RESUMO

Diffuse pigmented villonodular synovitis is characterized by synovial inflammation and hemosiderin deposition. It mainly occurs in adults, with the hip and knees being the most common sites of involvement. It is associated with high recurrence rates, with open synovectomy being the most common treatment method to avoid recurrences. Few cases of diffuse pigmented villonodular synovitis have been reported in pediatric patients, especially in uncommon locations such as the hand. This case presents pathology-confirmed diffuse pigmented villonodular synovitis in the hand of a pediatric patient with multiple recurrences despite adequate surgical margins. The patient underwent mass excision with adjuvant radiation treatment after his last recurrence, with excellent functional outcomes and no recurrence at the five-year follow-up.

RESUMO

Objetivo: Avaliar os casos nos quais os pacientes apresentassem SVNP na ATM, incluindo aspectos clínicos, imaginológicos, histopatológicos e tratamento. Metodologia: Trata-se de uma revisão integrativa com dados obtidos nas bases de dados SciELO, PubMed, Medline e Lillacs entre 1982 e 2021, através dos descritores: "Case report", "Temporomandibular Joint", "Pigmented Villonodular Synovitis". Critérios de inclusão: estudos de relato de caso, textos completos disponíveis, idiomas de publicação em inglês, português ou espanhol. Critérios de exclusão: estudos sem presença de aspectos clínicos, relatos não localizados na ATM, artigos de metanálise, revisão sistemática e de literatura, ensaios clínicos, capítulos de livro, dissertações e teses. Dos 156 resultados, apenas 23 compuseram a revisão. Resultados: Como tratamento, a ressecção total através da cirurgia aberta é recomendada. Os sintomas mais comuns foram: dor na mastigação, trismo, dor pré auricular, dormência, parestesia, perca auditiva e inchaço da glândula parótida. Conclusão: Os aspectos imaginológicos revelam erosão de fossa glenóide e côndilo, histopatologicamente, células gigantes com depósito de hemossiderina, e o tratamento recomendado, ressecção via cirurgia aberta com posterior curetagem... (AU)

Objective: To evaluate the cases in which patients presented PVNS in the TMJ, including clinical, imaging, histopathological and treatment aspects. Methodology: This is an integrative review with data obtained from the SciELO, PubMed, Medline and Lillacs databases between 1982 and 2021, using the descriptors: "Case report", "Temporomandibular Joint", "Pigmented Villonodular Synovitis". Inclusion criteria: case report studies, full texts available, languages of publication in English, Portuguese or Spanish. Exclusion criteria: studies without the presence of clinical aspects, reports not located in the TMJ, meta analysis articles, systematic and literature reviews, clinical trials, book chapters, dissertations and theses. Of the 156 results, only 23 made up the review. Results: As a treatment, total resection through open surgery is recommended. The most common symptoms were: chewing pain, trismus, pre-auricular pain, numbness, paresthesia, hearing loss and parotid gland swelling. Conclusion: The imaging findings reveal erosion of the glenoid fossa and condyle, histopathologically, giant cells with hemosiderin deposits, and the recommended treatment, resection via open surgery with subsequent curettage... (AU)

Objetivo: Evaluar los casos en que los pacientes presentaron SVNP en la ATM, incluyendo aspectos clínicos, imagenológicos, histopatológicos y tratamiento. Metodología: Se trata de una revisión integradora con datos obtenidos de las bases de datos SciELO, PubMed, Medline y Lillacs entre 1982 y 2021, utilizando los descriptores: "Caso clínico", "Articulación temporomandibular", "Sinovitis villonodular pigmentada". Criterios de inclusión: estudios de casos clínicos, textos completos disponibles, idiomas de publicación en inglés, portugués o español. Criterios de exclusión: estudios sin aspectos clínicos, informes no localizados en la ATM, artículos de metanálisis, revisiones sistemáticas y de literatura, ensayos clínicos, capítulos de libros, disertaciones y tesis. De los 156 resultados, 23 conformaron la revisión. Resultados: Como tratamiento se recomienda la resección total mediante cirugía abierta. Los síntomas más frecuentes fueron: dolor masticatorio, trismus, dolor preauricular, entumecimiento, parestesia, hipoacusia e inflamación de glándula parótida. Conclusión: Los hallazgos imagenológicos revelan erosión de fosa glenoidea y cóndilo, histopatológicamente células gigantes con depósitos de hemosiderina y el tratamiento recomendado, resección abierta con posterior curetaje... (AU)

Assuntos

RESUMO

Resumen: La sinovitis villonodular pigmentada extraarticular, también llamada tumor de células gigantes de la vaina tendinosa, es frecuente en la mano, siendo extremadamente rara su localización en la rodilla. Se presenta el caso de un paciente con una bursitis villonodular pigmentada de la bursa de la pata de ganso sin afectación intraarticular. Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon sheath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.

Abstract: Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon seath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.

