Pigmented villonodular synovitis on lumbar spine : a case report and literature review

Diffuse-type tenosynovial giant cell tumor between the suboccipital bone and posterior C1 arch: illustrative case

BACKGROUND

Tenosynovial giant cell tumor (TGCT) occurs most commonly in the appendicular skeleton and is only rarely found in the vertebral column. Lesions of the craniocervical junction are particularly rare, with only 4 cases reported in the literature. The authors describe the case of a diffuse-type TGCT at the craniocervical junction.

OBSERVATIONS

A patient presented with a 1-year history of right-sided neck pain and bilateral neurological symptoms in the distribution of the right occipital nerve. A 20-mm homogeneously contrast-enhancing mass in the suboccipital and posterior C1 region was discovered on magnetic resonance imaging of the cervical spine. The tumor was operated on via a posterior approach, and gross-total resection (GTR) was achieved. Immunohistochemical (IHC) examination revealed a diffuse-type TGCT. The patient had an uneventful recovery.

LESSONS

TGCT can arise at the craniocervical junction and is easily misdiagnosed because of its rare occurrence. IHC examination of a tumor specimen should be done to confirm the diagnosis. GTR is the objective when treating these tumors, especially when they are the diffuse type, as they have a high recurrence rate. Radiation and small-molecule therapies are viable postoperative therapies if GTR cannot be achieved or in cases of recurrence.

Clinical outcomes of endoscopic synovectomy with adjuvant radiotherapy of pigmented villonodular synovitis of the hip: a case series of single center

Background

Though radiotherapy has been widely used for knee pigmented villonodular synovitis (PVNS), there is few literatures about radiotherapy for the treatment of PVNS hip. Thus, the purpose of this study was to analyze the clinical outcomes of endoscopic synovectomy with/without radiotherapy postoperatively of PVNS hip.

Methods

We performed a retrospective study of patients who underwent endoscopy in our hospital from November 2010 to January 2021. Inclusion criteria was patients with magnetic resonance image (MRI) signs, endoscopic findings and/or histological evidence of PVNS. Exclusion criteria was patients lost follow-up. All patients underwent synovectomy endoscopically and were divided into two groups depending on receiving postoperative radiotherapy or not. The primary outcome measurements were the recurrence of PVNS, receiving revision, and/or converting to total hip arthroplasty (THA). The secondary outcome measurements were the patient-reported outcome (PRO) collected at pre- and post-operation, which consist of Hip Outcome Score Activities of Daily Living (HOS-ADL), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (IHOT-12), Non-arthritic Hip Scale (NAHS), and visual analog scale (VAS).

Results

In a case series of 16 patients (8 cases of male, 50%), 4 (25%) cases were localized type and 12 (75%) cases were diffuse type. The average follow-up was 44.8 ± 38.2 months (range,3 to 110). 8 (50%) cases (6 diffuse cases and 2 localized cases) received radiotherapy postoperatively, and the rest (6 diffuse cases and 2 localized cases) received endoscopic treatment alone. At the latest follow-up, 3 (18.75%) cases (2 diffuse cases and 1 localized case) who did not receive radiotherapy converted to arthroplasty. The preoperative HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of remaining 13 patients were 63.1 ± 19.1 (range,32.0 to 98.8), 54.8 ± 20.1 (range, 10.0 to 77.0), 50.9 ± 15.4 (range, 31.0 to 76.6),51.6 ± 15.9 (range, 20.0 to 84.4), 6.0 ± 1.4 (range,4.0 to 8.0) points, respectively. The latest HOS-ADL, mHHS, IHOT-12, NAHS, VAS scores of the 13 patients were 79.7 ± 10.8 (range, 58.0 to 97.6), 78.6 ± 9.1 (range,55.0 to 87.0), 74.7 ± 9.7 (range, 55.6 to 91.0), 78.9 ± 18.7 (range,20.0 to 92.5), 3.1 ± 1.2 (range,2.0 to 6.0) points respectively.

