Fine needle aspiration of pigmented villonodular synovitis of the temporomandibular joint

Temporomandibular joint (TMJ) problems are usually the result of functional disorders. Tumors of the TMJ are rarer entities, the diagnosis of which may be delayed due to a clinical impression of a functional ailment. We report a case of a patient with a recurrent TMJ area lesion diagnosed cytologically as pigmented villonodular synovitis (PVNS), an entity that very rarely involves the TMJ and is usually diagnosed by histology. The differential diagnosis of PVNS in the context of its location in and around the TMJ is also discussed.     

Fine-needle aspiration of pigmented villonodular synovitis of the temporomandibular joint masquerading as a primary parotid gland lesion

The fine-needle aspiration findings in a case of pigmented villonodular synovitis of the temporomandibular joint are presented. The characteristic cytomorphologic and clinical features of this uncommon, benign fibrohistiocytic lesion are discussed. In addition, due to the initial clinical impression of a primary parotid gland lesion, the differential diagnosis for the cytomorphologic features observed (histiocytoid cells admixed with osteoclast-like giant cells) are discussed within the context of a primary salivary gland mass. Diagn. Cytopathol., 16:47–50,1997. © 1997 Wiley-Liss, Inc.     

Diffuse pigmented villonodular synovitis of the temporomandibular joint diagnosed by fine-needle aspiration cytology

Diffuse pigmented villonodular synovitis is a rare tumor in the temporomandibular joint region. This article deals with a 32-yr-old male who suffered from pain and swelling in the right temporomandibular joint region associated with restricted mouth opening. Computed tomography showed a tumor lateral to the temporomandibular joint. Arthrography revealed a displaced temporomandibular joint disk. Fine-needle aspiration cytology showed characteristic cellular changes, including rounded or oval cells with abundant cytoplasm and intracytoplasmatic hemosiderin deposits and numerous multinucleated giant cells without nuclear atypia. A benign mesenchymal lesion suggestive for pigmented villonodular synovitis was diagnosed and later verified at histologic examination. Fine-needle aspiration cytology seems to be useful for this diagnosis.     

A cause of erroneous diagnosis of pigmented villonodular synovitis.

An unusual type of benign vascular hamartoma, which shows a curious papillary organization of thrombus and abundant haemosiderin deposition, is liable to be misdiagnosed histologically as pigmented villonodular synovitis. Nine examples of this type of lesion are briefly presented and the differential diagnosis is discussed.     

Recurrent and non-recurrent pigmented villonodular synovitis 1

Pigmented villonodular synovitis (PVNS) is a benign intra-articular lesion. Patients are at risk for local recurrence. Factors that predict recurrence are not established. Two groups of patients were retrieved from our files. One consisted of 25 patients who had one or more recurrences within 5 years after primary surgery. The second group contained 18 historical controls free of recurrence for at least 5 years after primary surgery. Patient medical records and surgical notes were reviewed. We compared proliferative activity and DNA ploidy using digital image analysis, and other clinicopathologic features between the 2 groups of patients. The location of PVNS was significantly different between the two groups (p=0.03). In the recurrence group, there were 7 (28%) cases with disease in the knee. However, none of the controls had disease in the knee. Among recurrent cases, tumors in the knee were, on average, larger than tumors in the small joints. The size of all recurrent tumors was not significantly different than non-recurrent tumors (median of 1.8 cm versus 1.3 cm, respectively; p=0.06). There were no significant differences in age, sex, completeness of surgical removal, MIB-I index, DNA ploidy, or the percent of tumor nuclei in the diploid, S-phase, tetraploid, or hypertetraploid DNA histogram categories between the two groups. Our results indicate that recurrent PVNS tumors were more likely to be located in the knee, which may be related to larger tumor size. Patient age, sex, completeness of surgical removal, DNA ploidy, and MIB-I proliferation were not significantly different between recurrent and non-recurrent lesions.     

