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Kim DH, Min S, Lee HJ, Kim HJ, Lee H, Yoon JP. Synchronization of Synovial Chondromatosis and Mycobacterium intracellurae Infection in Olecranon Bursitis: A Case Report. Clin Shoulder Elb 2019; 22:46-49. [PMID: 33330194 PMCID: PMC7713878 DOI: 10.5397/cise.2019.22.1.46] [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: 07/09/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022] Open
Abstract
A 73-year-old woman presented with a recurrent cystic mass around her left olecranon. She had a history of 8 steroid injections due to elbow pain beginning 3 years ago and twice had undergone aspiration of olecranon bursitis that developed two months prior to presentation. She had been taking medications for hypertension and diabetes with no pertinent past history. On magnetic resonance imaging (MRI), there were multiple nodules in the olecranon bursa, which were isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Our initial diagnosis was synovial chondromatosis. On bursoscopy, masses of gray-white colored nodules were observed in the bursa. Finally, synovial chondromatosis and non-tuberculous mycobacterial infection were concurrently diagnosed. In conclusion, uncalcified synovial chondromatosis and rice bodies can have similar visual and MRI characteristics; therefore, we suggest that clinicians should be aware of the possibility of other infections in cases of this type.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seunggi Min
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hoseok Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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Severe ulnar nerve palsy caused by synovial chondromatosis arising from the pisotriquetral joint: a case report and review of literature. Acta Neurochir (Wien) 2013; 155:1153-6. [PMID: 23563745 DOI: 10.1007/s00701-013-1680-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
Abstract
We report here the unique case of 60-year-old man with severe ulnar nerve palsy caused by synovial chondromatosis arising from the pisotriquetral joint. At operation, the tumor entrapped the ulnar nerve proximal to the Guyon canal so that it was severely paralyzed. The ulnar neurovascular bundle could be separated safely under the microscope. To our knowledge, this type of severe neuropathy has not been reported before. Although synovial chondromatosis associated with peripheral nerve neuropathy is extremely rare, we should be aware of the existence of this type of compression neuropathy in the upper limb.
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Ho YY, Choueka J. Synovial chondromatosis of the upper extremity. J Hand Surg Am 2013; 38:804-10. [PMID: 23474166 DOI: 10.1016/j.jhsa.2013.01.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 03/23/2012] [Accepted: 01/28/2013] [Indexed: 02/02/2023]
Abstract
Synovial chondromatosis is a rare, benign, proliferative cartilaginous lesion arising from the synovial tissue or bursal lining of or near joints. This disease process can be classified into intra-articular and extra-articular, or tenosynovial, subtypes. Diagnosis can often be delayed due to the rarity of the disease and its nonspecific symptoms of pain, reduced range of motion, or swelling. This article reviews the literature and describes the classification, clinical course, demographics, diagnosis, histology, and treatment of synovial chondromatosis and tenosynovial chondromatosis in the upper extremity.
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Affiliation(s)
- Yvette Y Ho
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 60005, USA
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Cebesoy O, Isik M, Subasi M, Karsli B, Pamukcu U. Extra-articular Tenosynovial Chondromatosis Mimicking a Neoplastic Disease in the First Web Space of the Hand. Oman Med J 2012; 27:316-8. [PMID: 23071886 DOI: 10.5001/omj.2012.78] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 06/08/2012] [Indexed: 11/03/2022] Open
Abstract
Tenosynovial chondromatosis is a very rare disease. The most common symptom is a slowly enlarging soft tissue mass, which may be painful or cause limitation of joint motion. Plain radiograph may appear normal during early phases of the disease, but subsequent imaging may be necessary to exclude other pathologies. Nonoperative treatment may be elected for some patients, but a synovectomy and the removal of loose bodies are indicated for persistent symptoms. This report describe a case with a multinodular cartilaginous proliferation and rice body in the first web space of the hand, similar to synovial chondromatosis, but arising in the tenosynovial membranes.
