Giant solitary synovial chondromatosis

The purpose of this report is to describe giant solitary synovial chondromatosis, a previously unrecognized feature of synovial chondromatosis that may histologically and radiographically mimic a malignant neoplasm. Giant solitary synovial chondroma is an intra-and/or extraarticular lesion measuring over 1 cm in size and sometimes as large as 20 cm. The radiographic appearance is that of a large, well-marginated mass either of irregular feathery calcification from coalescence of multiple small synovial chondromas, or a rounded calcified mass from the growth of a single synovial chondroma. Radiographically, giant solitary synovial chondromatosis may appear similar to chondrosarcoma and parosteal osteosarcoma.     

Primary synovial chondromatosis and synovial chondrosarcoma: a pictorial review

This article illustrates the imaging characteristics of primary synovial chondromatosis (PSC) using 20 cases referred to a tertiary orthopaedic oncology centre. Three quarters of patients presented with a large intra-articular soft tissue mass and a suspected clinical and radiological diagnosis of malignancy made in the referring centres. Radiographs demonstrated fine cartilaginous mineralisation in the soft tissue masses in 85% cases and bone erosions were shown on MR imaging in 80%. Malignant transformation to chondrosarcoma was proven in 2 cases with longstanding disease. There were no specific MR features to distinguish these cases with malignant change from PSC alone. Primary synovial chondromatosis should be considered in the diagnosis of the monarticular presentation of an intra-articular soft tissue mass, particularly in the presence of superficial bone erosions and signal voids due to the mineralisation.     

Synovial chondrosarcoma arising in synovial chondromatosis of the right hip

 The case of a 55-year-old man with chondrosarcoma to the cervical spine is described. Two years previously the patient had undergone a right hip replacement for synovial chondromatosis. Re-evaluation of the biopsy specimen from the right hip taken at the time of the initial operation showed areas of chondrosarcoma arising in the background of synovial chondromatosis. The unusual presentation of this rare entity is discussed.     

Intraneural synovial sarcoma

This report describes and discusses the clinical, MRI, and pathologic findings in a case of synovial sarcoma arising within a peripheral nerve. Intraneural origin of synovial sarcoma is very unusual, and the MR imaging appearance of this condition has not been previously reported. MR imaging was valuable, as it showed the intraneural location and extent of the tumor, but it did not allow a specific histologic diagnosis.     

Extensively calcified synovial sarcoma

 Synovial sarcoma is an uncommon fibroblastic soft tissue neoplasm, commonly arising near, but not necessarily from, the synovium of joint capsules, bursae or tendon sheaths. The radiological diagnosis is difficult. We present a case of synovial sarcoma studied with plain film radiography, CT, and pathology that had an unusual extensive calcification, which complicated its radiological diagnosis.     

Scintigraphic presentation of hip joint synovial chondromatosis

A case of hip joint synovial chondromatosis with an unusual scintigraphic pattern is described. This pattern was suggestive of a hip joint destructive reactive articular process or late manifestations of avascular necrosis of the femoral head. Concurrent radiographs were normal, as were laboratory investigations. Follow-up radiographs six months later showed radiolucencies and erosive bone changes in the diseased joint. Surgical and histopathological findings revealed well developed hip synovial chondromatosis (HSC) with thickened synovium and large, loose, cartilaginous bodies occupying and widening the tightened joint space, with destructive secondary juxta articular pressure and bone erosions. This and other scintigraphic patterns in HSC, and the differential diagnosis of the findings in patients with painful hip presentations are discussed.     

滑膜软骨瘤病MRI与病理对照分析

目的：研究滑膜软骨瘤病的MRI表现及其与病理变化之间的联系。方法：回顾性分析经手术病理证实的12例滑膜软骨瘤病的MRI表现和病理变化。结果：①MRI表现：所有12例关节滑膜均增厚,其中3例增强扫描者滑膜明显强化;滑膜软骨瘤病结节呈现五种信号表现：1型.与骨骼肌相比呈均匀的长T1长T2信号;2型.在所有脉冲序列呈均匀低信号;3型.低信号的结节中心为高信号;4型.与3类似,但在高信号区内散在点状低信号;5型.黄骨髓信号。X线不能显示1型结节,增强扫描者滑膜软骨瘤病结节无强化。3例病变邻近骨质出现外压性侵蚀;②病理变化：大体病理可见增厚的滑膜表面有多发的结节状突起;显微镜下可见滑膜软骨瘤病结节主要有以下特点：可见结节状的透明软骨,结节部分区域被覆纤维组织层;软骨结节中见软骨细胞,软骨结节部分区域钙化和骨化。结论：MRI能准确的反映滑膜软骨瘤病的病理变化,对该病有很高的诊断价值。     

