is a rare, distinct synovial tumor with a predilection for the temporomandibular joint that has a similar immunophenotype as conventional TGCT. Chondroid metaplasia may be extensive and have a variety of matrix patterns. Chondroid TGCT needs to be distinguished from other chondroid lesions, including chondroblastoma and chondrosarcoma.
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Affiliation(s)
- Benjamin L Hoch
- Department of Anatomic Pathology, University of Washington Medical Center, Seattle, WA 98195, USA.
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Cai XY, Yang C, Chen M, Yun B. Simultaneous pigmented villonodular synovitis and synovial chondromatosis of the temporomandibular joint: case report. Int J Oral Maxillofac Surg 2009; 38:1215-8. [DOI: 10.1016/j.ijom.2009.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 05/05/2009] [Accepted: 06/03/2009] [Indexed: 11/27/2022]
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Herman C, Swift J, Schiffman E. Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: a case and literature review. Int J Oral Maxillofac Surg 2009; 38:795-801. [DOI: 10.1016/j.ijom.2009.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Revised: 10/24/2008] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
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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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Mikami T, Takeda Y, Ohira A, Hoshi H, Sugiyama Y, Yoshida Y, Ambo J. Tumoral calcium pyrophosphate dihydrate crystal deposition disease of the temporomandibular joint: Identification on crystallography. Pathol Int 2008; 58:723-9. [DOI: 10.1111/j.1440-1827.2008.02300.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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