Pigmented villonodular synovitis is a rare, benign, but potentially locally aggressive disease that should be considered in younger patients who present with monoarticular joint symptoms and pathology. Pigmented villonodular synovitis pvns oxford university hospitals. The purpose of this study is to define the spectrum and frequency of mri characteristics for pvns using conventional spin echo in two cases before and after intravenous. Magnetic resonance imaging of a knee with diffuse pigmented villonodular synovitis of the knee. Sinovitis villonodular pigmentada, difusa con apariencia. Pigmentierte villonodulare synovitis des kiefergelenkes. A search through the english literature yielded 18 publications describing 25 cases of pvns affecting the shoulder joint. The purpose of this study is to define the spectrum and frequency of mri characteristics for pvns using conventional spin echo in two cases before and after intravenous administration of. This is not a primary inflammatory disease of joints, despite the name. Pigmented villonodular synovitis is an uncommon disease that remains a diagnostic challenge. In 1852 chassaignac 1 reported the first case of a nodular lesion developing in the flexor tendon sheaths of the middle and index fingers. We present a case of pvns involving the lumbar spine. Both pigmented villonodular synovitis as well as giant cell tumor of the. However, other sites including the hip, temporalmandibular joint and bursa have been described.
Pigmented villonodular synovitis is a rare proliferative disorder of the synovial membrane most frequently found in the knee. The objective of this study is to present two series of cases of pigmented villonodular disease of joints pvns treated at different periods. It is characterized by a noncancerous mass or tumor. The hip is less frequently affected than the knee, and hence is less discussed in. Surgical treatment of pigmented villonodular synovitis of the hip. Multiple nodular form of localized pigmented villonodular. Pigmented villonodular synovitis is a benign lesion located in joints. The diffuse form commonly involves the large joints, and the nodular form typically occurs around the hands. The appearance of synovitis may be very different on bmode ultrasound, changing from a hypoechoic to isoechoic pattern and progressing to a hyperechoic pattern. Although there is no typical mr appearance for this lesion, many features help to differentiate it from pigmented villonodular synovitis. Britt, russell tucker, in textbook of veterinary diagnostic radiology seventh edition, 2018.
Postoperative management of pigmented villonodular. Polyarticular pigmented villonodular synovitis milton l. Pigmented villonodular synovitis pvns is a rare disease that can affect any joint, bursa or tendon sheath. Pigmented villonodular synovitis pvns is a rare benign but aggressive disease of the synovium. Radiation therapy in the adjuvant treatment of pigmented villonodular synovitis.
The youngest patient reported with pvns was 12 months old. Despite the benign histological character, recurrent surgery need may be necessary because of frequent recurrence. Background pigmented villonodular synovitis pvns belongs to a family of uncommon benign neoplastic diseases of uncertain etiology that. Localized pigmented villonodular synovitis of the proximal.
Pathology outlines pigmented villonodular synovitis pvns. A patient s guide to pigmented villonodular synovitis of. Pigmented villonodular synovitis, also known as pvns, is a rare idiopathic proliferative disorder of the synovium that leads to villous and or nodular formations within joints, tendon sheaths and bursae 569. T2 a clinical, radiological, and morphological study of 12 cases.
Radiological features of pigmented villonodular synovitis and. Pigmented villonodular synovitis radiology reference. Histologically, the synovial tissue in pigmented villonodular syno. The mass or tumor that results from this overgrowth is not cancerous and does not spread metastasize to other areas of the body. Dec 19, 2008 pigmented villonodular synovitis pvns is a benign proliferative histiocytic disorder of the synovium. It can also occur in the shoulder, ankle, elbow, hand or foot.
Pigmented villo nodular synovitis is most often painless inflammation or swelling, and overgrowth of the lining of a joint. Villonodular synovitis an overview sciencedirect topics. Radiological features of pigmented villonodular synovitis. Pigmented villonodular synovitis urban rydholm department of orthopedics, lund university hospital, se221 85 lund, sweden. Pdf bilateral pigmented villonodular synovitis of the knee. Pigmented villonodular synovitis pvns, first coined by jaffe et al. Pigmented villonodular synovitis has a variable histologic appearance, jaffe and others propose this reflects maturation of the process with the early cellular hypervascular phase giving way to subsequent hyalinization and fibrosis. Pigmented villonodular synovitis pvns is a rare benign proliferative condition affecting synovial membranes of joints, bursae or tendons. Response to imatinib in villonodular pigmented synovitis.
