DOCSLIB.ORG

Giant Cell Tumors of Tendon Sheath

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Giant Cell Tumors of Tendon Sheath TUMORS OF THE HAND AND FOkEARM 0749-0712/95 $0.00 + .20 GIANT CELL TUMORS OF TENDON SHEATH Keith A. Glowacki/ MD/ and Arnold-Peter C. Weiss/ MD Giant cell tumor of tendon sheath is a well- five names that have been used to describe recognized histopathologic entity.1'3'4'6'12'14 It these lesions include fibrous xanthoma/ xan- is the second most common tumor of the thoma of the synovium,. benign synovioma/ hand/ and although it can occur in other loca- and sclerosing hemangioma.3'6'81 11'13'15 Cer" tions of the body/ such occurrences are quite iauily the lack of definitive nomenclahire for uncommon.4'6r " Several authors have exam- this particular tumor demonstrates that the ined- the clinical and histologic parameters of exact pathologic nature is unknown. This tu- this tumor/ and in fact there is no general mor is one that is frequently misdiagnosed agreement as to the nomenclature of the le- and thought to represent a cyst. Commonly/ sion.'1"6'"' "'15 In addition/ the cause of these it is only after presentation to and evaluation lesions as well as the optimal treatment re" by a hand surgeon that tihe definitive diag- gime is poorly understood at the present nosis of this lesion is made. This scenario time. appears to be more due to the lack of wide- Jaffe has termed these lesions a localized spread knowledge on this particular condi- pigmented villonodular synovitis based on tion than inappropriate examination. Al- the histologic similarity to the diffuse form of though surgical excision is the most common pigmented villonodular synovitis involving route/ reported recurrence rates of 5% to 50% larger joints.6 He believed these to be variants of primary excisions suggest that for several of the same process with a localized form reasons the present surgical treatment is not found more predominantly in the hand and always adequate.3'5'n-15 upper extremity and the diffuse form seen more commonly as a monoarticular arthritis in the lower extremity joints. Anatomically/ CLINICAL ISSUES the lesion is less frequently directly associated with joints when it presents in the upper ex" Although giant cell tumor of tendon sheath tremity and is always associated with the in- may occur at any age/ it is most common tracapsular region when presenting in the between the ages of 30 and 50 years, with lower extremity. a peak incidence in the fifth decade. A 3:2 Moore et al prefer the term localized nod- predominance is noted towards women. Typ- ular tenosynovitis" to try to more accurately ically the lesion occurs in the hands and fin- describe the clinical appearance of the tumor gers; it is second only to ganglions as the when it is noted in the hand." Other descrip- most common tumor of the hand. Giant cell From the Deparhnent of Orthopaedics, Brown University School of M'edicine; and Division of Hand, Upper Extremity, and Mscrovascular Surgery/ Rhode Island Hospital/ Providence/ Rhode Island HAND CLINICS VOLUME 11 • NUMBER 2 • MAY 1995 245 246 GLOWACKI & WEISS tumor of tendon sheath most commonly oc- Cartilage invasion and cystic bone disruption curs adjacent to the distal interphalangeal have not been generally described with this (DIP) joint and has a propensity to occur in lesion. These two changes are characteristi- the index and long fingers (Figures 1A and cally noted in pigmented villonodular synovi- B). The lesion is found along the volar aspect tis involving the toes/ knee and hip joints.6 of the digit in approximately two thirds of The lesion does not appear to be related to patients who present with an easily palpable trauma despite its common location at the and definable lesion location. Other less com- DIP joint of the digit. A strong association mon sites of involvement mclude the foot/ between the presence of giant cell tumor and ankle/ knee and hip.4'8'11'15 rheumatord arthritis has been reported.10 No On initial physical examiiiation/ the lesions documented case of degencration of a benign are noted to be firm/ tabulated/ nontender giant cell tumor of tcndon sheath into a ma- masses firmly fixed to the deep tissues. The lignaiit form has been reported. Nevertheless/ tumor may involve all the structures of the the lesion can be quite aggressive and behave digit and include the tendon sheath/ volar in a low-grade malignant fashion: recurrence plate/ capsular ligaments and joints. When after surgical removal/ often requiring several they are located dorsally in the digits, they further procedures for eventual eradication/ frequently involve the joint itself or the tcndi- is reported in many patients. nous attachments to bone. The tumor is slow- On clinical presentation/ patients fre- growing/ increasing in size only gradually for quently note nodular swelling in the region a long period of time/ and can