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Abstract
Purpose
Pigmented villonodular synovitis (PVNS) is a rare soft tissue tumor, which usually arises in larger joints, such as the knee. It has a high recurrence rate after surgical treatment. The purpose of this study is to evaluate and analyze the clinical results of diffuse-type pigmented villonodular synovitis cases that were treated with open total synovectomy.
Materials and Methods
Between 1994 and 2006, 21 patients who had diffuse-type pigmented villonodular synovitis were selectively reviewed. Among the 21 cases studied, 14 patients presented at the knee, 5 at the ankle, and 2 at the shoulder and elbow. The mean follow up period was 5.5 years (range, 36-157 months). The average age of the patients was 34 years consist of 7 men and 14 women. Clinical outcomes were analyzed retrospectively, including range of motion and complications.
Results
Open total synovectomy and adjuvant electrocautrization were done in all cases except one. During the regular followup period after the surgery, two patients showed symptoms of recurrence. After re-operation, only one case was pathologically confirmed as a recurrence. The patient who had partial synovectomy and the other patient who had second operation due to recurrence received additional radiation therapy. Clinical outcome scores were improved in every aspect (p<0.0001). 2 out of 14 Patients who had pigmented villonodular synovitis at the knee developed stiff knee after the surgery.
REFERENCES
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Figure 1.
MRI and gross photos representing the diffuse type PVNS located in anterior and posterior aspect of the knee. (A) Pre-operative MRI revealing diffuse mass on anterior and posterior aspect of the knee. (B) Intraoperative findings after an anterior medial para patella approach. (C) Intraoperative findings after a posterior popliteal approach. (D) Gross photo of pathology.
Figure 2.
A 36 year old male who had diffuse-type PVNS in his left ankle. (A) Preoperative x-ray presenting radiolucent lesions on distal fibular and tibia. (B) Preoperative MRI images showing diffuse mass on anterior and posterior aspect of the ankle. (C) Intraoperative gross findings after a posterolateral approach. (D) Microscopic findings present synovial-like mononuclear cells, hemosiderin laden macrophages, foam cells and giant cells which are consistent findings of PVNS (H&E stain).
Figure 3.
Representive plain radiography, MRI and Microscopic findings of diffuse-type PVNS in shoulder joint. (A) Preoperative plain radiography presenting radiolucent lesion and bony erosions on glenohumeral joint. (B) Pre-operative MRI images (axial) presenting infiltrative diffuse mass on glenohumeral joint with bony erosion and cysts. (C) Microscopic findings present hypertrophied synovium, foam cells, giant cells which are consistent findings of PVNS (H&E stain).
Table 1.
Summary of Cases
| No | Age/ Sex | Site | Trauma | Previous surgery | Surgical method (approach) | RTx. | Complication | F/U (month) | Recurrence |
|---|---|---|---|---|---|---|---|---|---|
| 1 | 40/F | Left shoulder | r No | Once: arthroscopy | Open total synovectomy, | (-) | None | 43 | No |
| 92-11(YUMC) | Electrocautrization (Anterior) | ||||||||
| 2 | 38/F | Right elbow | No | Once: arthroscopy | Open total synovectomy, | (-) | None | 62 | No |
| 92-07 (YUMC) | Electrocautrization | ||||||||
| (Anterior+posterior) | |||||||||
| 3 | 7/F | Left knee | No | (-) | Open total synovectomy, | (-) | None | 41 | No |