Rheumatoid and other types of arthritis frequently involve. Pvns is usually found in adults aged 2050 years, but it may also be found in children 2,3,4. Pigmented villonodular synovitis is a disorder resulting in a villous, nodular, or villonodular proliferation of the synovium, with pigmentation related to the presence of hemosiderin. Pigmented villonodular synovitis of the hip and knee. Pigmented villonodular synovitis with bone involvement. Localized nodular synovitis can be treated by simple excision. Localized nodular synovitis shares histologic features with pigmented villonodular synovitis, but it is important to make a distinction between the two entities because their clinical presentations differ, as do their responses to treatment. Pigmented villonodular synovitis pvns is a rare, benign disorder characterized by idiopathic proliferation affecting the synovium of joints, tendon sheaths, and bursae. Both pigmented villonodular synovitis as well as giant cell tumor of the tendon sheath are considered similar from the point of view of the histological findings. Mri was useful to objectify both the similar and differential radiological features of these entities, which along with the location, enabled us to distinguish 4 patterns of.
Pigmented villonodular synovitis pvns is a benign proliferative joint disease with an uncertain etiology that uncommonly involves the spine. Both pigmented villonodular synovitis as well as giant cell tumor of the tendon sheath are considered similar from the point of view of histological findings. Pigmented villonodular synovitis or pvns of knee is a serious condition and if not treated soon, it can spread to other tissues. Localized pigmented villonodular synovitis of the hip. Localized nodular synovitis of the knee predominantly involves the infrapatellar fat pad. Though they have very different names, they have the same histology, and stain positive for cd68, ham56, and vimentin. The form affecting the tendon sheath is known as the localized form of. Pvns is characterized in most cases by a specific t1. It may affect the joints, tendon sheaths or bursae. It is characterized by synovial hyperplasia and pigment deposition hemosiderin inside the joints, tendon sheaths and bursae. The 215 cases from our hospital are current 19722009 and those 62 from the jaffe collection from 1920 to 1968. Histology marks the final diagnosis of multifocal pvns. Pigmented villonodular synovitis in pediatric population.
Pigmented villonodular synovitis is a nonneoplastic proliferation of synovial tissue. Intraoperative appearance of the mass excision with a posterolateral approach. Pigmented villonodular synovitis pvs is a rare aggressive lesion occurring primarily within joint spaces, usually the knee. Aug 30, 2005 pigmented villonodular synovitis pvns is a rare but potentially aggressive lesion that attacks the synovium of joints, tendon sheaths or bursae. Radiological features of pigmented villonodular synovitis and giant. The pigmented villonodular synovitis pvns is a very uncommon nonmalignant, but proliferative disease, eventually with locally aggressive behavior, that can affect synoviallined joints, bursae and tendon sheaths. Pigmented villonodular synovitis pvns is an uncommon benign proliferative. All three categories display similar histology including villous. Low dose radiotherapy and staged surgical resection for. The knee is a frequent target of this disease, and it is the joint most likely to be affected by special forms of synovitis such as pigmented villonodular synovitis and synovial chondromatosis. Pigmented villonodular synovitis was first described by chassaignac 1 in 1852 as a nodular lesion of the synovial membrane that affects the flexor tendons of. It is painful, and may temporarily disable the affected part. Pigmented villonodular synovitis, semin arthritis rheum.
Pigmented villonodular synovitis pvns is a proliferative disorder of the synovial lining of joints that produces localized or diffuse nodular thickening of the synovial membrane. Diffuse pigmented villonodular synovitis in knee joint. The lesion is always monoarticular, the knee joint being by far the most common location. Introduction pigmented villonodular synovitis pvns is a very rare disease. Pigmented villonodular synovitis pvns is a rare proliferative process that affects the synovial joints, tendon sheaths, and bursa membranes. Compared to knee joint pvns, elbow joint pvns has less joint effusion. Pigmented villonodular synovitis pvns is a rare proliferative process that affects the synovial joint, tendon sheaths, and bursa membranes. Malignant pigmented villonodular synovialitis of flexor tendon sheath of little fingerj. Pigmented villonodular synovitis pvns is a disease in which the tissue lining the joints and tendons in the body synovium grows abnormally.
