Age / Sex : 30 / M

Age/Sex : 30/M

Chief complaint : left ankle
swelling

pigmented villonodular synovitis (PVNS)

Discussion

Findings :

Simple : left ankle lateral view shows soft tissue mass in
posterior ankle joint area without obliteration of Kager’s fat triangle

MRI : ill defined, lobulated,
bulcky mass with iso or slight high SI to muscle on T1WI, mixed SI on T2WI and
heterogeneous enhancement on post-contrast image in supracalcaneal fat triangle
area. mass infiltrated posterior TF joint and posterior aspect of FHL tendon

Differential
Diagnosis :

Synovial sarcoma

Synovial chondromatosis

Hemophilia

Rheumatoid arthritis

Lipoma arborescence

Discussion
:

General features

-General path comments:
Locally destructive fibrohistiocytic proliferation and villonodular protrusions
of synovial membranes, affecting joints, bursae, tendon sheaths

-Genetics: Clonal chromosomal
aberrations, aneuploidy

 *Trisomies 5 and 7

-Etiology

  *Controversial:
Reactive inflammatory process

  *Low-grade,
locally aggressive neoplasm

-Epidemiology

  *5% of
all primary soft tissue tumors

  *GCTTS:
Second most common soft tissue mass of hand

Presentation

-Most common signs/symptoms:
Limited joint mobility

-Clinical profile

*GCTTS

    #Slowly enlarging, mobile, soft tissue mass

    #Pain increased with activity

  *PVNS

    #Joint swelling, pain of insidious onset

    #Increased skin temperature

    #Pain increased with motion, improved by
rest

    #Sudden increase in pain due to torsion of
synovial nodules

    #Decreased range of motion, joint locking

    #Joint effusion:
Serosanguinous/xanthochromic fluid

    #Recurrent sanguinous effusions without
history of trauma

    #Rapid accumulation of joint fluid after
aspiration

    #Pathologic fracture secondary to
subchondral bone invasion can be seen

Demographics

-Age

  *GCTTS: 30-50 years, mean: 32years

  *PVNS: 30-40 years, childhood appearance
reported

-Gender

  *GCTTS: M:F=1:1

  *PVNS: F:M=2:1

Natural
history & prognosis

-Benign,
locally aggressive lesion

-Progressive
destruction of articular cartilage and subchondral bone results in severe
osteoarthritis

-PVNS:
Recurrence 20-50%

References :

De Beuckeleer L et al:
Magnetic resonance imaging of localized giant cell tumor of the tendon
sheath(MRI of localized GCTTS). Eur Radiol 7:198-201, 1997

Cotton A et al: Pigmented
villonodular synovitis of the hip: Review of radiographic features in 58
patients. Skeletal Radiol 24:1-6, 1995

Hughes TH et al: Pigmented
villonodular synovitis: MRI characteristics. Skeletal Radiol 24:7-12, 1995

Abdul-Karim EW et al: Diffuse
and localized tenosynovial giant cell tumor and pigmented villonodular
synovitis: A clinicopathologic and flow cytometric DNA analysis. Hum Pathol
23:729-35, 1992