DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20214973

Intra and extraarticular localized pigmented villonodular synovitis

Johney Juneja, Raghvendra Choubisa, Ramesh Sen, A. K. Mehra, Basant Aggarwal, Krishan Kumar Sharma

Abstract


A 28 year old woman had a history of knee trauma and presented with unilateral knee acute swelling and pain symptoms with sudden onset, which was there from last 2 years. She had been treated for seronegative rheumatoid patient for 1 year. Recent expansion of the LPVNS (localized pigmented villonodular synovitis) caused the development of a tender palpable soft tissue mass in the anterolateral aspect of the knee and acute reduced mobility. Preoperative magnetic resonance imaging of the knee revealed the presence of only the soft tissue mass and mild degenerative changes. Open synovectomy was performed successfully to excise the mass. Intraoperatively, macroscopic features of the bright brown inflamed synovium suggested LPVNS, which was confirmed histopathologically. Postoperatively, the symptoms of limited mobility and pain were appreciably relieved. Recurrence was not observed during the clinical follow up at 1, 6 or 18 months after surgery. Here, we reported the unique case of localized pigmented villonodular synovitis of the knee in a misdiagnosed patient with intra and extraarticular lesion, which might be attributed to the history of knee trauma and the focal defect of the lateral patellar retinaculum. Open synovectomy effectively relieved the symptoms of limited mobility and pain and no recurrence was observed prior to 18 months postoperatively. To reduce misdiagnosis, MRI examinations are recommended for all patients suspected of having PVNS, including those who have a history of hyperuricemia.


Keywords


Case report, Pigmented villonodular synovitis, Intraarticular, Extraarticular, Synovectomy

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References


Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics. 2008;28(5):1493-518.

Ottaviani S, Ayral X, Dougados M, Gossec L. Pigmented villonodular synovitis: a retrospective single-center study of 122 cases and review of the literature. Semin Arthritis Rheum. 2011;40(6):539-46.

Shah SH, Porrino JA, Green JR, Chew FS. Bilateral pigmented villonodular synovitis of the knee. Radiol Case Rep. 2015;10(4):56-60.

O’Connell JX. Pathology of the synovium. Am J Clin Pathol. 2000;114(5):773-84.

Xie GP, Jiang N, Liang CX, Zeng JC, Chen ZY, Xu Q, et al. Pigmented villonodular synovitis: a retrospective multicenter study of 237 cases. PloS One. 2015;10(3):0121451.

Abdul-Karim FW,Naggar AK, Joyce MJ, Makley JT, Carter JR. Diffuse and localized tenosynovial giant cell tumor and pigmented villonodular ynovitis: a clinicopathologic and flow cytometric DNA analysis. Human Pathol. 1992;23(7):729-35.

Flandry F, Hughston JC. Pigmented villonodular synovitis. J Bone Joint Surg. 1987;69(6):942-9.

Flandry F, Hughston JC, McCann SB, Kurtz DM. Diagnostic features of diffuse pigmented villonodular synovitis of the knee. Clinic Orthopaed Rel Res. 1994;298:212-20.

Flandry FC, Hughston JC, Jacobson KE, Barrack RL, McCann SB, Kurtz DM. Surgical treatment of diffuse pigmented villonodular synovitis of the knee. Clinic Orthopaed Rel Res. 1994;300:183-92.

Gu HF, Zhang SJ, Zhao C, Chen Y, Bi Q. A comparison of open and arthroscopic surgery for treatment of diffuse pigmented villonodular synovitis of the knee. Knee Surg Sport Traumatol Arthrosc. 2014;22(11):2830-6.

Valle AGD, Piccaluga F, Potter HG, Salvati EA, Pusso R. Pigmented villonodular synovitis of the hip: 2- to 23-year followup study. Clinic Orthopaed Rel Res. 2001;388:187-99.

Fecek C, Carter KR. Pigmented villonodular synovitis. Treasure Island (FL): StatPearls Publishing; 2020.

Bassetti E, Candreva R, Santucci E. Pigmented villonodular synovitis of the knee: a case report. J Ultrasound. 2011;14(3):167-9.