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Affiliation(s)
- Oguz Cebesoy
- Gaziantep University Faculty of Medicine, Orthopedic and Traumatology Department, Gaziantep, 27010, Turkey
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Reverté Vinaixa MM, Singh R, Monyart JM, Llado GD, Dominguez MP, Feliu EC, Nardi Vilardaga J, Palou EC. Wrist synovial chondromatosis: case report and literature review. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2012; 17:233-8. [PMID: 22745090 DOI: 10.1142/s0218810412720239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 11/19/2011] [Accepted: 11/21/2011] [Indexed: 11/18/2022]
Abstract
Primary synovial chondromatosis is a proliferation of cartilaginous bodies within the synovial membrane, tendon sheath or bursa. It is a rare orthopaedic entity especially when it occurs in the distal radioulnar joint. We report a 27-year-old man with recurrent synovial chondromatosis, nine years after his first operation. Although rare, synovial chondromatosis must be considered in the differential diagnosis in a patient with pain and swelling of the distal radioulnar joint. From our literature review, we report a 17% (5/30) recurrence rate for synovial chondromatosis involving the wrist joint which has not been documented in the medical literature previously.
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Christoforou D, Strauss EJ, Abramovici L, Posner MA. Benign extraosseous cartilage tumours of the hand and wrist. J Hand Surg Eur Vol 2012; 37:8-13. [PMID: 21987274 DOI: 10.1177/1753193411421419] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Benign extraosseous cartilage tumours of the hand and wrist comprise soft tissue chondromas, synovial chondromatosis and tenosynovial chrondromatosis. These tumours can significantly affect patients as they are often painful, functionally limiting and cosmetically displeasing. Although each tumour is generally considered to be a distinct entity, they share radiological and histopathological similarities. Occasionally, all three tumours may be seen in the same patient. This is an important consideration because of the risk of recurrence that may not necessarily occur at the same anatomical site but instead extend to different sites, such as a tendon sheath and/or joint.
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Affiliation(s)
- D Christoforou
- Division of Hand Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
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Abstract
Lesions and tumors of the carpus are usually identified radiographically during a routine workup for wrist pain. Although most of these entities are benign, a failure to appreciate their presence may delay diagnosis and treatment. More importantly, a small subset of these tumors may be quite aggressive, and early recognition can spare the patient the morbidity of late sequelae such as pathologic fracture, progressive wrist arthrosis, or even tumor metastasis. This article provides current information on how to identify, differentiate, and treat the varied lesions and tumors that may be discovered in the carpus.
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Polster JM, Evans P, Schils J, Sundaram M. Radiologic case study. Synovial chondromatosis of the pisotriquetral joint. Orthopedics 2005; 28:1130, 1205-7. [PMID: 16237875 DOI: 10.3928/0147-7447-20051001-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ueo T, Kashima K, Daa T, Kashima N, Tsuji KI, Hisaoka M, Yokoyama S. A case of tenosynovial chondromatosis with tophus-like deposits. Case report. APMIS 2004; 112:624-8. [PMID: 15601313 DOI: 10.1111/j.1600-0463.2004.apm1120911.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Tenosynovial chondromatosis has not been well recognized because of its rarity, but it is clinically important because of its high rate of recurrence. We report here a case of tenosynovial chondromatosis with deposits of crystalline material that appeared to be sodium urate (gouty tophi). A 37-year-old Japanese man was admitted because of a hard mass in his left third finger. He had undergone surgery at the same anatomical site four and seven years previously. The roentgenogram revealed a soft tissue mass in the flexor aspect of the proximal phalanx. At operation, the tumor was found to have arisen in the tendon sheath. Histopathological examination showed that the tumor was composed of well-defined, multiple, cartilaginous nodules that were surrounded by tenosynovial tissue. A few of the nodules were calcified. The chondrocytes had mild atypia, and were immunopositive for S-100 protein. A diagnosis of tenosynovial chondromatosis was made. The nodules also contained crystalline deposits, which bore a histological resemblance to gouty tophi. We were unable to define the exact nature of these deposits even by transmission electron microscopy and electron roentgenographic microanalysis. Crystalline deposits in chondromas of soft tissue have been reported but not in tenosynovial chondromatosis.
