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Ha S, Lankalis J, Panchal N. Unilateral temporomandibular joint swelling with progressive malocclusion and chin deviation. J Am Dent Assoc 2024; 155:625-629. [PMID: 37943217 DOI: 10.1016/j.adaj.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/26/2023] [Accepted: 09/12/2023] [Indexed: 11/10/2023]
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2
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Barlas N, Barlas S, Adalier E, Basnyat S. Pigmented villonodular synovitis and rheumatoid arthritis: diagnostic challenges and therapeutic considerations in a case of knee pain. BMJ Case Rep 2024; 17:e258004. [PMID: 38821562 DOI: 10.1136/bcr-2023-258004] [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: 06/02/2024] Open
Abstract
We present a case of a woman in her 30s who visited the rheumatology clinic due to her persistent knee pain for 5 years, which spread to multiple joints. She was diagnosed with seropositive rheumatoid arthritis (RA). While most joints responded well to methotrexate and subsequently etanercept, persistent unilateral knee pain prompted further investigation. Imaging revealed synovitis and joint effusion in her knee, prompting arthroscopy and synovial biopsy, revealing pigmented villonodular synovitis (PVNS). Despite initial success with a tricompartmental synovectomy, her disease recurred. The decision was made to pursue medical therapy, with pexidartinib initiated by the oncology team. Our case report highlights the importance of considering other underlying conditions in patients with RA who do not achieve full clinical improvement despite standard treatment. Physicians should remain vigilant for atypical presentations and imaging features in patients with RA, for early recognition of PVNS can significantly impact treatment decisions and patient outcomes.
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Affiliation(s)
- Nur Barlas
- Department of Internal Medicine, Florida State University-Cape Coral Hospital, Cape Coral, Florida, USA
| | - Sait Barlas
- Department of Internal Medicine, Florida State University-Cape Coral Hospital, Cape Coral, Florida, USA
| | - Emre Adalier
- Harvey School of Medicine, University of Pavia, Pavia, Lombardia, Italy
| | - Shristi Basnyat
- Department of Rheumatology, Florida State University- Lee Health, Bonita Springs, Florida, USA
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Seneldir L, Celep S, Yildiz S, Verim A, Zer Toros S, Ozcan Z. A severe headache due to pigmented villonodular synovitis in a rare location: facial nerve on temporomandibular joint. A case report. Cranio 2023; 41:565-568. [PMID: 33834955 DOI: 10.1080/08869634.2021.1911501] [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: 10/21/2022]
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is an infrequent benign tumor-like proliferative lesion developing from the synovial membranes of the joint, tendon sheath, and bursa. CLINICAL PRESENTATION A 44-year-old woman with numbness on the right side of her face, severe headaches, and swelling in temporomandibular region is presented. On head and neck magnetic resonance imaging, an encapsulated mass approximately 2 cm was detected. The fine-needle aspiration biopsy resulted as suspicion of mesenchymal tumor. A complete resection with the capsule was performed over the temporal branch by monitoring of the facial nerve. The final histopathologic examination resulted as a giant cell tendon sheath tumor. CONCLUSION Headache is not the main symptom in PVNS, but in severe pain spreading from the temporomandibular region, physical examination should be done carefully for slight swelling, and the possibility of pigmented villonodular synovitis should be considered. Because of the high recurrence rate, en bloc resection is necessary.
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Affiliation(s)
- Lutfu Seneldir
- ENT Department, Haydarpa#şa Numune Training and Research Hospital, Istanbul, Turkey
| | - Sinan Celep
- ENT Department, Tuzla State Hospital, Istanbul, Turkey
| | - Selçuk Yildiz
- ENT Department, Haydarpa#şa Numune Training and Research Hospital, Istanbul, Turkey
| | - Aysegul Verim
- ENT Department, Haydarpa#şa Numune Training and Research Hospital, Istanbul, Turkey
| | - Sema Zer Toros
- ENT Department, Haydarpa#şa Numune Training and Research Hospital, Istanbul, Turkey
| | - Zuhal Ozcan
- Pathology Department, Haydarpa#şa Numune Training and Research Hospital, Istanbul, Turkey
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4
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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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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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Yang X, Sun Y, Yu W, Fu J. Pigmented villonodular synovitis of the temporomandibular joint: case report and the literature review for postoperative radiotherapy. J Radiol Case Rep 2019; 13:31-39. [PMID: 31558968 DOI: 10.3941/jrcr.v13i8.3661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of the synovium that usually involves joints, tendon sheaths, and bursae. It presents rarely, however, in the temporomandibular joints (TMJs). This paper reports a 59-year-old female patient with PVNS of the TMJ and its clinico-pathologic features are discussed. The patient was treated with surgery and postoperative radiotherapy (PORT). Follow-up was conducted, and there were no recurrences, metastases, skin changes or joint stiffness noted. The main treatment of PVNS is surgical resection. However, postoperative radiotherapy is important for local control of extensive tumors or positive margins. We conducted a literature review for postoperative radiotherapy case reports related to PVNS of the TMJ.