remain dor- of the tumor. They commonly describe the maiit as to size increase for several years at a lesion as slowly growing in size; very rarely/ time. It is not uncommon to see a tumor pain is associated with the growth. Numb- envelop the flexor or extensor tendons or ness at the distal aspect of the finger is occa- even the neurovascular bundles. A large re- sionally noted but if present is usually imld. view of 115 cases demonstrates joint involve- Patients note occasional decreased range of ment by the tumor in only one fifth of all motion/ especially if the lesion is in a palmar patients." The giant cell hmior often extends location/ and occasional snapping of un" into the flexor sheath to the vinculae and/ known cause is also noted during digital rarely/ can erode the underlymg bone or joint. flexion. Duration of symptoms prior to pre- Figure 1. (A & B)A multilobulated weli-circum- scribed mass is noted along Ihe dorsal aspect of the DIP joint in this 53-year-old woman. Some flattening of the nail plate was noted along the radial aspect (A). Excision of the le- sion was undertaken through a transverse inci- sion with adequate Jocalization of the tumor. Extensive involvement of the extensor tendon was noted requiring reconstruction and percu- taneous Kirschner wire pinning of the DIP joint during healing (B). GTANT CELL TUMORS OF TENDON SHEATH 247 sentation for treatment ranges from several On microscopic examination/ the lesions weeks to 30 years/ with an average of approx- consist of variable portions of collagenized imately 2 years in most reported studies.3' ' stroma/ hemosiderin pigi'n.entation/ multinu" cleated giant cells/ and the characteristic poly- hedral histiocyte (Fig. 2). Both diffuse and GROSS AND HISTOLOGIC localized forms of this tumor contain actively APPEARANCE proliferating histiocytes and the large multi- nucleated giant cells. The origin and differen- Giant cell tumor of tendon sheath most tiation of these tumors has been extensively frequently presents as a multilobular mass debated; recent histochemical studies demon- that is fairly well circumscribed and subcuta- strate that the mononuclear cells and the mul- neous. The villous structure and deep brown tmucleated giant cells represent osteoclasts liemosiderin- pigmentation often, associated and exhibit a phenotype consistent with the with diffuse pigmented villonodular synovi- bone-marrow-derived monocytes and macro- tis is seldom found m a localized multilobular phages. Jaffe et al have pointed out an evolu- form of giant cell tumor of tendon sheath.6'1() tion of these nodules from more cellular im- The color of these lesions varies significantly mature lesions to more advanced acellular but is generally a fairly bright yellow with lesions with a hyalinized sh'oma.6 A recent areas of discoloration turning to a brown hue. study by Abdul-Karim et al compared the Tumors vary m color from entirely greyish localized form of giant cell himor of tcndon brown, to entirely yellow-orange. The color sheath to a more diffuse form of this condi- of the lesions is affected by the degree of tion and pigm.ented villonodular synovitis.1 hemosiderin and collagcn and the quantity of They concluded that all three lesions were histiocytes present in the lesion.1 The nodules essentially similar from a hlstopathologic ba" range in size from. 0.5 to 5.0 cm with a vari- sis but formed clinically distinct lesions. They able degree of encapsulation from the sur- proposed a spectrum ranging from a local- rounding tissue. Giant cell tumor of tendon ized^ benign form to a more destructive dif- sheath that occurs in association with large fuse form. A measure termed the //prolifera- joints is more difficult to diagnose because five index may assist in distinguishing lesion location is more frequently ii-ttra-articu- between aggressive and benign lesions. The lar and symptoms are generally nonspecific diffuse form of this condition shows a more as far as localization is concerned. Ushijima et rapid proliferation and less controlled bio- al have recognized the clinical and pathologic logic behavior which should be considered differences between digital and large-joint when managmg and counseling the patient forms of this tumor.14 about the possibility of recurrence. Giant cell tumor of tendon sheath in the On rare occasion/ the histologlc features digits generally present as relatively small/ may be confused with those of other soft firm and regular-app earing lesions. Lesions tissue tumor such as synovial sarcoma/ fi- elsewhere, iiicluding the Jfeet/ are generally broma of tendon sheath and rhabdomyosar- large. Tumors associated with the digits are coma. The nodular growth pattern/ occasional generally surrounded by a thin fibrous cap- presence of mitotic figures and the propensity sule with very little invasion of the capsule for recurrence in certain lesions after inadc- into the lesion itself.
