Extra-synovial Pigmented Villonodular Synovitis of the knee joint, Case Repor


Extra-synovial Pigmented Villonodular Synovitis of the knee joint, Case Repor


Rebar Mohammed Noori, Musaab Mohammed Hazim*

Department of Orthopedic Surgery, School of Medicine, University of Sulaimaniya, Iraq.


Background: PVNS is a rare, benign & aggressive disorder arising from either synovial joints or tendon sheaths; it may erode articular structures and bones. We present a case with unique features of PVNS being extra-synovial and by this report we open a gate for more researches in this field.

Case Presentation: This case report concerns a 35-year-old female with a history of right knee pain for 6-month duration proceeded by gradual swelling over posterior aspect of the knee, she denies any history of trauma, clinical examination was unremarkable but apart from tenderness over the infrapatellar region with full flexion.

MRI shows a heterogenous signal extra-articular and extra-synovial lesion in posterior aspect of the knee suggesting Pigmented Villonodular Synovitis, FNA revealed a hemosiderin-laden macrophages and multinucleated giant cells, Tru-cut biopsy result was suggesting PVNS as synovial cells were seen admixed with hemosiderin-laden macrophages with fibroblastic elements.

Through posterior approach; the lesion was surgically excised and histopathological examination confirmed the diagnosis, the lesion was recurrent after 1-year and MRI revealed the same features, the lesion was excised by arthroscopic intervention.

Conclusion: We concluded that PVNS cannot be excluded when extra-synovial lesion is assessed, and further researches on this topic will expand our understanding of the etiological and pathological aspects of this tumor.


Keywords: Pigmented Villonodular Synovitis, Giant Cell Tumor, Knee, Synovitis, Benign tumor


Free Full-text PDF


How to cite this article:

Rebar Mohammed Noori, Musaab Mohammed Hazim. Extra-synovial Pigmented Villonodular Synovitis of the knee joint, Case Report. International Journal of Case Reports, 2021; 5:192. DOI: 10.28933/ijcr-2020-12-0106


References:

1. Ogilvie-Harris DJ, McLean J, Zarnett ME. Pigmented villonodular synovitis of the knee. The results of total arthroscopic synovectomy, partial, arthroscopic synovectomy, and arthroscopic local excision. J Bone Joint Surg Am 1992; 74:119–23.
2. Nilsson M, Hoglund M, Panagopoulos I, et al. Molecular cytogenetic mapping of recur-rent chromosomal breakpoints in tenosynovial giant cell tumors. Virchows Arch 2002;441:475–80.
3. Dahlen A, Broberg K, Domanski HA, et al. Analysis of the distribution and frequency of trisomy 7 in vivo in synovia from patients with osteoarthritis and pigmented villonodular synovitis. Cancer Genet Cytogenet2001;131 :19–24.
4. Hantes ME, Basdekis GK, Zibis AH, et al. Localized pigmented villonodular synovitis in the anteromedial compartment of the knee associated with cartilage lesions of the medi-al femoral condyle: report of a case and review of the literature. Knee Surg Sports Trau-matol Arthrosc 2005; 13:209–12.
5. Auregan JC, Bohu Y, Lefevre N, et al. Primary arthroscopic synovectomy for pigmented villo-nodular synovitis of the knee: recurrence rate and functional outcomes after a mean follow-up of seven years. Orthop Traumatol Surg Res 2013; 99:937–43.
6. Richter M, Trzeciak T, Owecki M, et al. The role of adipocytokines in the pathogenesis of knee joint osteoarthritis. Int Orthopaed 2015; 39:1211 –7.
7. Chin KR, Brick GW. Extraarticular pigmented villonodular synovitis: a cause for failed knee arthroscopy. Clin Orthop Relat Res 2002; 404: 330–8.
8. Lee M, Mahroof S, Pringle J, et al. Diffuse pigm-
a. ented villonodular synovitis of the foot and ankle treated with surgery and radio-therapy. Int Orthop 2005;29:403–5.
9. Berger B, Ganswindt U, Bamberg M, et al. External beam radiotherapy as postoperative treatment of diffuse pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys 2007; 67:1130–4.
10. Horoschak M, Tran PT, Bachireddy P, et al. External beam radiation therapy enhances local control in pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys 2009; 75:183–7.
11. Myers B, Masi A, Feigenbaum S. Pigmented villonodular synovitis and tenosynovitis: a clinical epidemiologic study of 166 cases and literature review. Medicine (Baltimore). 1980; 59:223–238
12. S. Clifton Willimon, Tim Schrader, Crystal A. Perkins, Arthroscopic Management of Pig-mented Villonodular Synovitis of the Hip in Children and Adolescents. Orthop J Sports Med. 2018 Mar; 6(3): 2325967118763118.
13. Oda Y., Takahira T., Yokoyama R., Tsuneyoshi M. Diffuse-type giant cell tu-mor/pigmented villonodular synovitis arising in the sacrum: malignant form. Pathol Int. 2007;57(9):627–631.
14. Jaffe H.L., Lichtenstein L., Sutro C.J. Pigmented villonodular synovitis, bursitis and te-nosynovitis. Arch Pathol. 1941; 31:731–765.
15. Hamlin B.R., Duffy G.P., Trousdale R.T., Morrey B.F. Total knee arthroplasty in patients who have pigmented villonodular synovitis. J Bone Joint Surg Am. 1998;80(1):76–82.
16. AAOS Comprehensive Orthopedic Review 2009, Volume 1, Chapter 4: Orthopedic On-cology and Systemic Disease, Page 454
17. Miller’s Review of Orthopaedics, 7th Edition 2016, Chapter 4: Sport Medicine, Page 357
18. Miller’s Review of Orthopaedics, 7th Edition 2016, Chapter 9: Orthopaedic Pathology, Page 717
19. Apley & Solomon’s System of Orthopaedics and Trauma 10th Edition 2018, Chapter 9: Tumors, Page 225
20. Campbells Operative Orthopaedics 13th edition 2017, Chapter 28: Soft Tissue Tumors, Page 990
21. L. Pinheiro Junior, M. Cenni,R. Leal, and L. Teixeira, Total Knee Replacement in Patients with Diffuse Villonodular Synovitis, Rev Bras Ortop. 2017 Sep-Oct; 52(5): 616–620.
22. Ushijima M, Hashimoto H, Tsuneyoshi M, Enjoji M. Pigmented villonodular synovitis. A clinicopathologic study of 52 cases. Acta Pathol Jpn. 1986;36(3):317–326
23. Extraarticular pigmented villonodular synovitis: a cause for failed knee arthroscopy. Chin KR, Brick GW. Clin Orthop Relat Res. 2002; 404: 330–338.
24. Abdalla JR, Cohen M, Nóbrega J, Forgas A. Tumor gigantocelular sinovial do jo-elho. Rev Bras Ortop. 2009;44(5):437–449.
25. Pigmented villonodular synovitis: keys to early diagnosis. Bhimani MA, Wenz JF, Frassi-ca FJ. Clin Orthop Relat Res. 2001; 386:197–202.
26. Kim SJ, Shin SJ, Choi NH, Choo ET. Arthroscopic treatment for localized pigmented vil-lonodular synovitis of the knee. Clin Orthop Relat Res. 2000;(379):330–379
27. Aşik M, Erlap L, Altinel L, Cetik O. Localized pigmented villonodular synovitis of the knee. Arthroscopy. 2001;17
28. Oda Y, Takahira T, Yokoyama R, Tsuneyoshi M. Diffuse-type giant cell tumor/pigmented vil-lonodular synovitis arising in the sacrum: malignant form. Pathol Int. 2007;57(9):627–631


Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details).



This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.