Friedman T, Chen T, Chang A. MRI diagnosis of recurrent pigmented villonodular synovitis following total joint arthroplasty. HSS. 2013;9(1):100-5.

Garner HW, Ortiguera CJ, Nakhleh RE. Pigmented villonodular synovitis. Radiographics. 2008;28(5):1519-23.

Granowitz SP, Mankin HJ. Localized pigmented villonodular synovitis of the knee. Report of five cases. J Bone Joint Surg Am. 1967;49(1):122-8.

Auregan JC, Klouche S, Bohu Y, Lefevre N, Herman S, Hardy P. Treatment of pigmented villonodular synovitis of the knee. Arthroscopy. 2014;30(10):1327-41.

Stephan SR, Shallop B, Lackman R, Kim TW, Mulcahey MK. Pigmented villonodular synovitis: a comprehensive review and proposed treatment algorithm. JBJS Rev. 2016;4(7).

Dines JS, DeBerardino TM, Wells JL, Dodson CC, Shindle M, DiCarlo EF, et al. Long-term follow-up of surgically treated localized pigmented villonodular synovitis of the knee. Arthroscopy. 2007;23(9):930-7.

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(1):119-23.

Atik OS, Bozkurt HH, Ozcan E, Bahadir B, Ucar M, Ogut B, et al. Localized pigmented villonodular synovitis in a child knee. Joint Dis Rel Surg. 2017;28(1):46-9.

Sezgin EA, Atik OS. Tumors and tumor-like lesions of infrapatellar fat pad and surrounding tissues: a review of the literature. Joint Dis Rel Surg. 2018;29(1):58-62.

Asik M, Erlap L, Altinel L, Cetik O. Localized pigmented villonodular synovitis of the knee. Arthroscopy. 2001;17(6):23.

Calmet J, Hernandez-Hermoso J, Gine J, Jimeno F. Localized pigmented villonodular synovitis in an unusual location in the knee. Arthroscopy. 2003;19(2):144-9.

Flandry FC, Jacobson KE, Andrews JR. Localized pigmented villonodular synovitis of the knee mimicking meniscal injury. Arthroscopy. 1986;2(4):217-21.

Moraux A, Bianchi S. Soft tissue masses of the knee related to a focal defect of the lateral patellar retinaculum. J Ultrasound Med. 2018;37(7):1821-5.

Fang Y, Zhang Q. Recurrence of pigmented villonodular synovitis of the knee: a case report with review of literature on the risk factors causing recurrence. Medicine. 2020;99(16):19856.

Chin KR, Barr SJ, Winalski C, Zurakowski D, Brick GW. Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am. 2002;84(12):2192-202.

DePonti A, Sansone V, Malchere M. Result of arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy. 2003;19(6):602-7.

Zvijac JE, Lau AC, Hechtman KS, Uribe JW, Tjin ATEW. Arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy. 1999;15(6):613-7.

Papamerkouriou YM, Posantzis MI, Kouremenos D, Manousakis C, Plessas SI. Arthroscopic technique for the treatment of localized pigmented villonodular synovitis of the knee. Cureus. 2020;12(4):7832.

Sharma V, Cheng EY. Outcomes after excision of pigmented villonodular synovitis of the knee. Clin Orthop Relat Res. 2009;467(11):2852-8.

Jobe CM, Raza A, Zuckerman L. Pigmented villonodular synovitis: extrasynovial recurrence. Arthroscopy. 2011;27(10):1449-51.

Dürr HR, Capellen CF, Klein A, Baur-Melnyk A, Birkenmaier C, Jansson V, et al. The effects of radiosynoviorthesis in pigmented villonodular synovitis of the knee. Arch Orthop Trauma Surg. 2019;139(5):623-7.

Verspoor FG, Zee AA, Hannink G, Geest IC, Veth RP, Schreuder HW. Long-term follow-up results of primary and recurrent pigmented villonodular synovitis. Rheumatology. 2014;53(11):2063-70.

Capellen CF, Tiling R, Klein A, Baur-Melnyk A, Knösel T, Birkenmaier C, et al. Lowering the recurrence rate in pigmented villonodular synovitis: a series of 120 resections. Rheumatology. 2018;57(8):1448-52.