Load more

Recommended publications
  • Pigmented Villonodular Synovitis in Pediatric Population: Review of Literature and a Case Report Mohsen Karami*, Mehryar Soleimani and Reza Shiari
    Karami et al. Pediatric Rheumatology (2018) 16:6 DOI 10.1186/s12969-018-0222-4 CASEREPORT Open Access Pigmented villonodular synovitis in pediatric population: review of literature and a case report Mohsen Karami*, Mehryar Soleimani and Reza Shiari Abstract Background: Pigmented villonodular synovitis (PVNS) is a rare proliferative process in children that mostly affects the knee joint. Case Presentation: The study follows the case of a 3-year-old boy presenting recurrent patellar dislocation and PVNS. Due to symptoms such as chronic arthritis, he had been taking prednisolone and methotrexate for 6 months before receiving a definitive diagnosis. After a period of showing no improvements from his treatment, he was referred to our center and was diagnosed with local PVNS using magnetic resonance imaging (MRI). The patient was treated for his patellar dislocation by way of open synovectomy, lateral retinacular release, and a proximal realignment procedure, with no recurrence after a 24-month follow-up. Conclusion: PVNS may appear with symptoms resembling juvenile idiopathic arthritis, thus the disease should be considered in differential diagnosis of any inflammatory arthritis in children. PVNS may also cause mechanical symptoms such as patellar dislocation. In addition to synovectomy, a realignment procedure can be a useful method of treatment. Keywords: Juvenile idiopathic arthritis, Patellar dislocation, Pigmented villonodular synovitis Background aberrations that cause hemorrhagic tendencies, as well as Pigmented villonodular synovitis (PVNS) is a rare prolif- genetic factors, have been proposed as potential causes erative process that affects the synovial joint, tendon [2, 3]. Trauma and rheumatoid arthritis association have sheaths, and bursa membranes [1]. The estimated inci- also been considered [14, 15, 33].
    [Show full text]
  • Pigmented Villonodular Synovitis Does Not Influence the Outcomes
    Lin et al. Journal of Orthopaedic Surgery and Research (2020) 15:388 https://doi.org/10.1186/s13018-020-01933-x RESEARCH ARTICLE Open Access Pigmented villonodular synovitis does not influence the outcomes following cruciate- retaining total knee arthroplasty: a case- control study with minimum 5-year follow- up Wei Lin, Yike Dai, Jinghui Niu, Guangmin Yang, Ming Li and Fei Wang* Abstract Background: Pigmented villonodular synovitis (PVNS) is a rare synovial disease with benign hyperplasia, which has been successfully treated with total knee arthroplasty (TKA). The purpose of this study was to investigate the middle-term follow-up outcomes of cruciate-retaining (CR) TKA in patients with PVNS. Methods: From January 2012 to December 2014, a retrospective study was conducted in 17 patients with PVNS who underwent CR TKA as PVNS group. During this period, we also selected 68 patients with osteoarthritis who underwent CR TKA (control group) for comparison. The two groups matched in a 1:4 ratio based on age, sex, body mass index, and follow-up time. The range of motion, Knee Society Score, revision rate, disease recurrence, wound complications, and the survivorship curve of Kaplan-Meier implant were assessed between the two groups. Results: All patients were followed up at least 5 years. There was no difference in range of motion and Knee Society Score between the two groups before surgery and at last follow-up after surgery (p > 0.05). In the PVNS group, no patients with the recurrence of PVNS were found at the last follow-up, one patient underwent revision surgery due to periprosthetic fracture, and three patients had stiffness one year after surgery (17.6% vs 1.5%, p = 0.005; ROM 16–81°), but no revision was needed.