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Affiliation(s)
- Xiaojing Yang
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Sun
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weiwei Yu
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jie Fu
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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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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Biyani P, Khurram SA, Thomas M, Nusrath M. Chondroid tenosynovial giant cell tumour: a rarity in the temporomandibular joint. Br J Oral Maxillofac Surg 2019; 57:282-284. [PMID: 30904202 DOI: 10.1016/j.bjoms.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/14/2019] [Indexed: 12/01/2022]
Abstract
Tenosynovial giant cell tumours of the temporomandibular joint (TMJ) are extremely rare, particularly the subset of chondroid tumours. They can be broadly divided into localised and diffuse types, of which we know of only 116 reported cases in the TMJ. Rarer still are the subset of chondroid tenosynovial giant cell tumours, of which we know of only 30 cases that have affected the TMJ. We present a case that involved the TMJ, and include a discussion of its management.
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Affiliation(s)
- P Biyani
- Sheffield Teaching Hospitals, Sheffield, UK.
| | - S A Khurram
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, UK
| | | | - M Nusrath
- Sheffield Teaching Hospitals, Sheffield, UK
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Affiliation(s)
| | | | - Shaza Mardini
- University of Tennessee, Graduate School of Medicine, Knoxville, TN
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10
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11
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Wang JG, Liu J, He B, Gao L, Zhang L, Liu J. Diffuse Tenosynovial Giant Cell Tumor Around the Temporomandibular Joint: An Entity With Special Radiologic and Pathologic Features. J Oral Maxillofac Surg 2019; 77:1022.e1-1022.e39. [PMID: 30796908 DOI: 10.1016/j.joms.2019.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Diffuse tenosynovial giant cell tumor (TGCT) of the temporomandibular joint (TMJ) is rare. The aim of the present study was to summarize the clinical, radiologic, and pathologic features of this tumor. MATERIALS AND METHODS Nine cases of TGCT in the TMJ region were examined. All available radiologic and pathologic documents were carefully reviewed. These cases were grouped into 3 types according to the radiologic features: bone-centered type, intraosseous type, and soft tissue type. Cases reported in the literature were reviewed to better summarize the clinical characteristics. RESULTS TGCTs in the TMJ region showed some special radiologic and pathologic features. Radiologically, the lesion could be centered in the craniofacial bone or centered in the surrounding soft tissue. Four cases were categorized as the bone-centered type, 1 was categorized as the intraosseous type, and 4 were categorized as the soft tissue type. Pathologically, epithelioid mononuclear cells with abundant eosinophilic cytoplasm and eccentric nuclei were observed in all cases. Chondroid metaplasia was noted in 8 cases. Some areas were similar to giant cell reparative granuloma and chondroblastoma. All patients who underwent complete tumor resection showed no evidence of recurrence at follow-up. Of the 93 reported cases, only 5 developed postoperative recurrence and distant metastasis. CONCLUSION TGCTs of the TMJ region share similar radiologic and pathologic features as other tumors, which indicates the TGCT might be a special entity within a spectrum of diseases.
