Giant-cell tumor of the tendon sheath involving the thoracic spine

Giant-cell tumor of the tendon sheath is a common benign lesion of the synovial membrane that frequently occurs in the hand. It is related to pigmented villonodular synovitis and the occurrence of pigmented villonodular synovitis or giant-cell tumor of the tendon sheath in the axial skeleton is very rare. To data, only three cases of giant-cell tumor of the tendon sheath involving cervical spine have been reported, compared with 26 cases of pigmented villonodular synovitis. Pigmented villonodular synovitis involving the thoracic spine is also extremely rare and our case represents the first reported case of a giant-cell tumor of the tendon sheath involving the thoracic spine. A 26-year-old man presented with left back pain without neurological deficit. Computed tomography and magnetic resonance imaging (MRI) revealed an osteolytic and expansive lesion in the left facet joint between the seventh and eighth thoracic vertebrae. A complete facetectomy and excision of the lesion followed by a posterior arthrodesis between Th5 and Th9 was performed. Postoperatively, the patient recovered with complete relief of symptoms, there was no evidence of recurrent disease or regrowth of the residual lesion, as investigated by plain radiographs and MRI within a follow-up period of two years. Although giant-cell tumor of the tendon sheath in the thoracic spine may be extremely uncommon, it should be considered in the differential diagnosis, especially when a benign lesion appears to originate in the face joint. Considering the high rate of recurrence, every effort should be made to achieve total excision.     

Pigmented villonodular synovitis of 1st metatarsophalangeal joint: A case report and literature review

Pigmented villonodular synovitis is a common disease entity particularly in the knee joint but its incidence in the foot is quite rare. A case of first metatarsophalangeal (MTP) joint pigmented villonodular synovitis (PVNS), presented to us with recurrence of symptoms after surgical excision done outside our institute. After histological confirmation of recurrence of the disease, repeat open surgical excision was performed. After being asymptomatic for two months she presented to us with recurrence of symptoms for which hyperkeratotic plaque at the ventral aspect of the first MTP joint was found to be responsible on physical examination. It was treated surgically by pairing it and now patient is symptom free for last 1 year. It signifies the importance of the histopathology in the diagnosis and recurrence of the PVNS and thorough physical examination in the management of the foot pathologies.     

Arthroscopic resection of pigmented villonodular synovitis pseudotumor of the shoulder: a case report with three year follow-up

Pigmented villonodular synovitis can be localized or diffuse. Lesions predominate in the knee but all of the joints can be involved. Thirty cases in the glenohumeral joint have been reported in the literature. The different reports to date have not identified any specific clinical signs. Our female patient presented non-specific shoulder pain which persisted for three years. The plain x-rays were normal. MRI and arthroscan revealed an intra-articular pseudotumor. Arthroscopy was performed for tumor biopsy which was followed by total resection. The diagnosis of villonodular synovitis pseudotumor suspected at arthroscopy was confirmed at the pathology examination. The functional outcome was excellent and no recurrence has been observed at three years follow-up. Arthroscopy is less aggressive than open surgery for arthrotomy. Arthroscopy must be performed for diagnostic purposes since imaging findings are not specific. Arthroscopic synovectomy is the treatment of choice for pigmented villonodular synovitis in both the diffuse and pseudotumor forms.     

Pigmented villonodular synovitis of the lumbosacral spine

Pigmented villonodular synovitis commonly occurs in synovial joints of the appendicular skeleton but rarely affects the synovial joint of the spine, and thus information regarding its natural history, treatment and prognosis remains limited. This case report illustrates a male patient with lumbosacral spinal pigmented villonodular synovitis who presented with lower back pain. It was treated by radical surgical excision and posterior instrumentation. Surgical decompression and follow-up of a patient with magnetic resonance imaging (MRI) constitute a satisfactory treatment of pigmented villonodular synovitis.     

Pigmented Villonodular Synovitis of the Hip Presenting as a Buttock Mass Treated by Total Hip Arthroplasty

Pigmented villonodular synovitis (PVNS) of the hip is a relatively uncommon benign but locally aggressive disease that should be considered in younger patients presenting with monoarticular joint symptoms. Pigmented villonodular synovitis begins in and usually remains confined within a synovium-lined joint, but rarely, it may extend beyond the joint capsule and present as a soft tissue mass. The authors report a previously unrecognized presentation of PVNS of the hip in a 36-year-old man, who presented with a buttock mass arising from the right hip joint. The patient was treated by synovectomy and total hip arthroplasty.     

