Tenosynovial Bilateral Lipoma Arborescens of the Ankle in Adults

Heui-Chul Gwak; Duck-Hee Kim; Sang-myung Roh; Hye-Jung Choo; Young-Jun Kim; Jun-Woo Jeong; Soo-Hwan Jung

doi:10.14193/jkfas.2019.23.1.35

Journal List > J Korean Foot Ankle Soc > v.23(1) > 1127166

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Gwak, Kim, Roh, Choo, Kim, Jeong, and Jung: Tenosynovial Bilateral Lipoma Arborescens of the Ankle in Adults

Case Report

Journal of Korean Foot and Ankle Society 2019; 23(1): 35-38.

Published online: 18 March 2019

DOI: https://doi.org/10.14193/jkfas.2019.23.1.35

Tenosynovial Bilateral Lipoma Arborescens of the Ankle in Adults

Heui-Chul Gwak, Duck-Hee Kim

, Sang-myung Roh, Hye-Jung Choo^*, Young-Jun Kim, Jun-Woo Jeong, Soo-Hwan Jung

Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

^*Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Corresponding Author: Duck-Hee Kim. Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel: 82-51-890-8666, Fax: 82-51-892-6619, rmaqjawjr@gmail.com

Received 7 September 2018 Revised 5 February 2019 Accepted 12 February 2019

Korean Foot and Ankle Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lipoma arborescens or synovial lipomatosis is a rare disorder that is characterized by mature fat infiltration of the hypertrophic synovial villi, most frequently affecting the supra-patellar pouch of the knee. This paper presents a case of lipoma arborescens of the ankle joint bilaterally in an adult patient with involvement of both the intra-articular synovium and the synovial sheath of the tendons around the ankle.

Keywords: Lipoma arborescens, Ankle, Tendons, Peroneal tendon sheath, Magnetic resonance imaging

Figures and Tables

Figure 1

Photographs of the right ankle (A) and the left ankle (B) show soft-tissue swelling around lateral malleolus. Soft and movable mass-like lesion (A: 5×7 cm size, B: 4×6 cm size) was observed.

Figure 2

Internal oblique radiographics of the right ankle (A) and the left ankle (B) show soft tissue swelling of the postero-lateral ankle.

Figure 3

(A, B) Ultrasound scan, longitudinal view, shows encasement of the extensor tendons by the thickened synovium (black arrows). A Large amount of joint effusion in lateral aspect of both ankles (white arrows).

Figure 4

(A) Axial proton density-weighted magnetic resonance image showing high signal intensity within the peroneus brevis tendon at the postero-lateral malleolar level representing longitudinal tear (black arrow). The peroneus longus tendon (white arrow) is normal. (B) Axial T2-weighted fat-suppression magnetic resonance image at the corresponding level shows fluid collection with frond-like proliferations of the synovium of the involved tendon sheaths and ankle joint, with low signal intensity of the hyperplastic fat tissues (white arrows).

Figure 5

(A) The Anterior talofibular ligament is thin and has irregular margin and suspicious disruption of contour, meaning a chronic partial tear (black arrow). (B) Axial T2-weighted fat-suppression magnetic resonance image at the corresponding level shows fluid collection with frond-like proliferations of the synovium of the involved tendon sheaths and ankle joint, with low signal intensity of the hyperplastic fat tissues (white arrows).

Figure 6

(A, B) Intraoperative photographs demonstrate abundant fat within the opened peroneal tendon sheath and partial tear of peroneus longus tendon in both ankles (black arrows). (C) There is a longitudinal split tear of the peroneus brevis tendon (black arrow).

Figure 7

Gross photos of mass which are lipoma arborscence with abundant fat tissue and remnant of peroneus longus tendon in left ankle (A: 2×5 cm sized, 3.5 cm sized mass) and in right ankle (B: 2×2.5 cm sized, 6×6 cm sized mass).

Figure 8

(A) Photomicrographs of excised synovium showing a lipomatous infiltrate within the synovium. On low power, a fatty infiltrate is seen in the synovium, giving it a lobular or villous contour (H&E stain, ×40). (B) High magnification shows mature adipose cells deep to a hyperplastic layer of synovial cells with scattered inflammatory cells and small plexiform vessels (H&E stain, ×40).

Notes

^{Financial support} None.

^{Conflict of interest} None.

References

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ORCID iDs: Duck-Hee Kim
https://orcid.org/0000-0002-4144-3671
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