Factors for Recurrence in Pigmented Villonodular Synovitis of Large Joints

Ilkyu Han; Sang-Ho Kwak; Hee-Jung Kim; Myung-Chul Lee; Sang-Hoon Lee; Joo-Han Oh; Han-Soo Kim

doi:10.4055/jkoa.2008.43.5.544

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Han, Kwak, Kim, Lee, Lee, Oh, and Kim: Factors for Recurrence in Pigmented Villonodular Synovitis of Large Joints

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(5): 544-550.

Published online: 31 October 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.5.544

Factors for Recurrence in Pigmented Villonodular Synovitis of Large Joints

Ilkyu Han, M.D., Sang-Ho Kwak, M.D., Hee-Jung Kim, Myung-Chul Lee, M.D., Sang-Hoon Lee, M.D., Joo-Han Oh, M.D., Han-Soo Kim, M.D.

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

Address reprint requests to: Han-Soo Kim, M.D. Department of Orthopedic Surgery, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744, Korea. Tel: +82.2-2072-2362, Fax: +82.2-764-2718, hankim@snu.ac.kr

Abstract

Purpose

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovium, and this can affect the joints, tendon sheaths or bursae. PVNS is histologically benign, but it has a high propensity for local recurrence. The purpose of this study is to identify the clinical and pathological factors that are associated with local recurrence of PVNS.

Materials and Methods

Fifty-one patients with biopsy-proven PVNS were retrospectively reviewed. There were 20 men and 31 women with an average age of 34 years (range: 12-73). The average follow-up period was 4.1 years (range: 1-25 years). All lesions were located in large joints (knee 25, ankle 11, hip 7, foot 5, wrist 2, elbow 1). Of the 51 lesions in the large joints, 39 were the diffuse type and 12 were the localized type. The initial clinical presentation was pain or a painful mass in 32 patients and a painless mass in 19 patients. Complete surgical removal of the lesion was performed in 39 cases, whereas incomplete excision was performed in 12. No adjuvant therapy was given in any cases.

Results

Sixteen local recurrences (31%) developed at an average of 24 months (range, 4-96). Factors related to local recurrence in the large joints were incomplete surgical removal (p<0.001), diffuse type of the lesion (p=0.049) and the presence of bone erosion (p=0.037)

Conclusion

In cases of PVNS in large joints, the factors that increased the local recurrence rate were incomplete surgical removal, diffuse type lesion and the presence of bone erosion.

Keywords: Pigmented villonodular synovitis, Recurrence, Factor, Large joint

Figures and Tables

Fig. 1

A representative histological specimen is shown. Note the accumulation of mononuclear cells with interspersed giant cells and lipid laden macrophages (H&E stain, ×400).

Fig. 2

Representative MRI images of the two types of PVNS are presented. (A) A localized type of PVNS is located in the posterior aspect of the distal femur. (B) A diffuse type of PVNS is seen at the posterior part of the ankle.

Fig. 3

A 14-year-old girl was diagnosed with PVNS in her left hip joint. (A) Plain radiography suggests bone erosion at the femoral head and acetabulum of the left hip joint (arrow). (B) MRI image shows the tumor eroding into the acetabulum and the femoral head.

Fig. 4

Representative MRI images of PVNS according the location of the lesion are presented. (A) Extraarticular location, (B) intraarticular location, (C) mixed location.

Fig. 5

Kaplan-Meier curve showing the risk of recurrence is illustrated. The recurrence-free survival rate was 90% and 60% at postoperative 1 and 5 years respectively.

Table 1

Recurrence Rate According to Each Variables

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