Pigmented villonodular synovitis of the elbow in a 6-year-old girl: a case report

Pigmented villonodular synovitis of the elbow is rare and even rarer in children. We report a case of pigmented villonodular synovitis of the elbow in a 6-year-old girl who underwent total synovectomy after the diagnosis was confirmed by biopsy. The osteochondral defect at the olecranon was filled with calcium phosphate bone paste. Two years after surgery, neither recurrence nor joint degeneration was found.     

Pigmented villonodular synovitis of the hip mimicking soft-tissue sarcoma: a case report

Pigmented villonodular synovitis is a rare and benign but potentially locally aggressive disease that should be considered in younger patients who present with monoarticular joint symptoms and pathology. We present a 30-year-old Sudanese woman with a huge mass arising from the right hip joint. A multimodality radiological approach to investigation and diagnosis is demonstrated and discussed. Histopathological examination of the resected specimen confirmed the diagnosis of pigmented villonodular synovitis with the mass consisting of a proliferation of fibrohistiocytic cells, abundant haemosiderin, foamy histiocytes, and occasional giant cells. The patient made a good recovery, with mobility aided by arm crutches and a hip abduction brace.     

Pigmented villonodular synovitis of the shoulder

No characteristic clinical presentation of pigmented villonodular synovitis of the shoulder can yet be determined. Symptoms of discomfort and stiffness may appear insidiously or, in some cases, pigmented villonodular synovitis may be found incidentally during surgery for unrelated problems. Cystic and degenerative changes are more likely to occur in the shoulder than in joints with large synovial recesses such as the knee. Histologic findings parallel those in other joints. Optimal treatment appears to be early marginal excision for the localized form or total synovectomy for the diffuse form. The incidental finding of pigmented villonodular synovitis should not influence the decision to proceed with a preplanned reconstructive procedure. No experience with arthroscopic treatment or radiation therapy for diffuse pigmented villonodular synovitis of the shoulder has been reported.     

Toothpick injury simulating a pigmented villonodular synovialitis

Injuries to the foot caused by foreign bodies are a frequent cause of local wounds and infections. In most cases, removal of the debris is easy and no comprehensive surgical care is needed.This case report is about a patient who stepped on a toothpick 10 years ago. The toothpick penetrated the intermetatarsal region I/II of the patient's right foot without any harm to bone or tendon. Assuming total removal of the toothpick only a partial removal was performed. Eight years after the injury a painless swelling occurred for the first time. The tumor was removed surgically. The histologic workup showed a pigmented villonodular synovitis. In the subsequent year swelling occurred again. Under the impression of recurrent pigmented villonodular synovitis a surgical revision was performed. Surprisingly, an almost completely preserved toothpick surrounded by a distinct reaction of a foreign body granuloma was found.In conclusion, foreign-body injuries, as easy as they might seem, need a careful diagnostic workup and sufficient therapy. With injuries documented in medical history, the possibility of a retained foreign body should be considered.     

Pigmented villonodular synovitis of the ankle occurring in a patient on anticoagulation therapy

A case report is presented of a 45-year-old woman with an 18-month history of pain and swelling in her right ankle. There was no history of trauma. Routine investigations failed to elicit a diagnosis. The patient had been on warfarin anticoagulation therapy for 12 years. The onset of symptoms coincided with a period of poor control of her anticoagulation therapy and her international normalized ratio was recorded at 5 or above on three occasions. A diagnosis of pigmented villonodular synovitis (PVNS) was made on arthroscopic examination of her ankle; this was confirmed histologically. The etiology of PVNS remains controversial. Hemarthrosis has been suggested as an etiological factor. Although there are reports of PVNS in patients with hemophilia, there are no reports of PVNS occurring in patients on anticoagulation therapy. This case report supports a possible role for hemarthrosis in the etiology of PVNS.     

