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Bruns J, Rosenbaum B, Thorns C. Localized pigmented villo-nodular synovitis of trochanteric bursa. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2023; 12:Doc08. [PMID: 38024102 PMCID: PMC10665716 DOI: 10.3205/iprs000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This is the first report on a localized pigmented villo-nodular synovitis (PVNS or TSGCT) occurring in the trochanteric bursa. Bursal involvement in PVNS is extremely rare. Most often PVNS occurs either as a localized or diffuse lesion in a major synovial joint, such as the knee, ankle joint or hip joint. In principle, all synovial structures can be involved. The case reported here is remarkable regarding the long period between the occurrence of the first symptoms and the final diagnosis as well as the age of the female patient (75 yrs). Therapeutically a complete resection was performed in order to avoid recurrence. More then three years later the patient did well and there has been no evidence of recurrence yet.
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Affiliation(s)
- Juergen Bruns
- Dept. of Orthopedic Surgery, Wilhelmsburg Hospital Groß-Sand, Hamburg, Germany
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Cao S, Jiang L, Yang S, Liu Z, Wei F, Liu X. Surgical treatment of spinal tenosynovial giant cell tumor: Experience from a single center and literature review. Front Oncol 2023; 12:1063109. [PMID: 36733355 PMCID: PMC9887179 DOI: 10.3389/fonc.2022.1063109] [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] [Received: 10/06/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Spinal tenosynovial giant cell tumor (TGCT) is a rare benign primary spinal tumor with aggressive behavior. The treatment strategy and prognosis of spinal TGCT remain unclear. This retrospective study aimed to evaluate the effectiveness of surgical treatment of spinal TGCT. Methods We enrolled 18 patients with spinal TGCT who underwent surgical treatment in our hospital between January 2002 and January 2021. Additionally, we reviewed 72 cases of spinal TGCT with surgical treatment reported in the previous literature. Therefore, a total of 90 cases of spinal TGCT were evaluated for their clinical characteristics, surgical details, radiotherapy, and prognosis. Results In terms of the extent of resection, 73 cases (81.1%) underwent gross total resection (GTR), and 17 cases (18.9%) underwent subtotal resection (STR). Regarding the technique of GTR, 12 cases (16.7%) underwent en bloc resection, while 60 cases (83.3%) underwent piecemeal resection. During a median follow-up duration of 36 months (range: 3-528 months), 17.8% (16/90) cases experienced local recurrence/progression. The local recurrence/progression rate in cases that underwent GTR was 8.2% (6/73), which was significantly lower than that in cases with STR (58.8%, 10/17) (p<0.001). The local recurrence/progression rate of en bloc resection was 8.3% (1/12), and that of piecemeal resection was 8.3% (5/60). Twelve cases underwent perioperative adjuvant radiotherapy, and one (8.3%, 1/12) of them showed disease progression during follow-up. Six recurrent/progressive lesions were given radiotherapy and all of them remained stable in the subsequent follow-up. Eight recurrent/progressive lesions were only treated with re-operation without radiotherapy, and half of them (50.0%, 4/8) demonstrated repeated recurrence/progression in the subsequent follow-up. Conclusion Surgical treatment could be effective for spinal TGCT cases, and GTR is the preferred surgical strategy. Piecemeal resection may be appropriate for spinal TGCT cases with an acceptable local recurrence/progression rate. Perioperative adjuvant radiotherapy may reduce the risk of postoperative local recurrence/progression, and radiotherapy plays an important role in the treatment of recurrent/unresectable spinal TGCT lesions.
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Affiliation(s)
- Shiliang Cao
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Bejing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China,Department of Interventional Medicine, China Japan Friendship Hospital, Beijing, China
| | - Liang Jiang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Bejing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China,*Correspondence: Liang Jiang,
| | - Shaomin Yang
- Pathology Department, Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Bejing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Feng Wei
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Bejing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Bejing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
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Malignant Diffuse-Type Tenosynovial Giant Cell Tumor in the Subcutaneous Tissue of the Midthigh: A Report of a Rare Tumor in an Unusual Location. Case Rep Orthop 2022; 2022:6986741. [PMID: 36171796 PMCID: PMC9512598 DOI: 10.1155/2022/6986741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Malignant TS-GCT is an extremely rare and aggressive tumor with only few cases published in the literature, due to the small number of cases is not completely understood and is diagnostically challenging. Although surgical treatment is the primary treatment modality, there is no consensus regarding adjuvant treatment. Regardless of mode of treatment, the tumor still caries unfavorable prognosis. In this paper, we reviewed the literature for cases of malignant TS-GCT. We also would like to present an additional case of malignant TS-GCT that was found in an unusual location in subcutaneous tissue of the midthigh.
