|
Age / Sex : 23 / M
Chief complaint : incidental bone lesion, left 5th toe
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)
Courtesy: 이근영(Geun Young Lee), 분당서울대병원(Seoul National University Bundang Hospital)
Diagnosis: PVNS (GCTTS, giant cell tumor of tendon sheath)
Discussion
Findings: Large infiltrative lesion revealed dark and low
signal intensity on T2 weighted images with heterogenous strong enhancement and
bone erosions of 5th metatarsal bone was also seen.
Differential Diagnosis: (1) gout
(2)
Tuberculosis
Diagnosis:
PVNS (GCTTS, giant cell tumor of tendon
sheath)
Discussion: PVNS (pigmented villonodular tenosynovitis) is
benign proliferative lesion originating in synovium of the joint, bursa, and
tendon sheath. This may induce progressive destruction of articular cartilage
and subchondral bone, resulting in osteoarthritis. Low and dark signal
intensity of the lesion on T2 weighted image due to hemosiderin deposition may
be clue of the diagnosis. External bone erosions may be indicative of
extraosseous origin of the lesion and secondary involvement of bone. Treatment
of PVNS is usually surgical resection, but the recurrence rate is reported
0-44% showing a wide range.
References: RadioGraphics 2008; 28:1493–1518
|