Localized pigmented villonodular synovitis presenting as recurrent dislocation of the patella

Summary: A 31-year-old woman presented with a 1-year history of recurrent dislocation of the patella. On examination, she was found to have a mass at the medial patellofemoral joint line. Arthroscopy showed this to be a vascular synovial tumor extending into the medial patellofemoral joint and causing lateral deviation of the patella. The mass was resected with resolution of her symptoms and histologic examination showed this to be pigmented villonodular synovitis. There are an increasing number of case reports of these lesions causing varying mechanical symptoms in the knee and they should be considered as a differential diagnosis.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 7 (October), 2000: pp 767–769     

Spinal locations of pigmented villonodular synovitis: case report and review of the literature

Pigmented villonodular synovitis is rarely observed in the spine: less than thirty cases have been reported. We report a new case observed in the cervical spine and review the pertinent literature. The clinical and radiological presentation of these forms of villonodular synovitis is non-specific and similar to that if primary or secondary spinal tumors. Histology is indispensable for certain diagnosis. Complete surgical resection is the treatment of choice but with a risk of recurrence to the order of 20%. Non-surgical treatments have not proven to be effective for spinal villonodular synovitis. Regular MRI surveillance is indicated. Spinal localizations may raise difficult technical problems in the event of recurrence.     

Pigmented villonodular synovitis: keys to early diagnosis

Pigmented villonodular synovitis is a synovial proliferative disorder that remains a diagnostic difficulty. Many clues in the history, physical examination, and radiographic studies can aid in the diagnosis. A patient in the third or fourth decade of life often will present with vague monoarticular complaints. Symptoms include intermittent, extreme deep pain localized to the hip, occasionally relieved by position. Decreased active and passive range of motion may be found. Small erosions in the head of the femur and acetabulum may occur early in the course of the disease. Magnetic resonance imaging is the imaging modality of choice and will show the characteristic findings of a joint effusion, synovial proliferation, and bulging of the hip. The synovial lining has a low signal on T1- and T2-weighted images, secondary to hemosiderin deposition. Pigmented villonodular synovitis should be included in the differential diagnosis of young patients with unexplained hip pain.     

Surgical treatment of pigmented villonodular synovitis of the hip

BACKGROUND: Pigmented villonodular synovitis of the hip is a rare disease. Synovectomy is generally accepted as the only surgical treatment for the disorder, but there have been few studies with a sufficient sample size and duration of follow-up to allow the evaluation of long-term outcomes. The aim of this study was to determine the long-term outcome of the treatment in sixteen patients. METHODS: Sixteen patients (nine men and seven women), with a mean age of 35.5 years at the time of surgery, were treated between 1970 and 1996. Complete synovectomy was performed in all patients; in addition, three had a cup arthroplasty, four had a total hip arthroplasty, and one had a monopolar arthroplasty. Clinical and radiographic outcomes were evaluated retrospectively at a mean of 16.7 years postoperatively. Only one patient was followed for less than eight years. RESULTS: Nine patients needed repeat surgery, but only one had recurrent synovitis, as detected with pathological examination fourteen years after treatment with synovectomy and cup arthroplasty. Secondary osteoarthritis developed in all eight patients who had been treated with synovectomy alone, and four of them required a total hip arthroplasty within the follow-up period. CONCLUSIONS: These results support earlier data indicating that osteoarthritis consistently develops in patients with pigmented villonodular synovitis of the hip. Complete synovectomy seems to be effective in preventing recurrence of the synovitis, but it does not appear to prevent the development of secondary osteoarthritis.     

Pigment villonodular synovitis of the spine. Case report and review of the literature

Pigmented villonodular synovitis (PVNS) is a disease of the joints which uncommonly involves the spine. We present a 70-year-old woman with radicular symptoms who was found to have a mass arising from a lumbar zygapophyseal joint with extension into the spinal canal. Following gross-total excision of the mass, histology revealed PVNS. One month after surgery, the patient had no symptoms and there was no evidence of residual or recurrent disease.     