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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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Gader G, Belaïd A, Zehani A, Daghfous A, Zammel I, Badri M. Villonodular synovitis of the lumbar spine: Case report of a rare pathology. Clin Case Rep 2020; 8:2346-2349. [PMID: 33363737 PMCID: PMC7752619 DOI: 10.1002/ccr3.3107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/06/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022] Open
Abstract
Lumbar pigmented villonodular synovitis is rarely localized on the lumbar spine. Awareness of pigmented villonodular synovitis is important despite its rarity because it may mimic several other lesions of this location.
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Affiliation(s)
- Ghassen Gader
- Department of NeurosurgeryTrauma and Burns CenterBen ArousTunisia
| | - Aymen Belaïd
- Department of RadiologyTrauma and Burns CenterBen ArousTunisia
| | - Alia Zehani
- Department of PathologyLa Rabta HospitalTunisTunisia
| | - Alifa Daghfous
- Department of RadiologyTrauma and Burns CenterBen ArousTunisia
| | - Ihsèn Zammel
- Department of NeurosurgeryTrauma and Burns CenterBen ArousTunisia
| | - Mohamed Badri
- Department of NeurosurgeryTrauma and Burns CenterBen ArousTunisia
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Malignant Tenosynovial Giant Cell Tumor: The True "Synovial Sarcoma?" A Clinicopathologic, Immunohistochemical, and Molecular Cytogenetic Study of 10 Cases, Supporting Origin from Synoviocytes. Mod Pathol 2019; 32:242-251. [PMID: 30206409 DOI: 10.1038/s41379-018-0129-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/27/2023]
Abstract
We present our experience with ten well-characterized malignant tenosynovial giant cell tumors, including detailed immunohistochemical analysis of all cases and molecular cytogenetic study for CSF1 rearrangement in a subset. Cases occurred in 7 M and 3 F (mean age: 52 years; range: 26-72 years), and involved the ankle/foot (n = 1), finger/toe (n = 3), wrist (n = 1), pelvic region (n = 3), leg (n = 1), and thigh (n = 1). There were eight primary and two secondary malignant tenosynovial giant cell tumors. Histologically, all cases showed definite areas of typical tenosynovial giant cell tumor. The malignant areas varied in appearance. In some cases, isolated malignant-appearing large mononuclear cells with high nuclear grade and mitotic activity were identified within otherwise-typical tenosynovial giant cell tumor, as well as forming larger masses of similar-appearing malignant cells. Occasionally, these nodules of malignant large mononuclear cells showed transition to pleomorphic spindle cell sarcoma, with varying degrees of collagenization and myxoid change. One malignant tenosynovial giant cell tumor was composed of sheets of monotonous large mononuclear cells with high nuclear grade, growing in a hyalinized, osteoid-like matrix, with areas of heterologous osteocartilaginous differentiation. Mitotic activity ranged from 2 to 34 mitoses per 10 HPF (mean 18/10 HPF). Geographic necrosis was observed in four cases. The malignant-appearing large mononuclear cells were consistently positive for clusterin and negative for CD163, CD68, and CD11c. Desmin was positive in a small minority of these cells. Areas in malignant tenosynovial giant cell tumor resembling pleomorphic spindle cell sarcoma or osteo/chondrosarcoma showed loss of clusterin expression. RANKL immunohistochemistry was positive in the large mononuclear cells in eight cases. Two cases showed an unbalanced rearrangement of the CSF1 locus. Follow-up (nine patients; range 0.5-66 months; mean 20 months) showed three patients dead of disease, with three other living patients having lung and lymph node metastases; three patients were disease-free. We conclude that malignant tenosynovial giant cell tumors are highly aggressive sarcomas with significant potential for locally destructive growth, distant metastases, and death from disease. The morphologic and immunohistochemical features of these tumors and the presence of CSF1 rearrangements support origin of malignant tenosynovial giant cell tumor from synoviocytes.
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Localized Pigmented Villonodular Synovitis of the Posterior Knee Compartment with Popliteal Vessel Compression: A Case Report of Arthroscopic Resection Using Only Anterior Knee Portals. Case Rep Orthop 2018; 2018:7532358. [PMID: 30034899 PMCID: PMC6033245 DOI: 10.1155/2018/7532358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/03/2018] [Indexed: 12/25/2022] Open
Abstract
Background Pigmented villonodular synovitis is a rare pathology causing hyperplasia of the synovium. It mostly affects young populations and most commonly the knee joint. It rarely affects the posterior compartment of the knee as the case presented in this study. Open surgery is usually used to treat this condition; however, in our case it was excised arthroscopically despite the anatomical challenges of the posterior knee compartment. Case Presentation This case presents a female patient with a complaint of posterior-region pain of her left knee post direct trauma post fall. This was directly followed by knee joint blockage for 1-week duration before presentation to the hospital. On MRI, she was found to have a multiloculated hemosiderin-containing structure of synovial origin within the femoral notch, extending beyond the joint capsule displacing the popliteal vessels. The patient underwent arthroscopic resection of the lesion, which was found to be pigmented villonodular synovitis on anatomopathological examination. On 6-month follow-up, the patient showed good clinical evolution with the absence of symptoms and back-to-normal daily activities. Conclusion This is a rare case of PVNS affecting the posterior knee joint compartment of a middle-aged woman, which was successfully excised arthroscopically, with no residual affected tissue or recurrence on 6-month follow-up.