| Electrocautrization | |||||||||
| (Popliteal fossa) | |||||||||
| 4 | 43/F | Right knee | No | ∗Twice: arthroscopy | Open total synovectomy, | (-) | Pain | 41 | No |
| 92-10 1st op | Electrocautrization | swelling | |||||||
| 97-04 2nd op | (Anterior+popliteal fossa) | ||||||||
| 5 | 20/M | Left knee | No | (-) | Open total synovectomy, | (-) | Pain | 44 | No |
| Electrocautrization (Anterior) | |||||||||
| 6 | 37/F | Left knee | No | (-) | Open total synovectomy, | (-) | None | 54 | No |
| Electrocautrization | |||||||||
| (Popliteal fossa) | |||||||||
| 7 | 38/F | Left knee | No | (-) | Open total synovectomy, | (-) | None | 78 | No |
| Electrocautrization (Anterior) | |||||||||
| 8 | 25/F | Left knee | No | (-) | Open total synovectomy, | (-) | None | 87 | Re-operation |
| Electrocautrization | pathology | ||||||||
| (Anterior+popliteal fossa) | (-) | ||||||||
| 9 | 47/F | Left knee | No | ∗Once: open | Open total synovectomy, | (-) | None | 75 | No |
| excision 01-12 | Electrocautrization | ||||||||
| (Anterior+popliteal fossa) | |||||||||
| 10 | 31/F | Right knee | No | (-) | Open total synovectomy, | (+) after | LOM | 36 | Yes |
| Electrocautrization | 2nd op. | ||||||||
| (Anterior+popliteal fossa) | |||||||||
| 11 | 44/F | Left knee | No | Once: arthroscopy | Open total synovectomy, | (-) | None | 44 | No |
| 04-11 (YUMC) | Electrocautrization | ||||||||
| (Popliteal fossa) | |||||||||
| 12 | 15/M | Left knee | No | ∗Three times: | Open total synovectomy, | (-) | Stiff knee | 38 | No |
| arthroscopy | Electrocautrization | (0-45) | |||||||
| 03-11 1st op | (Anterior+popliteal fossa) | ||||||||
| 04-02 2nd op | |||||||||
| 04-10 3rd op | |||||||||
| 13 | 42/M | Left knee | No | Twice: open excision | Open total synovectomy, | (-) | Stiff knee | 36 | No |
| (unknown) | Electrocautrization (Anterior) | (15-70) | |||||||
| 14 | 13/M | Right knee | No | (-) | Open total synovectomy, | (-) | Swelling | 41 | No |
| Electrocautrization (Anterior) | |||||||||
| 15 | 39/M | Left knee | No | (-) | Open total synovectomy, | (-) | None | 36 | No |
| Electrocautrization (Popliteal fossa | a) | ||||||||
| 16 | 54/F | Right knee | No | Once: open excision | Open partial synovectomy, | (+) | LOM | 37 | No |
| (unknown) | Electrocautrization (Popliteal fossa | a) | |||||||
| 17 | 42/F | Right ankle | No | ∗Once: open | Open total synovectomy, | (-) | None | 157 | No |
| excision 95-6 | Electrocautrization | ||||||||
| (Anterolateral+posteromedial) | |||||||||
| 18 | 42/F | Left ankle | No | Once: open excision 92-09 (at local hospital) | Open total synovectomy, Electrocautrization (Anterolateral+posterolateral) | (-) | None | 133 | No |
| 19 | 36M | Left ankle | Yes | (-) | Open total synovectomy, | (-) | LOM | 135 | No |
| Electrocautrization | |||||||||
| (Anterolateral+posterolateral) | |||||||||
| 20 | 43/F | Right ankle | No | (-) | Open total synovectomy, | (-) | None | 38 | No |
| Electrocautrization | |||||||||
| (Anterolateral+posterolateral) | |||||||||
| 21 | 19/M | Right ankle | No | (-) | Open total synovectomy, | (-) | Pain | 58 | No |
| Electrocautrization | |||||||||
| (Anterolateral+posteromedial) |
Table 2.
Criteria for Assessment Proposed by Ogilvie-Harris
Table 3.
Preoperative Symptoms
| Symptom | No. of patients |
|---|---|
| Palpable mass | 14 (66%) |
| Pain | 11 (52%) |
| Swelling | 7 (33%) |
| LOM | 2 (9%) |
Table 4.
Result of Clinical Assessment
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