滑膜软骨瘤病X线征象分析

目的：探讨本病的X线征象及其诊断价值。方法：回顾性分析经手术病理证实的80例滑膜骨软骨瘤病的临床及X线表现。结果：病变累及膝关节52例，肩关节12例，髋关节8例，肘关节6例，踝关节2例，双侧膝关节对称性发现7例。X线表现为关节均有轻度肿胀，关节周围见大小不等的小结节样钙化或骨化影。结论：根据病变游离体发生部位可分囊内和囊外型。囊外型不出现关节退行性改变。囊内型通常表现有关节退行性改变和关节内游离体多发游离体钙化具有重要诊断价值。     

Arthroscopic treatment for synovial chondromatosis of the subacromial bursa: a case report

Synovial chondromatosis of the subacromial bursa has been reported rarely. To the best of our knowledge, there was no case report of arthroscopic treatment for synovial chondromatosis of the subacromial bursa in English literature. The authors present a case of synovial chondromatosis of the subacromial space in a 45-year-old male, which was managed by arthroscopy. This rare condition can be well managed on similar lines as the other joints through arthroscopic surgery.     

Rocky form giant synovial chondromatosis: a case report

We report a case of painless synovial chondromatosis with an extremely large mass at the popliteal area related to the right knee joint. A hard mass at the posterior aspect of the knee was the only complaint reported by the patient. Plain X-ray studies revealed punctuated calcifications both intra-articularly and around the knee joint. With the surgical procedure performed subsequently, multiple rocky-hard giant chondroid nodules were excised from the posterior aspect of the knee. After 9 months following the surgery, the patient had full range of motion, and no complaints. We emphasize on the importance this case because these lesions may simulate tumors, and lead to misdiagnosis.     

Idiopathic synovial chondromatosis in two unusual sites: inferior radioulnar joint and ischial bursa

Synovial chondromatosis is a rare disorder of unknown cause characterized by multiple calcific bodies in the vicinity of the affected joint. It is most commonly seen in the knee, hip, elbow, and shoulder. We describe three cases of synovial chondromatosis in two extremely uncommon sites, the inferior radioulnar joint and the ischial bursa, and review the literature on the subject. The characteristic radiographic appearance, even if in an uncommon location, should prompt the radiologist to suggest the correct diagnosis preoperatively.     

Synovial chondrosarcoma: report of a case and review of the literature

Primary synovial chondromatosis is a relatively uncommon condition. Synovial chondrosarcoma is considered to be very rare and it is not always clear whether the sarcoma develops by malignant transformation of synovial chondromatosis or whether it arises de novo. Differentiation of the two conditions on clinical and radiographic features is not possible and on histological criteria can be difficult. We report the case of a 59-year-old man who, 4 years after a synovectomy for synovial chondromatosis, developed a synovial chondrosarcoma of the hip. The literature is reviewed.     

Synovial sarcoma arising in association with a popliteal cyst

Synovial sarcoma is a relatively common soft tissue sarcoma particularly in the adolescent and young adult. We report an unusual case of a synovial sarcoma arising within a popliteal cyst in a 13-year-old female presenting with bilateral popliteal cysts. MR imaging demonstrated the cyst with evidence of subacute haemorrhage and a discrete nodule of tumour. Received: 20 July 2000 Revision requested: 10 August 2000 Revision received: 24 August 2000 Accepted: 28 August 2000     