    [Show full text]
  • View Presentation Notes
    When is a musculoskeletal condition a tumor? Recognizing common bone and soft tissue tumors Christian M. Ogilvie, MD Assistant Professor of Orthopaedic Surgery University of Pennsylvania University of Pennsylvania Department of Orthopaedic Surgery Purpose • Recognize that tumors can present in the extremities of patients treated by athletic trainers • Know that tumors may present as a lump, pain or both • Become familiar with some bone and soft tissue tumors University of Pennsylvania Department of Orthopaedic Surgery Summary • Introduction – Pain – Lump • Bone tumors – Malignant – Benign • Soft tissue tumors – Malignant – Benign University of Pennsylvania Department of Orthopaedic Surgery Summary • Presentation • Imaging • History • Similar conditions –Injury University of Pennsylvania Department of Orthopaedic Surgery Introduction •Connective tissue tumors -Bone -Cartilage -Muscle -Fat -Synovium (lining of joints, tendons & bursae) -Nerve -Vessels •Malignant (cancerous): sarcoma •Benign University of Pennsylvania Department of Orthopaedic Surgery Introduction: Pain • Malignant bone tumors: usually • Benign bone tumors: some types • Malignant soft tissue tumors: not until large • Benign soft tissue tumors: some types University of Pennsylvania Department of Orthopaedic Surgery Introduction: Pain • Bone tumors – Not necessarily activity related – May be worse at night – Absence of trauma, mild trauma or remote trauma • Watch for referred patterns – Knee pain for hip problem – Arm and leg pains in spine lesions University of Pennsylvania
    [Show full text]
  • Imaging Evaluation of Heel Pain
    Imaging Evaluation of Heel Pain Yadavalli S, MD, PhD & Omene OB, MD Beaumont Health, Royal Oak, MI Oakland University William Beaumont School of Medicine, MI Disclosures The authors do not have a financial relationship with a commercial organization that may have a direct or indirect interest in the content. Goals and Objectives •Review causes of heel pain with attention to various anatomic structures in the region • Understand strengths and limitations of different imaging modalities in assessment of heel pain Introduction • Heel pain –Seen in patients of all ages –With varied activity levels – Including young athletes, middle-aged weekend warriors, people with sedentary life style, or the very old • Often debilitating whether from acute injury or due to chronic changes • Imaging plays an important role – May be difficult to delineate cause of pain from physical exam alone – Often essential to make an accurate diagnosis – Helps with treatment planning • Knowledge of relationship of anatomic structures in the region and anatomic variants is essential in reaching the correct diagnosis Causes of Heel Pain • Congenital • Infection – Accessory Muscles • Medical disorders – Coalition • Trauma • Inflammatory processes • Tendon related processes – Enthesitis – Achilles tendon – Plantar fasciitis – Flexor tendons – Inflammatory arthropathies – Tarsal tunnel pathology – Bursitis • Tumors – Sever’s Accessory Soleus Muscle A: Ax T1 B: Ax T2 FS C: Sag T1 D: Sag STIR * * * • A-D: Accessory muscle (oval) is seen deep to Achilles tendon (*) and superficial
    [Show full text]
  • Localized Pigmented Villonodular Synovitis of the Shoulder, Acta Med Port 2013 Jul-Aug;26(4):459-462
    Madruga Dias J, et al. Localized pigmented villonodular synovitis of the shoulder, Acta Med Port 2013 Jul-Aug;26(4):459-462 Joint Bone Spine. 2013;80:146–54. Emerg Med. 2012 (in press). 12. Citak M, Backhaus M, Tilkorn DJ, Meindl R, Muhr G, Fehmer T. Necrotiz- 14. Young MH, Aronoff DM, Engleberg NC. Necrotizing fasciitis: pathogen- ing fasciitis in patients with spinal cord injury: An analysis of 25 patients. esis and treatment. Expert Rev Anti Infect Ther. 2005;3:279–94. Spine. 2011;36:E1225-9. 15. Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F. Necrotizing 13. Wilson MP, Schneir AB. A Case of Necrotizing Fasciitis with a LRINEC fasciitis: classification, diagnosis, and management. J Trauma Acute Score of Zero: Clinical Suspicion Should Trump Scoring Systems. J Care Surg. 2012;72:560–6. CASO CLÍNICO Localized Pigmented Villonodular Synovitis of the Shoulder: a Rare Presentation of an Uncommon Pathology Sinovite Vilonodular Pigmentada Circunscrita do Ombro: uma Apresentação Rara de uma Patologia Incomum João MADRUGA DIAS1, Maria Manuela COSTA1, Artur DUARTE2, José A. PEREIRA da SILVA1 Acta Med Port 2013 Jul-Aug;26(4):459-462 ABSTRACT Pigmented Vilonodular Synovitis is a rare clinical entity characterized as a synovial membrane benign tumour, despite possible aggres- sive presentation with articular destruction. The localized variant is four times less frequent and the shoulder involvement is uncommon. We present the case of a Caucasian 59 year-old patient, who presented with left shoulder pain, of uncharacteristic quality, with local swelling and marked functional limitation of 1 month duration. Shoulder ultrasonography showed subacromial bursitis.