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Affiliation(s)
- Ji-Gang Wang
- Associate Chief Physician and Postdoctoral Research Fellow, Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingwei Liu
- Resident, Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Bing He
- Resident, Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ling Gao
- Attending Doctor, Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijuan Zhang
- Professor, Medical Systems Biological Center for Complex Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jihua Liu
- Professor, Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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12
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Treatments of tenosynovial giant cell tumours of the temperomandibular joint: a report of three cases and a review of literature. Int J Oral Maxillofac Surg 2018; 47:1288-1294. [DOI: 10.1016/j.ijom.2018.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/10/2018] [Accepted: 04/06/2018] [Indexed: 12/31/2022]
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13
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Mao WY, Liu MQ, Fu KY. [CT imaging features of diffuse tenosynovial giant cell tumor of temporomandibular joint]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:282-286. [PMID: 29984929 DOI: 10.7518/hxkq.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to investigate the characteristic features of CT images of diffuse tenosynovial giant cell tumor (D-TSGCT) from the temporomandibular joint (TMJ) to understand CT imaging diagnosis of the disease. METHODS CT images and clinical information from 10 patients with D-TSGCT of TMJ were recruited for retrospective analysis from March 2013 to March 2017 in Peking University Hospital of Stomatology. All cases were treated by surgery and confirmed by pathology. RESULTS CT scan demonstrated hyperdense soft-tissue masses and various kinds of calcification in all of the 10 subjects. Contrast-enhanced scan exhibited obvious enhancement in six patients. Bone destruction of the mandibular condyles and skull base was found in seven and six subjects, respectively. CONCLUSIONS CT appearance of D-TSGCT of the TMJ is characterized by hyperdense soft tissue with calcification, further enhancement in contrast-enhanced scan, and bone destruction in the mandibular condyles and skull base in some cases.
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Affiliation(s)
- Wei-Yu Mao
- Dept. of Oral Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Mu-Qing Liu
- Dept. of Oral Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Kai-Yuan Fu
- Dept. of Oral Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Bhatnagar K, Bawa AS, Narang V, Kaur P. Pigmented Villonodular Synovitis of Thumb-A Cytological Diagnosis. J Clin Diagn Res 2017; 11:ED18-ED20. [PMID: 28764182 DOI: 10.7860/jcdr/2017/28184.10099] [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: 03/16/2017] [Accepted: 05/11/2017] [Indexed: 11/24/2022]
Abstract
Pigmented Villonodular Synovitis (PVNS) is a unique benign proliferative process of unknown aetiology involving the synovial lined joints diffusely or focally. The entity remains a diagnostic challenge. This condition is attributed to an increased synovial proliferation causing villous or nodular changes of synovial lined joints leading to PVNS, Pigmented Villonodular Bursitis (PVNB) when arising from bursae or Pigmented Villonodular Tenosynovitis (PVNTS) originating from the tendon sheath. We present a case of a young female with nodular masses on right thumb with cytomorphological features on FNAC suggestive of PVNS which was finally confirmed by histopathology.
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Affiliation(s)
- Kaneeka Bhatnagar
- Senior Resident, Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Akshdeep Singh Bawa
- Senior Resident, Department of Orthopedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vikram Narang
- Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Pavneet Kaur
- Professor, Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Roman-Ramos M, Cariati P, Cabello-Serrano A, Garcia-Martin M, Garcia-Medina B. Arthroscopic approach for treating a pigmented villonodular sinovitis of TMJ. A case report. J Clin Exp Dent 2017; 9:e312-e314. [PMID: 28685013 PMCID: PMC5494200 DOI: 10.4317/jced.53114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/29/2016] [Indexed: 11/05/2022] Open
Abstract
The present report describes the case of a 29-year-old man referred to our service for TMJ pain and progressive reduction of the mouth opening. Differential diagnostics included rheumatologic diseases, monoarthritis and intraarticular lumps. In this line, a face CT scan and a MRI of TMJ were carried out in order to ensure a proper diagnosis. These tests showed a solid lesion into the joint cavity. In view of that, we decided to perform a diagnostic and therapeutic arthroscopy of TMJ. Histopathological studies confirmed the diagnosis of pigmented villonodular synovitis. The main aim of this report is to describe this rare syndrome with the goal of proposing suitable treatments. Moreover, we highlight the benefits of using arthroscopic procedures in the cases which the tumor is still confined to the joint. As far as we are aware, scientific literature documents only a single case of pigmented villonodular synovitis of TMJ treated with arthroscopic approach. Key words:Arthroscopic approach, pigmented villonodular synovitis, TMJ, mouth opening.
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Affiliation(s)
- Maria Roman-Ramos
- Oral and Maxillofacial surgery resident. Hospital Universitario Virgen de las nieves, Granada, Spain
| | - Paolo Cariati
- Oral and Maxillofacial surgery resident. Hospital Universitario Virgen de las nieves, Granada, Spain
| | | | | | - Blas Garcia-Medina
- Maxillofacial Surgeon. Hospital Universitario Virgen de las nieves, Granada, Spain
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