Characterized by hyperplastic synovium, large effusions, and bone erosions, the synovial proliferation may be either villous or nodular or both. Mri was useful to objectify both radiological features in common, such as the differential, which along with the location, allow us to classify patterns into 4 individual presentations. Pigmented villonodular synovitis pvns is a rare locally aggressive tumor. Pain, joint swelling or a tumuor, and repeated joint effusions. Joints pigmented villonodular synovitis pvns 15 year old with new onset of fatigue, diffuse arthralgia, butterfly rash, tenosynovitis of wrist, lymphopenia and thrombocytopenia j med case rep 2011. Pigmented villonodular synovitis involving the wrist. Presenting complaints commonly involve one joint, most often the knee or hip. An mri scan should be taken along with synovial fluid aspiration from the knee for testing. A patients guide to pigmented villonodular synovitis of the knee compliments of. Pigmented villonodular synovitis pvns is a rare proliferative disorder of the synovium with locally aggressive behavior. Pigmented villonodular synovitis of joints histological and clinical. In all 75 patients, diagnosis was made by pathological examination. Pigmented villonodular synovitis definition of pigmented.
Large joints, usually of the lower extremity, are affected. Pigmented villonodular synovitis of the wrist invading bonereport of a case. A case of avascular pigmented villonodular synovitis in the foot was encountered and surgically verified. Treatment for pigmented villonodular synovitis with swelling. A woman presents with right knee villonodular synovitis. Other articles where pigmented villonodular synovitis is discussed. The term pigmented villonodular synovitis is generally used when diffuse intraarticular involvement is present, 2, 3.
In the diffuse form entire synovium is involved and in the localized form a portion of the synovium is affected. Pdf adult multifocal pigmented villonodular synovitis clinical. Pvns affects people in their third or fourth decades of life. Pigmented villonodular synovitis pvns is an uncommon benign proliferative disorder of the synovium that results in formation of villous and nodular protrusions. Pigmented villonodular synovitis pvns, also known as intraarticular giantcell tumor of the tendon sheath, is a joint disease characterized by inflammation and overgrowth of the joint lining, becoming benign tumors. Pigmented villonodular synovitis is an uncommon disease that affects primarily tendon sheaths and less commonly joints and bursae. Pigmented villonodular synovitis wiley online library. Treatment of diffuse pigmented villonodular synovitis of. Villonodular synovitis leads to a firm, nonfluctuating swelling located primarily at the dorsal aspect of the joint. Six patients had a recurrence of disease after one or two surgical synovectomies. Apr 04, 2016 pigmented villonodular synovitis pvns is a disease in which the tissue lining the joints and tendons in the body synovium grows abnormally. Localized and diffuse forms of synovial involvement were reported. Pigmented villonodular synovitis is a benign but locally aggressive synovial tumor.
In cases where significant degeneration has occurred and the damage is more advanced, a joint replacement is recommendable in the hip. Villonodular synovitis is a type of synovial swelling types include. Villonodular tenosynovitis definition of villonodular. Pigmented villonodular synovitis pvns is a disease in which the tissue. Treatment of pigmented villonodular synovitis of the knee. Radiotherapy on kneerelated pigmented villonodular synovitis. There is a localized and a diffuse form of the disorder with the localized or nodular version amenable to. Pigmented villonodular synovitis pvns is a locally aggressive synovial proliferative disorder of. Introduction pigmented villonodular synovitis p vns is a condition of the synovial membrane that is characterized by the presence of inflammation and hemosiderin deposition in the synovium. Localized pigmented villonodular synovitis of the shoulder. This lesion can be found in one in each 2500 arthroscopies. Pigmented villonodular synovitis of joints, on the other hand, is a rare complaint.