An Unusual Case of Pigmented Villonodular Synovitis 14 Years After Total Hip Arthroplasty

Pigmented villonodular synovitis (PVNS) is a rare benign proliferation lesion of the synovium of the joint, bursa, and the tendon sheath. We report here a case of PVNS in a 78-year-old woman 14 years after she underwent total arthroplasty of her right hip. Diffuse PVNS was detected in her right hip during surgery to replace her prosthesis, which had loosened. Macroscopically, the surface of the resected tissue was black and composed of papillae and nodules. Histologically, the tissue consisted of proliferative synoviocytes with black pigment in the cytoplasm. Beneath the synoviocytes were foamy cells. Pathologic analysis confirmed the diagnosis of PVNS with black pigment and the presence of hemosiderin. This indicates that implantation of the prosthesis might have caused the lesion or might have caused its proliferation.     

Pigmented villonodular synovitis of the elbow: a case report and literature review

Pigmented villonodular synovitis is a well-described, benign proliferative disorder of the synovium that rarely affects the elbow joint. Only 12 cases have been reported in this site. A case is presented of elbow involvement by pigmented villonodular synovitis that was documented by magnetic resonance imaging before surgery and monitored until recurrence.     

Extraarticular pigmented villonodular synovitis: a cause for failed knee arthroscopy

Arthroscopic treatment of diffuse pigmented villonodular synovitis of the knee is reported to have low recurrence rates and morbidity. The purpose of the current study was to evaluate demographic information, clinical symptoms, treatment parameters, and functional outcome in a group of 38 consecutive patients referred to the authors' hospital with persistent extraarticular diffuse pigmented villonodular synovitis of the knee after arthroscopic synovectomy. There were 23 males and 15 females with an average age of 31.7 years (range, 11-65 years) at the time of arthroscopy. All had an average of 1.7 (range, 1-5) arthroscopies. Thirty-four of 38 (89.5%) patients had some improvements of their symptoms after arthroscopic synovectomy, but all had worse symptoms and function at the latest followup of 3.63 years (range, 0.25-19.5 years). Although arthroscopic synovectomy offered some short-term relief, a critical review of prior reports and the data in the current study suggest poor outcomes in patients who have extraarticular diffuse pigmented villonodular synovitis of the knee after arthroscopic synovectomy. Magnetic resonance imaging is recommended for accurate staging of the disease and for long-term followup after arthroscopic treatment.     

Knee locking and pain mimicking lateral meniscal tear due to unusual location of localized pigmented villonodular synovitis: a diagnostic surprise

Pigmented villonodular synovitis (PVNS) is one of the rare conditions, which typically involves the knee joint. There are two main types of PVNS-localized and diffuse, with localized type relatively rare when compared to diffuse PVNS. This case report describes a 30-year-old man presenting with a short history of swelling, posterolateral joint line pain and intra-articular mechanical locking of the left knee. There was localized tenderness, and McMurray’s test was positive. Arthroscopy revealed a firm pedicular localized pigmented villonodular synovitis originating from the beneath of the body and posterior horn of the lateral meniscus. The lesion was excised arthroscopically. This allowed a return to normal daily activities. Localized pigmented villonodular synovitis (LPVNS) arising from posterolateral aspect of knee mimicking lateral meniscal tear has not been reported in the literature. Though rare, LPVNS should be kept as differential diagnosis of meniscal tear. LPVNS can be managed effectively with arthroscopy.     

A rare case of extensive diffuse nonpigmented villonodular synovitis as a cause of total knee arthroplasty failure

INTRODUCTION

Nonpigmented villonodular synovitis (non-PVNS) is a benign proliferative disease involving the synovium. It is a rare condition that is little recognized. Non-PVNS has been reported as a cause of total knee replacement failure.

PRESENTATION OF CASE

We report a case of extensive diffuse non-PVNS in a patient with tibial component loosening after total knee replacement and review the related literature.

DISCUSSION

It is reported that pigmented villonodular synovitis (PVNS) occurs less frequently than non-PVNS after knee replacement. However, there are many more case reports of PVNS than non-PVNS after knee arthroplasty in the English-language literature.

CONCLUSION

Previously, there were no reported cases of extensive diffuse non-PVNS after total knee arthroplasty (TKA). This case study highlights an unusual case of non-PVNS as a cause of TKA failure. We propose that non-PVNS should be considered as a differential diagnosis in patients after TKA who present with recurrent pain and effusion/hemarthrosis of the knee, and that it is one of the causes of implant loosening after TKA.