膝关节置换与关节镜治疗膝关节色素沉着绒毛结节性滑膜炎

背景：外科治疗色素沉着绒毛结节性滑膜炎能够最大程度的切除病变滑膜,最大限度的恢复关节功能。目的：探讨人工全膝关节置换与关节镜下滑膜切除治疗膝关节色素沉着绒毛结节性滑膜炎的膝关节功能和复发率。方法：回顾性分析中南大学湘雅医院骨科2006年12月至2011年12月收治的34例膝关节色素沉着绒毛结节性滑膜炎行手术治疗患者,治疗后病检均为弥漫性色素沉着绒毛结节性滑膜炎,其中24例患者行膝关节镜下滑膜切除,10例色素沉着绒毛结节性滑膜炎患者行人工全膝关节置换,治疗后根据病情行辅助放疗。膝关节镜下滑膜切除组采用Lysholm功能评分,人工全膝关节置换组采用美国膝关节协会评分,比较两组患者治疗前后膝关节功能,随访观察比较两组间的膝关节功能恢复情况及复发率。结果与结论：34例膝关节色素沉着绒毛结节性滑膜炎患者均获有效随访,随访时间12-66个月,平均41.3个月。统计学分析结果表明关节镜下滑膜切除组治疗后膝关节Lysholm功能评分为(86.3±10.3)分,明显高于治疗前的(55.5±13.2)分(t=3.81,P =0.016,P < 0.05)。人工全膝关节置换组美国膝关节协会评分由治疗前的(40.7±2.2)分提高到(90.2±1.1)分(t =6.27,P < 0.01);关节镜下滑膜切除组美国膝关节协会评分由治疗前的(34.2±3.9)分提高到(80.8±1.9)分 (t =16.58,P < 0.01)。证实,关节镜下滑膜切除结合辅助放疗治疗膝关节色素沉着绒毛结节性滑膜炎可取得较好效果,人工全膝关节置换治疗晚期膝关节弥漫型色素沉着绒毛结节性滑膜炎可较好恢复膝关节功能,且复发率较低。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Fine-needle aspiration biopsy diagnosis of extrarenal malignant rhabdoid tumor

Two cases of extrarenal malignant rhabdoid tumors are presented in which diagnosis was suggested by fine-needle aspiration biopsy and confirmed by histologic and electron microscopic examination. Fine-needle aspiration smears in both cases revealed round to polygonal cells with vesicular nuclei and prominent nucleoli. Several tumor cells contained cytoplasmic inclusions composed of intermediate filaments. A majority of the tumor cells stained strongly for vimentin and cytokeratin. Electron microscopic examination revealed many cells with large aggregates of intermediate filaments corresponding to the cytoplasmic inclusions. Fine-needle aspiration biopsy may be used for diagnosing malignant rhabdoid tumor. The diagnosis may be further confirmed by immunohistochemistry and electron microscopy. Diagn Cytopathol 1994;11:271–276. © 1994 Wiley-Liss, Inc.     

Osteoclast formation and function in pigmented villonodular synovitis

Pigmented villonodular synovitis (PVNS) is a synovial tumour-like lesion that frequently causes osteolysis. PVNS contains numerous macrophages and osteoclast-like giant cells. In this study, we have analysed the cytochemical and functional characteristics of mononuclear and multinucleated cells in PVNS and determined the cellular and humoral mechanisms underlying giant cell formation and resorption in PVNS. Giant cells and CD14(+) and CD14(-) mononuclear cell populations were isolated from PVNS synovial tissue and cultured alone or in the presence and absence of the osteoclastogenic factors, RANKL and M-CSF. Osteoclast formation and activity was assessed by expression of TRAP and evidence of lacunar resorption. Giant cells in PVNS expressed an osteoclast-phenotype (CD51(+) , TRAP(+) , CD14(-) , HLA-DR(-) ) and were formed only in cultures of mononuclear cells that expressed the macrophage marker CD14. Osteoclast formation required RANKL and occurred in both the presence and absence of exogenous M-CSF. CD14(-) cells in PVNS expressed RANKL. Lacunar resorption by PVNS-derived giant cells was abolished by the addition of the bisphosphonate, zoledronate. Our findings indicate that osteoclasts form by a RANKL-dependent mechanism from CD14(+) mononuclear phagocytes in PVNS. Osteoclast formation occurred even in the absence of exogenous M-CSF, a finding which is in keeping with over-expression of M-CSF playing a pathogenic role in this condition. Anti-osteoclast resorptive treatment may be useful to control osteolysis in PVNS.     