12例原发性髋关节滑膜软骨瘤病临床病例分析

目的 探讨原发性髋关节滑膜软骨瘤病的临床、影像学、病理特点及术后疗效。方法 对1973年5月2004年5月解放军总医院收治的12例原发性髋关节滑膜软骨瘤病患者的术前临床表现、影像学资料及术后病理进行回顾性总结，同时对术后疗效进行追踪随访。结果 术前患者不同程度地存在间歇性髋关节疼痛、肿胀、活动受限，有些患者可触及包块、肌萎缩。术前X线片4例患者未见明显大片钙化影，仅见关节囊影外移，CT检查可见关节腔积液，关节内散在游离体，股骨头有骨侵蚀现象。其余8例患者术前X线片可见明显钙化影。所有患者术后均得到病理证实，8例属MilgramⅡ期，4例属MilgramⅢ期。术后8例获随访，时间1～7年，其中2例复发。结论 应结合临床特点、影像学资料及术后病理对本病进行诊断，并以病理结果为主要依据。为减少术后复发，建议术前行CT或MRI检查；对术前X线片游离体已钙化显影的患者，术中有必要进行X线监测。     

Arthroscopic treatment of synovial chondromatosis that possibly developed after open capsular shift for shoulder instability

Synovial chondromatosis is a rare disease with an unknown etiology, and can be defined as a synovial process characterized by the formation of metaplastic cartilaginous foci inside the connective tissue of articular surfaces. The disease is classified as primary or secondary. The cause of primary disease is unknown, but its pathogenesis involves the development of chondroid foci in synovial membranes. Secondary disease is caused by synovial tissue pathophysiologies, such as, trauma or infection, adjacent to an involved joint. Plain radiographs reveal multiple calcific nodules in glenohumeral joints. However, X-ray diagnosis is often delayed and extremely difficult when the disease is not calcified. Magnetic resonance imaging (MRI) and computed tomography are helpful. For treatment, open or arthroscopic synovectomy and loose body removal are recommended. The authors experienced a rare case of radiologically non-visible synovial chondromatosis, which was viewed as the cause of postoperative residual pain and limitation of motion in a young male with open capsular shift. This case report is presented to emphasize the role of arthroscopy and MRI in the early diagnosis and treatment of synovial chondromatosis.     

Synovial sarcoma of the hand

We report on a 23-year-old woman with a poorly differentiated synovial sarcoma on the palm of her hand which presented as a painless nodule. The MRI findings are presented along with the clinical and pathologic features. Becaue of similar morphological features, these tumors can be confused with benign lesions such as aggressive fibromatosis or ganglion cysts, especially when very small. The possibility of a synovial sarcoma mimicking a benign lesion needs to be considered when the mass does not have an unequivocal benign diagnosis on MR imaging. Following wide resection and reconstruction, our patient has been disease free with good function for 28 months.     

Primary synovial chondromatosis of the shoulder: clinical, arthroscopic and histopathological aspects

Primary synovial chondromatosis is an uncommon condition, and involvement of the glenohumeral joint is rare. Currently, the recommended treatment is arthroscope-assisted synovectomy and removal of the loose bodies. We report a case with the clinical findings, radiographic features, arthroscopic technique for treatment of this disease and the main histological appearance of the removed loose bodies. We believe this is an easy and safe method for management of this disorder and that the support of an experienced pathologist is necessary to avoid differential diagnostic problems with the uncommon malignant transformation.     

The use of arthrography in the diagnosis of temporomandibular joint synovial chondromatosis

Synovial chondromatosis (SC) involving the temporomandibular joint (TMJ) is very rare and can occur in either or both cavities. Differentiation of the affected cavity in SC is therefore as important as making the diagnosis. This report presents a case of SC in which both cavities were thought to be affected, but arthrography using cone beam CT (CBCT) allowed us to see that involvement was limited to the superior joint cavity. In addition, we describe the usefulness of arthrographic CBCT for diagnosis and treatment planning in SC of the TMJ.     

Epithelioid sarcoma mimicking abscess: review of the MRI appearances

A case of epithelioid sarcoma involving the soft tissues of the ankle is presented. The tumor was a hemorrhagic, fluid-filled, multiloculated lesion with inflammatory changes in the surrounding planes. Tuberculous abscess was diagnosed on the basis of the clinical picture, ultrasound and MRI findings. Surgical exploration of the ankle mass was carried out because of lack of local healing while the patient’s general and pulmonary status improved on antituberculosis treatment. This was an unusual case of epithelioid sarcoma mimicking a multilocular abscess. Received: 11 October 1999 Revision requested: 2 November 1999 Revision received: 30 October 2000 Accepted: 3 November 2000