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Pinheiro Junior LFB, Cenni MHF, Leal RHS, Teixeira LEM. Total knee replacement in patients with diffuse villonodular synovitis. Rev Bras Ortop 2017; 52:616-620. [PMID: 29062829 PMCID: PMC5643900 DOI: 10.1016/j.rboe.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/16/2016] [Indexed: 11/04/2022] Open
Abstract
This paper reports a case of diffuse pigmented villonodular synovitis (DPVNS), associated with advanced gonarthrosis, submitted to total knee replacement. The patient had progressive pain and swelling. She had two previous surgeries, firstly arthroscopic synovectomy and subsequently open synovectomy associated with radiotherapy, with recurrence of the disease. Magnetic resonance imaging revealed diffuse synovitis, advanced arthrosis, and bone cysts. The patient was submitted to a total knee replacement and synovectomy. There was a good postoperative clinical course, with improvement of pain, function, and joint edema on examination. The patient will be followed regarding the possibility of disease recurrence and implant survival.
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Artroplastia total do joelho em paciente com sinovite vilonodular pigmentada forma difusa. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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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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Theunissen CIJM, Bras J, Lienden KPV, Obdeijn MC. Malignant giant cell tumor in the carpal tunnel: a case report and review of literature. J Wrist Surg 2013; 2:271-275. [PMID: 24436827 PMCID: PMC3764239 DOI: 10.1055/s-0033-1350087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Malignant tenosynovial giant cell tumors (GCTs) are extremely rare, and their etiology is unknown. However, this type of malignancy is associated with high metastasis and mortality rates. Therefore, the treatment of choice is wide excision. Case Description A 66-year-old man complained of tingling and loss of sensation in the left hand, caused by a tumor that compressed the median nerve. The tumor was excised. Histopathologic examination revealed a ganglion cyst. Two years later, the patient visited our clinic with recurrent and similar complaints of the left hand. This time, however, the lesion turned out to be a malignant tenosynovial GCT and was treated by amputation of the forearm. Literature Review Since 1979, only 37 malignant tenosynovial GCTs have been reported in literature. Follow-up of these patients showed that 11 patients died of the disease, 4 patients were still living with the disease, and 14 patients had no evidence of disease after treatment. The other seven patients were lost to follow-up, and one patient died of other causes. In these 37 patients, a high incidence of lymph node metastasis (41%) and a high mortality rate (30%) were seen. Clinical Relevance Although this malignant tenosynovial GCT is very rare, high mortality rates have been observed because of the high incidence of lymph node metastases. Therefore, more awareness has to be created, to recognize and treat this tumor timely.
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Affiliation(s)
- Carla I. J. M. Theunissen
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes Bras
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Miryam C. Obdeijn
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
This case concerned a female patient with a complaint of pain in the anterior region of her left knee during and after sports activities, followed by joint blockage three months ago. From imaging examinations, simple radiography of the knee was normal and magnetic resonance showed a solid expansive mass, possibly corresponding to soft-tissue chondroma or focal nodular synovitis. Arthroscopic resection of the lesion was performed, and the diagnosis of diffuse giant cell tumor resembling localized pigmented villonodular synovitis (PVNS) was made from the result of the anatomopathological examination. The patient presented good clinical evolution, with disappearance of symptoms and return to physical activities.
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Imakiire N, Fujino T, Morii T, Honya K, Mochizuki K, Satomi K, Fujioka Y. Malignant pigmented villonodular synovitis in the knee - report of a case with rapid clinical progression. Open Orthop J 2011; 5:13-6. [PMID: 21270951 PMCID: PMC3027190 DOI: 10.2174/1874325001105010013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 08/30/2010] [Accepted: 09/02/2010] [Indexed: 12/25/2022] Open
Abstract
Malignant pigmented villonodular synovitis (PVNS) (or malignant giant cell tumor of tendon sheath (GCTTS) is an extremely rare condition defined as a malignant lesion occurring with concomitant or previously documented PVNS at the same site. To date, only less than 20 cases have been reported in English literatures. We report a case of malignant PVNS in the knee in a 56-year-old woman with unpredictable rapid progression. This case raised a caution that when atypical components in specimens of recurrent benign PVNS are detected, even if low-grade or tiny, both pathologists and surgeons should consider the risk of malignant PVNS, which could display aggressive clinical progression.
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Affiliation(s)
- Naoaki Imakiire
- Department of Orthopaedic Surgery, Kyorin University Faculty of Medicine. 6-20-2 Shinkawa Mitaka Tokyo 181-8611 Japan
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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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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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