Extensive pigmented villonodular synovitis with markedly pigmented lymphadenopathy and its implication for differential diagnosis with malignant melanoma

A 51-year-old male presented with a 5 cm left knee mass. Fine needle aspiration revealed large epithelioid cells with prominent nucleoli and abundant cytoplasmic pigment, consistent with malignant melanoma. Left inguinal lymphadenopathy was present, which was suspicious for metastatic disease by ultrasound examination. A dark perianal skin lesion was also identified, therefore raising the possibility of a primary melanoma. The knee and perianal lesions were resected and inguinal sentinel node biopsy was performed. In the specimen from the knee, there were clusters and fascicles of spindle and epithelioid cells with prominent nucleoli. Many of the cells displayed abundant, granular, brown, cytoplasmic pigment. The lymph node showed clusters of similar cells located in the subcapsular sinus. Immunohistochemical study showed that the cells expressed CD68, but failed to express S-100, MART-1, and gp100. The cytoplasmic pigment was positive for iron staining. The final diagnosis was pigmented villonodular synovitis. This case illustrates that pigmented villonodular synovitis may present with lymphadenopathy, mimicking a malignant process, including melanoma. Immunohistochemical studies may be essential for establishing the correct diagnosis.     

Fine-needle aspiration biopsy in diagnosis of soft tissue infections.

This study explores the efficacy of fine-needle tissue aspiration biopsy in the diagnosis of soft tissue infections that cannot be sampled satisfactorily by regular microbiological techniques. Aspiration biopsy was performed on 50 patients with presumptive soft tissue infections. The conditions investigated were decubitus, diabetic, ischemic, venous, and traumatic ulcers (2, 6, 1, 2, and 7 patients, respectively), cellulitis (23 patients), chronic osteomyelitis (5 patients), and infected surgical wounds (4 patients). Where possible, comparison with superficial cultures was made. All of the cultures obtained from aspirate samples taken from ulcers, chronic osteomyelitis, and infected surgical wounds were positive. In cellulitis, cultures from aspirates were positive in 30 and 81% of the cases, respectively, depending on the presence or absence of concomitant antimicrobial therapy. These results suggest that fine-needle deep tissue aspiration biopsy is reliable and clinically applicable for deep tissue sample collection. The procedure is simple, brief, and does not cause significant discomfort to the patient. It also plays an important role in providing a guideline for antimicrobial therapy.     

Fine-needle aspiration diagnosis of synovial chondromatosis of the tibiofibular joint

We report a case of synovial chondromatosis of the tibiofibular joint in a 25-year-old woman that was diagnosed by fine-needle aspiration (FNA). The patient presented with pain in the left knee and a mass in the popliteal fossa. Synovial chondromatosis usually presents with joint symptoms and is often associated with intra-articular loose bodies, whereas presentation as a soft tissue mass is unusual and may raise the clinical suspicion of malignant neoplasm. The diagnosis is commonly confirmed by histopathologic examination of biopsy or excision of the specimen. To the best of our knowledge, this is the first case of synovial chondromatosis of a large joint successfully diagnosed by FNA. Two cases of synovial chondromatosis of the temporomandibular joint have been reported in which the diagnosis was suspected on the basis of FNA. In both these cases, the final diagnosis was established by histopathology of the excised specimens.     

Fine-needle aspiration biopsy diagnosis of malignant rhabdoid tumor of the kidney

A series of six fine-needle aspiration biopsies from three patients with malignant rhabdoid tumor of the kidney is reviewed. The smears revealed round, polygonal, and irregularly shaped cells with large nuclei and prominent nucleoli. Some of the tumor cells contained light pink to purple cytoplasmic inclusions that correlated with the eosinophilic inclusions seen in histopathologic sections and filamentous cytoplasmic aggregates noted on ultrastructural examination. Diagnosis of malignant rhabdoid tumor of the kidney may be suggested from aspiration biopsy smears; however, further confirmation of the diagnosis by histologic or ultrastructural examination is desirable.     

Fine-needle aspiration biopsy of orbital meningioma

Fine-needle aspiration was performed on an orbital mass in a 53-yr-old woman. The cytologic diagnosis was meningioma, which was later confirmed by histologic study of biopsy material. The cytologic features of the aspirated material (nuclear pseudoinclusions, psammoma bodies, and cells arranged in syncytial sheets and whorls) allowed a rapid, reliable, outpatient diagnosis to be formulated. The cytologic features are discussed and the literature is reviewed. Diagn. Cytopathol. 1999;21:402-404.