    [Show full text]
  • Soft Tissue Mass Around the Shoulder
    6 Ann Rheum Dis 1998;57:6–8 CASE STUDIES IN DIAGNOSTIC IMAGING Series editor: V N Cassar-Pullicino Ann Rheum Dis: first published as 10.1136/ard.57.1.6 on 1 January 1998. Downloaded from Soft tissue mass around the shoulder H S Reid, E McNally, A Carr Clinical history tumours but characteristically arise adjacent A previously fit 47 year old female school to joints and grow slowly. With the exception teacher presented with a six month history of a of PVNS, all these conditions typically show painful swelling over her right shoulder. There some degree of calcification on plain film.1 was rapid development of the swelling initially, Most cases of synovial osteochondromatosis which then stabilised. On examination she was show a pattern of coarse calcification and one apyrexial with a large, firm, non-tender mass third of cases of synovial sarcomas show spotty around the right shoulder, which clinically had calcification.1 Cystic lesions such as a ganglion some cystic features. There was no significant or synovial cyst can occasionally reach this limitation of movement. Other findings on size. clinical examination included some minor soft A lipoma would fit the clinical context but fat tissue capsular swelling of the second and third is of lower density on plain film than muscle metacarpophalangeal joints of the right hand. and consequently would appear blacker on Otherwise the remainder of the locomotor sys- plain film. Other benign neoplasms such as a tem was normal. haemangioma or an angiolipoma could give Her erythrocyte sedimentation rate was this appearance and sarcoma has to be consid- increased at 51 mm 1st h, but C reactive ered.
    [Show full text]
  • Anserine Syndrome
    Artigo de revisÃO A síndrome anserina Milton Helfenstein Jr1 e Jorge Kuromoto2 RESUMO Dor no joelho é uma condição comum na clínica diária e a patologia anserina, também conhecida como pata de ganso, tem sido considerada uma das principais causas. O diagnóstico tem sido realizado de maneira eminentemente clínica, o que tem gerado equívocos. Os pacientes queixam-se tipicamente de dor na parte medial do joelho, com sensibilidade na porção ínferomedial. Estudos de imagem têm sido realizados para esclarecer se tais pacientes possuem bursite, tendinite ou ambos os distúrbios na região conhecida como pata de ganso. Entretanto, o defeito estrutural responsável pelos sintomas permanece desconhecido, motivo pelo qual preferimos intitular como “Síndrome Anserina”. O diabetes mellitus é um fator predisponente bem reconhecido. O sobrepeso e a osteoartrite de joelho parecem ser fatores adicionais de risco, contudo, seus papéis na gênese da moléstia ainda não são bem entendidos. O tratamento atual inclui anti-inflamatório, fisioterapia e infiltração de corticoide, com evolução muito variável, que oscila entre 10 dias e 36 meses. A falta de conhecimento sobre a etiofisiopatologia e dados epidemiológicos exige futuros estudos para esse frequente e intrigante distúrbio. Palavras-chave: bursite anserina, tendinite da pata de ganso, síndrome da bursite/tendinite anserina, pata de ganso. INTRODUÇÃO A síndrome tem sido evidenciada em atletas corredores de longa distância.3 O diabetes mellitus (DM) tem sido identifi- A inserção combinada dos tendões dos músculos sartório, grácil cado em uma substancial proporção desses pacientes.4 Casos e semitendinoso, a cerca de 5 cm distalmente da porção medial considerados como bursite crônica foram documentados em da articulação do joelho, forma uma estrutura que se assemelha artrite reumatoide e em osteoartrite.5,6 à membrana natatória do ganso, razão pela qual os anatomistas A etiologia também inclui trauma, retração da musculatura a denominaram de “pata de ganso”, ou, do latim, pes anserinus.