Conclusion

Endoscopic synovectomy can achieve satisfactory PRO in PVNS hip patients. Besides, postoperative adjuvant radiotherapy can achieve higher hip survivability than synovectomy alone in this present study.

Spinal pigmented villonodular synovitis and tenosynovial giant cell tumor: A report of two cases and a comprehensive systematic review

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.

Villonodular synovitis of the lumbar spine: Case report of a rare pathology

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.

Mid-Term Results of Arthroscopic Synovectomy for Pigmented Villonodular Synovitis of the Hip

PURPOSE

To analyze mid-term outcomes after arthroscopic synovectomy of both diffuse and nodular hip pigmented villonodular synovitis (PVNS).

METHODS

This is a retrospective case series of patients that underwent hip arthroscopy for hip PVNS with a single senior surgeon between 2007 and 2016. Inclusion criteria were magnetic resonance imaging evidence, arthroscopic visualization, and/or histologic confirmation of PVNS; and a minimum of 3 years of follow-up. Concomitant pathology such as femoroacetabular impingement also was treated at the time of surgery. Primary outcome measures were recurrence of hip PVNS and the rate of revision hip surgery. Secondary outcomes were complications, visual analog scale pain score, pain relief, and patient satisfaction, and 6 patient-reported outcome measures were collected at latest follow-up.

RESULTS

In a case series of 14 patients consisting of 6 (42.9%) male and 8 (57.1%) female patients, the mean operative age was 32.69 ± 12.73 years with a mean follow-up was 6.66 ± 1.87 years. PVNS type was determined intraoperatively: 5 (35.7%) patients had diffuse hip PVNS and 9 (64.3%) had nodular type. There was only 1 case (7.14%) of recurrence that was treated arthroscopically and no cases (0%) progressed to revision open synovectomy or arthroplasty. Mean patient-reported outcome measure scores were notable for a modified Harris Hip Score of 74.08 ± 16.84. The mean visual analog scale pain score decreased by 4.9 ± 1.7, which was significant with a P < .001, with a larger decrease in patients with localized type.

CONCLUSIONS

This study presents a large case series of hip PVNS managed arthroscopically with mid-term follow-up of slightly over 6.5 years. The survival rate was 93%, with only 1 (7%) recurrence and 0 (0%) progression to revision open synovectomy or arthroplasty with 0 (0%) complications. We conclude that arthroscopic synovectomy is a reliable and effective treatment of hip PVNS.

LEVEL OF EVIDENCE

Case Series, Level IV.

Tenosynovial giant cell tumor of the cervical spine: a case report

Introduction

Tenosynovial giant cell tumors (TSGCTs) generally occur in the limb joints, and only rarely in the spine. This case report describes a patient with TSGCT of the spine at C1-C2, which was treated surgically and diagnosed as TSGCT.

Case presentation

A 32-year-old woman with a 4-month history of neck pain and numbness in both upper extremities was referred to our department. Magnetic resonance imaging (MRI) revealed a neoplastic lesion extending from the left epidural space to the erector spinae muscles at the C1-C2 vertebral level, which was isointense on T1-weighted images, heterogeneously hypointense on T2-weighted images, and showed heterogeneous enhancement on gadopentetate dimeglumine (Gd-DTPA)-enhanced T1-weighted images. Computed tomography showed no findings suggestive of bone destruction of the vertebral body. Because the neurological symptoms were progressive, total macroscopic resection of the tumor was performed via a posterior approach. Histopathological examination of the resected specimen revealed the diagnosis of TSGCT. Improvement of the both the neck pain and upper-extremity numbness was noted postoperatively. An MRI obtained 6 months after the surgery revealed no evidence of tumor recurrence and the postoperative course was uneventful.

Discussion

TSGCT of the upper cervical spine (C1-C2) is rare, and this is the tenth reported case. If a tumor is heterogeneously hypointense on T2-weighted MRI, which reflects hemosiderosis, the possibility of this tumor should be considered in the differential diagnosis.