Pigmented villonodular synovitis pvns is a disease rarely found in the elbow, and there is limited literature describing its ultrasonographic morphology. The histology report of the mass was consistent with. Pigmented villonodular synovitis pvns represents an uncommon benign neoplastic process that may involve the synovium of the joint diffusely or focally pvns or that may occur extraarticularly in a bursa pigmented villonodular bursitis pvnb or tendon sheath pigmented villonodular tenosynovitis pvnts. Lene terslev, in essential applications of musculoskeletal ultrasound in rheumatology, 2010. Pigmented villonodular synovitis is a rare disease, with an incidence of 1. Two cases 01 pigmented villonodular synovitis are reported. Pigmented villonodular synovitis pvns is a rare, proliferative disease of synovium. Pigmentierte villonodulare synovitis des kniegelenks springerlink. Diffuse pigmented villonodular synovitis of the foot and.
Three years ago she underwent synovectomy, followed by right knee pain with impressive swelling. Pvns is most commonly monoarticular 70% knee joint but occasionally it can be oligoarticular. In 1941, jaffe described it as a group of synovial, tenosynovial, and bursal lesions. Pigmented villonodular synovitis pvns dominic carreira. Diagnosing pvns in the knee is difficult because the clinical presentation and symptoms mimic those of more common disorders at the joint, such as internal derangements or. Pigmented villonodular synovitis pvns is a rare proliferative disease affecting the synovia of joints and the tendon sheaths. Pigmented villonodular synovitis pvns springerlink.
Pigmented villonodular synovitis pathology britannica. Pigmented villonodular synovitis genetic and rare diseases. Treatment of diffuse pigmented villonodular synovitis of the. Pigmented villonodular synovitis pvns represents an uncommon benign neoplastic process that may involve the synovium of the joint. The villonodular masses arise from enlargement of the synovial villi of the joint capsule and are associated with repetitive trauma. Although trauma, inflammation, neoplasia, and disorders of lipid metabolism have been implicated as causative factors of pvns, 4, 7, the etiology of this disease remains unclear. A key features is hemosiderin deposition and gradient echo gre can be very helpful if performed. Knee radiograph of a diffuse pigmented villonodular synovitis of the knee in a anteroposterior and b profile, evidencing areas of bone destruction. Askew4 pigmented villonodular synovitis isanunusual benign disease ofunknown cause producing circumscribed ondiffuse thickening ofthe synovial lining ofjoints, tendon sheaths, andbunsae. Burnett fromthe university ofglasgow, departmentofpathology. To illustrate the mri features of pigmented villonodular synovitis pvns, with special focus on the diffuse intraarticular form. Surgical outcomes of 26 patients with pigmented villonodular. It may produce symptoms related to mechanical derangement of the knee.
If the hip is involved early destruction of the joint is common due to the tight structure of the. Pigmented villonodular synovitis pvns is a rare benign proliferative condition affecting synovial membranes of joints, bursae or tendons resulting from possibly neoplastic synovial proliferation with villous and nodular projections and hemosiderin deposition. Pigmented villonodular synovitis pvns is a benign proliferative histiocytic disorder of the synovium. The diffuse form of pigmented villonodular synovitis of eight knee joints of eight patients was treated by intraarticular injection of 185 mbq yttrium90 silicate 90y. We present the case of a 33yearold woman with a mass arising from her right hip joint that was examined using a multimodal radiological approach. Pigmented villonodular synovitis of a lumbar intervertebral facet joint. Pigmented villonodular synovitis pvns is a rare, benign non cancerous. Roentgenographic aspects of articular pigmented villonodular synovitis. We report a case of elbow pvns, showing the sonographic features of a hyperechoic, heterogenous, irregularlyshaped mass. Surgical treatment options for video of pigmented villonodular synovitis pvns surgery is typically recommended as a treatment for pvns, with the type of surgery dictated by the extent of damage to the joint. Treatment for pigmented villonodular synovitis or pvns of knee involves removal of. It usually is not possible to determine the nature of an intraarticular mass, and even though fluid is displaceable. Chromosomal analysis suggests that it is a true neoplasm and not an inflammatory process. Pdf pigmented villonodular synovitis pvns is a rare, benign proliferative disease of the synovial.
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