    [Show full text]
  • Ultrasound Findings of the Painful Ankle and Foot
    Editor-in-Chief: Vikram S. Dogra, MD OPEN ACCESS Department of Imaging Sciences, University of Rochester Medical Center, Rochester, USA HTML format Journal of Clinical Imaging Science For entire Editorial Board visit : www.clinicalimagingscience.org/editorialboard.asp www.clinicalimagingscience.org ORIGINAL ARTICLE Ultrasound Findings of the Painful Ankle and Foot Suheil Artul1,2, George Habib3 1Department of Radiology, 3Rheumatology Clinic, EMMS Nazareth Hospital, Nazareth, 2Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel Address for correspondence: Dr. Suheil Artul, ABSTRACT Department of Radiology, EMMS Nazareth Hospital, Nazareth, Israel. Objectives: To document the prevalence and spectrum of musculoskeletal E‑mail: [email protected] ultrasound (MSKUS) findings at different parts of the foot. Materials and Methods: All MSKUS studies conducted on the foot during a 2-year period (2012-2013) at the Department of Radiology were reviewed. Demographic parameters including age, gender, and MSKUS findings were documented. Results: Three hundred and sixty-four studies had been conducted in the 2-year period. Ninety-three MSKUS evaluations were done for the ankle, 30 studies for the heel, and 241 for the rest of the foot. The most common MSKUS finding at the ankle was tenosynovitis, mostly in female patients; at the heel it was Achilles tendonitis, also mostly in female patients; and for the rest of the foot it was fluid collection and presence of foreign body, mainly in male patients. The number of different MSKUS abnormalities that were reported was 9 at the ankle, 9 at the heel, and 21 on the rest of the foot. Conclusions: MSKUS has the potential for revealing a huge spectrum of abnormalities.
    [Show full text]
  • Long-Term Results of Surgical Treatment of Pigmented Villonodular Synovitis of the Knee
    ACTA ORIGINAL ARTICLE ORTHOPAEDICA et TRAUMATOLOGICA Acta Orthop Traumatol Turc 2011;45(3):149-155 TURCICA doi:10.3944/AOTT.2011.2442 Long-term results of surgical treatment of pigmented villonodular synovitis of the knee Orhan AKINCI, Yavuz AKALIN, Mustafa ‹NCESU, Ahmet EREN Department of Orthopedics and Traumatology, ‹zmir Tepecik Training and Research Hospital, ‹zmir, Turkey. Objectives: The aim of this study was to evaluate the long-term results of total synovectomy in pigmented villonodular synovitis of the knee (PVNS). Methods: Open total synovectomy was performed for 19 patients (9 men, 10 women; mean age: 42.8 years) with PVNS. Of these patients, 15 had diffuse and 4 localized PVNS. The patients were followed for an average of 80.2 months and the average time between the onset of com- plaints and surgery was 23 months. In 4 patients, PVNS was identified during total knee replace- ment (TKR) performed due to gonarthrosis. Radiotherapy was performed as an adjuvant treat- ment in one patient with recurrence. Puncture was performed in 11 patients due to effusion and 8 to 70 cc of fluid was aspirated. Diagnosis was made during the exposure for TKR in 4 patients, by a biopsy in 2 and based on joint puncture and MRI findings in the rest. Results: Recurrence occurred in 5 patients. A second total synovectomy was performed in 4 patients. Radiotherapy was used for the remaining one patient. Two patients were operated three times. During the follow-up, TKR was performed in 7 of the 19 patients. None of the patients developed infection and hemarthrosis requiring puncture nor required amputation or arthrodesis.
    [Show full text]
  • Pigmented Villonodular Synovitis: Unusual Locations in Two Young
    Yanguas et al. Trauma Cases Rev 2016, 2:036 Volume 2 | Issue 2 ISSN: 2469-5777 Trauma Cases and Reviews Clinical Cases: Open Access Pigmented Villonodular Synovitis: Unusual Locations in Two Young Soccer Players Yanguas Javier*, Domínguez David, Florit Daniel, Terricabras Joaquim, Puigdellívol Jordi, Brau Juan José, Lizárraga María Antonia and Pruna Ricard Futbol Club Barcelona Medical Department, Barcelona, Spain *Corresponding author: Javier Yanguas, Futbol Club Barcelona Medical Department, Barcelona, Spain, E-mail: [email protected] on both T1 and T2-weighted images [1,9,10]. The recurrence rate Abstract for the diffuse type may be as high as 50% whereas the rate for the Pigmented villonodular synovitis is a relatively rare idiopathic localized type is considered low [11-13]. In addition malignant proliferative disorder affecting the synovium of joints, bursae and transformation is considered rare [14] but to avoid tumor spread, tendon sheaths. Knee and hip are the most affected joints. We complete surgical excision and careful tissue handling are essential report two cases of unusual locations in two young male soccer [1]. To date, we don’t have found in medical literature differences players (17 and 13 years old): distal tibiofibular joint and pes anserine bursa. Diagnoses were confirmed by magnetic resonance in terms of incidence between physically active people and their imaging (MRI). In the first case the treatment was conservative, sedentary counterparts. followed-up by MRI and computed tomographic several times during the season once pain disappeared and the player could return to Case 1 play normally. In the second case, due to the importance of doing Seventeen year old male soccer player sprains his left ankle an exact differential diagnose with a synovialosarcome, biopsy during a training session, causing severe pain in anterolateral aspect and subsequent excision was the only considered option.