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Affiliation(s)
- Tetsuya Ueo
- Department of Pathology, Faculty of Medicine, Oita University, Oita, Japan.
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10
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Lee EY, Rubin DA, Brown DM. Recurrent Mycobacterium marinum tenosynovitis of the wrist mimicking extraarticular synovial chondromatosis on MR images. Skeletal Radiol 2004; 33:405-8. [PMID: 15127246 DOI: 10.1007/s00256-004-0786-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Revised: 03/21/2004] [Accepted: 03/23/2004] [Indexed: 02/02/2023]
Abstract
Tenosynovitis caused by atypical mycobacterial infections may produce rice bodies within affected tendon sheaths. We report a case of recurrent M. marinum infection involving the flexor tendons within the carpal tunnel in which the rice bodies were mistaken for synovial chondromatosis on MR images.
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Affiliation(s)
- Edward Y Lee
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, MO, USA.
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Fetsch JF, Vinh TN, Remotti F, Walker EA, Murphey MD, Sweet DE. Tenosynovial (extraarticular) chondromatosis: an analysis of 37 cases of an underrecognized clinicopathologic entity with a strong predilection for the hands and feet and a high local recurrence rate. Am J Surg Pathol 2003; 27:1260-8. [PMID: 12960811 DOI: 10.1097/00000478-200309000-00010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tenosynovial chondromatosis is a multinodular cartilaginous proliferation that arises from the tenosynovial membranes. This report describes the clinical, radiologic, and histopathologic findings in 37 cases of this uncommon entity. There were 17 males and 20 females, ranging in age from 20 to 86 years (mean and median age, 46 years). The process involved tenosynovium of the fingers (n = 19), feet (n = 8), wrists (n = 4), ankles (n = 2), hand, not otherwise specified, or palm (n = 2), knee (n = 1), and forearm (n = 1). Signs of disease or symptoms were present for 5 weeks to 18 years (median duration, approximately 2 years) before surgical excision. The two most common complaints were a painless mass and a mass that was mildly tender with pressure. None of the tumors had clinical, radiologic, or histopathologic evidence of articular or bone involvement. Histologically, all tumors consisted of a multinodular cartilaginous proliferation involving tenosynovium and/or subsynovial connective tissue. Mild or moderate atypia, as encountered in chondroma of soft parts and synovial chondromatosis, was a frequent finding. Follow-up information was available for 16 patients (43%). Only two patients with follow-up information remained disease free after their initial surgical procedure. Seven patients had one recurrence and seven patients had two or more recurrences. Tenosynovial chondromatosis appears to be an extraarticular counterpart of synovial (intraarticular) chondromatosis. Our review indicates this process is often confused with chondroma of soft parts, in part, because both entities have a predilection for the hands and feet. Diagnosis of this underrecognized entity is of clinical importance because of the high local recurrence rate.
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Affiliation(s)
- John F Fetsch
- Department of Soft Tissue, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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Wong SHM, Salama S, Thoma A. Synovial chondromatosis of the hand: Three case reports and literature review. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2003; 11:47-52. [PMID: 24115851 PMCID: PMC3792781 DOI: 10.1177/229255030301100109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Synovial chondromatosis is a rare condition that is probably caused by synovial connective tissue metaplasia. It is very rare in the hand and wrist and because of its low prevalence and nonspecific symptoms, synovial chondromatosis can present diagnostic difficulties for the hand surgeon and may lead to a delay in treatment. We review the literature and report three additional cases of synovial chondromatosis in the hand.
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Affiliation(s)
| | - Sam Salama
- Department of Pathology, St Joseph’s Healthcare and McMaster University, Hamilton, Ontario
| | - Achilleas Thoma
- Department of Surgery, Division of Plastic Surgery, St Joseph’s Healthcare and McMaster University, Hamilton, Ontario
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