|
Year |
2003 |
|---|---|
|
Question Number |
111 |
|
Category |
Orthopaedic Disease |
Question
A 30-year-old woman has isolated knee pain and swelling exacerbated by activities. A radiograph and MRI scan are shown in Figures 30a through 30c. A biopsy specimen is shown in Figure 30d. What is the most likely diagnosis?
1- Synovial sarcoma
2- Synovial chondromatosis
3- Rheumatoid arthritis
4- Hemophilia
5- Pigmented villonodular synovitis
Figures
Answer (click for answer)
Best answer: 5
PVNS may occur in a localized or diffuse form. The localized form is apparently identical histologically to giant cell tumor of tendon sheath. The diffuse form also appears to be identical histologically to the localized form, but it involves the entire synovium. The diffuse form most commonly affects the knee, but the hip, ankle, shoulder, wrist, and other joints can be involved. The patient usually presents with monoarticular pain and swelling. A mass may be palpable. Aspiration of the joint characteristically reveals blood-tinged fluid. Routine roentgenograms may show bony erosion from without, especially if the hip is involved. CT is best to demonstrate bone involvement, and MRI best shows the soft tissue masses associated with this lesion. Situated within or around joints, MRI reveals marked T2-weighted hypointensity because of the presence of hemosiderin.
Recommended treatment for the localized form is marginal excision and for the diffuse form, total synovectomy. Radiotherapy in the diffuse lesion may be justified if surgery fails to control the process. If significant bony erosion has occurred (usually in hip and shoulder lesions), joint reconstruction may be necessary.
Reference: JBJS-A, 1987, 69: 942-949
Bone Tumors, 1998, pp 1041-1086