    [Show full text]
  • Imaging of Tendon Ailments
    7 Imaging of Tendon Ailments Tudor H. Hughes Introduction emulsion film will enhance detail. Exposure to ionizing radiation is always an issue, and low kV techniques Twenty-five years ago, imaging of tendons was confined to increase the absorbed dose. However, most tendons faint soft tissue opacities on conventional radiographs, imaged are in the periphery and through relatively thin possibly with the visualization of calcification, and to areas of the body, where reduced exposures are used and tenography to show the surface anatomy of tendons and the tissues are less sensitive to radiation. An experienced tears. Since then, there has been an enormous leap radiographer will produce reproducible high quality forward with the development of ultrasound (US) and studies with the need for fewer repeat films. magnetic resonance imaging (MRI). The fine internal There are essentially only four densities visible on radi- architecture of the tendons can now be visualized by both ographs: air, fat, soft tissue, and calcium. Visualization of of these methods, and their development continues apace. a structure therefore depends on the contrast between This chapter will concentrate on these later two methods. these. For instance, calcification can be seen in soft tissue. Local availability and experience are other major factors A tendon that is normally clearly seen due to adjacent fat determining the choice of imaging modality. Also, the may no longer be visible if the fat becomes edematous referring physician’s comfort zone with the report of a and takes on the density of soft tissue. This can be a dynamic study such as ultrasound may be a factor.
    [Show full text]
  • 3 CASE Rheumatoid Arthritis Mimicking Pigmented Villonodular
    SUMMER 2011 VOLUME 2 ISSUE 2 Grand Rounds from HSS MANAGEMENT OF COMPLEX CASES | RHEUMATOLOGY AUTHORS FROM THE EDITORS Susan M. Goodman, MD We are pleased to present the first issue of Grand Rounds Assistant Attending Physician from Hospital for Special Surgery that is devoted to Hospital for Special Surgery Assistant Professor of Clinical Medicine complex cases managed by our rheumatologists. HSS Weill Cornell Medical College Rheumatology fosters a collaborative approach to patient Michael D. Lockshin, MD care that is supported by the deep expertise of our faculty, Attending Physician Dr. Mary K. Crow Dr. Edward C. Jones the enthusiastic engagement of our rheumatology fellows, Hospital for Special Surgery and close interaction with orthopaedic surgeons, internal medicine specialists, expert Professor of Medicine and OB-GYN radiologists and musculoskeletal pathologists. The four cases presented demonstrate Weill Cornell Medical College the value of this multidisciplinary and interactive approach for excellent patient outcomes. Lisa R. Sammaritano, MD The first case, a woman with severe rheumatoid arthritis who underwent bilateral knee Associate Attending Physician Hospital for Special Surgery replacement (TKR), discusses some issues considered when weighing the risks and Associate Professor of Clinical Medicine benefits of simultaneous bilateral TKR in a patient with a significant rheumatologic Weill Cornell Medical College disease. The second case, a young woman with systemic lupus erythematosus who Arthur M.F. Yee, MD, PhD developed pulmonary hypertension, describes the excellent clinical outcome that Assistant Attending Physician followed aggressive medical therapy. The third case, a young woman who developed a Hospital for Special Surgery monoarticular synovitis that was initially diagnosed as pigmented villonodular synovitis, Assistant Professor of Clinical Medicine was later determined to have rheumatoid arthritis with a good response to therapy.
    [Show full text]