Bone Involvement Mimicking an Aggressive Bone Lesion in a Diffuse-type Tenosynovial Giant Cell Tumor in the Thoracic Vertebral Lamina: A Case Report

Introduction:

Diffuse-type tenosynovial giant cell tumor (D-TGCT), or pigmented villonodular synovitis, is a benign, but aggressive lesion, primarily involving large joints. The spine is rarely affected, with the involvement of the thoracic spine being particularly rare. Massive bone involvement associated with facet joints is a characteristic of spinal D-TGCT.

Case Report:

We report the case of a 26-year-old woman with D-TGCT in her first thoracic vertebral lamina. Computed tomography (CT) showed an osteolytic expansive lesion without the involvement of the facet joint. Magnetic resonance imaging (MRI)revealed a lesion with intermediate signal intensity on T1- and T2-weighted images. After computed tomographically guided biopsy, curettage was performed, and D-TGCTwas diagnosed.

Conclusions:

Features of CT and MRI suggested an aggressive bone lesion, and it was challenging to assume D-TGCT, particularly without the involvement of the facet joint.

Multifocal pigmented villonodular synovitis in a child: A case report

INTRODUCTION

Pigmented villonodular synovitis (PVNS) is a rare, benign proliferative disorder of the synovial membrane that typically presents in adults and affects a single joint. Multifocal PVNS is very rare, particularly in childhood. We reported a rare case of multifocal PVNS affecting over 20 joints in a child.

CLINICAL PROCEDURE

A 7-year-old female patient had a 6-month history of multifocal joints swelling with mild pain. She was diagnosed as polyarticular juvenile idiopathic arthritis at a local hospital. Naproxen, methotrexate, infliximab, and pavlin were used to treat the patient for 2 months. However, the treatment had no effect, the joints swelling remained. The patient was then transferred to our hospital. Physical examination revealed multiple joints swelling, especially in the shoulders joints. Puncture fluid from a shoulder joint was bloody. Magnetic resonance imaging (MRI) revealed synovial thickening and hemosiderin deposition. Biopsy of joint synovium found villous nodules, the invasion of foam cells, and hemosiderin deposition. By collecting all of the evidence, the diagnosis of PVNS was confirmed.

CONCLUSIONS

PVNS was easily misdiagnosed as rheumatoid arthritis and the formal treatment was usually delayed. This case described here is the first case of PVNS involving such a large numbers of joints that has been reported in the literature.

Tenosynovial Giant Cell Tumor, Diffuse Type/Pigmented Villonodular Synovitis in a Pars Defect: A Case Report

STUDY DESIGN

Case report.

OBJECTIVE

To describe a rare case of tenosynovial giant cell tumor, diffuse type/pigmented villonodular synovitis (PVNS) in a pars defect in a patient with lumbar spondylolysis.

SUMMARY OF BACKGROUND DATE

PVNS rarely occurred in lumbar spine, and no studies in the English literature have reported PVNS in a pars defect in lumbar spondylolysis.

METHODS

The patient was a 14-year-old female presented with a 5-month history of low back pain. Plain radiography showed spondylolysis at L5 and computed tomography revealed a 1 × 2-cm slightly eroding tumorous mass at the left L5 pars. On magnetic resonance imaging, the mass showed intermediate intensity and gadolinium enhancement on T1-weighted images (WI) and high intensity on T2-WI and T2 STAR-WI. After undergoing computed tomography-guided needle biopsy, a pathological diagnosis of PVNS was made and total gross resection was performed.

RESULTS

The gross appearance and the postoperative pathological diagnosis were consistent with PVNS. The postoperative clinical course was uneventful and postoperative computed tomography and magnetic resonance imaging revealed no residual lesion.

CONCLUSION

This is the first report of PVNS occurring in spondylolysis.

LEVEL OF EVIDENCE

N/A.