Assuntos

RESUMO

Pigmented villonodular synovitis is a benign tumor of synovial tissue with a very low incidence. Ankle location is even less frequent. Early diagnosis and management are required to avoid irreversible functional and mechanical sequelae. The clinical presentation starts with edema or joint effusion and may progress with pain and advanced joint degenerative changes. Pigmented villonodular synovitis can be focal or diffuse, the latter being the type with the worst prognosis. When suspected, magnetic resonance imaging is performed, and the diagnosis confirmed with a biopsy in which synovial inflammatory tissue with hemosiderin deposits is observed. An open or arthroscopic synovectomy is preferred over surgical management. Recurrence is up to 40%, which is why biological coadjutant therapies and radiotherapy are described. This article presents the case of a 30-year-old man who presented with pain and claudication of the left ankle; the imaging study findings were compatible with diffuse pigmented villonodular synovitis of the ankle with extension to the subtalar joint, leading to arthroscopy for treatment and biopsy. This case report illustrates the results with this patient and a literature review of the subject.

La sinovitis villonodular pigmentada es un tumor benigno del tejido sinovial de muy baja incidencia. El compromiso de tobillo es aún menos frecuente. Se requiere diagnóstico y manejo precoz para evitar secuelas funcionales y mecánicas irreversibles. Se manifiesta inicialmente con aumento de volumen de partes blandas, edema o derrame articular y puede evolucionar con dolor progresivo y daño articular avanzado. Existe una forma focal y una difusa, siendo esta última la de peor pronóstico. El examen diagnóstico de elección es la resonancia magnética, confirmándose por biopsia en la que se observa tejido sinovial inflamatorio con depósitos de hemosiderina. El tratamiento es quirúrgico y consiste en sinovectomía abierta o artroscópica. La recurrencia es de hasta un 40%, por lo que están descritas terapias coadyuvantes biológicas y radioterapia. Este artículo expone el caso de un hombre de 30 años que consulta por dolor y claudicación del tobillo izquierdo, encontrándose en el estudio imagenológico (resonancia magnética) hallazgos compatibles con sinovitis villonodular pigmentada difusa del tobillo, con extensión a la articulación subtalar, por lo que se realiza artroscopía para tratamiento y biopsia. En este reporte de caso se ilustran los resultados con este paciente y una revisión bibliográfica del tema.

Assuntos

RESUMO

La sinovitis villonodular pigmentada es un tumor benigno del tejido sinovial de muy baja incidencia. El compromiso de tobillo es aún menos frecuente. Se requiere diagnóstico y manejo precoz para evitar secuelas funcionales y mecánicas irreversibles. Se manifiesta inicialmente con aumento de volumen de partes blandas, edema o derrame articular y puede evolucionar con dolor progresivo y daño articular avanzado. Existe una forma focal y una difusa, siendo esta última la de peor pronóstico. El examen diagnóstico de elección es la resonancia magnética, confirmándose por biopsia en la que se observa tejido sinovial inflamatorio con depósitos de hemosiderina. El tratamiento es quirúrgico y consiste en sinovectomía abierta o artroscópica. La recurrencia es de hasta un 40%, por lo que están descritas terapias coadyuvantes biológicas y radioterapia. Este artículo expone el caso de un hombre de 30 años que consulta por dolor y claudicación del tobillo izquierdo, encontrándose en el estudio imagenológico (resonancia magnética) hallazgos compatibles con sinovitis villonodular pigmentada difusa del tobillo, con extensión a la articulación subtalar, por lo que se realiza artroscopía para tratamiento y biopsia. En este reporte de caso se ilustran los resultados con este paciente y una revisión bibliográfica del tema.

Pigmented villonodular synovitis is a benign tumor of synovial tissue with a very low incidence. Ankle location is even less frequent. Early diagnosis and management are required to avoid irreversible functional and mechanical sequelae. The clinical presentation starts with edema or joint effusion and may progress with pain and advanced joint degenerative changes. Pigmented villonodular synovitis can be focal or diffuse, the latter being the type with the worst prognosis. When suspected, magnetic resonance imaging is performed, and the diagnosis confirmed with a biopsy in which synovial inflammatory tissue with hemosiderin deposits is observed. An open or arthroscopic synovectomy is preferred over surgical management. Recurrence is up to 40%, which is why biological coadjutant therapies and radiotherapy are described. This article presents the case of a 30-year-old man who presented with pain and claudication of the left ankle; the imaging study findings were compatible with diffuse pigmented villonodular synovitis of the ankle with extension to the subtalar joint, leading to arthroscopy for treatment and biopsy. This case report illustrates the results with this patient and a literature review of the subject.

Assuntos

RESUMO

OBJECTIVES: Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary. METHODS: The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor. RESULTS: Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28 -year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1- and T2-weighted images. These were associated with hemosiderin pigmentation. CONCLUSION: The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site. Level of Evidence IV; Case series.

OBJETIVOS: Diversos casos de sinovite vilonodular pigmentada difusa bilateral (SVNP) ou tumor de células gigantes tenossinoviais foram descritos na literatura. Entretanto, algumas apresentações são raras e o diagnóstico diferencial é necessário. MÉTODOS: O objetivo do estudo foi realizar uma revisão da literatura relacionada à SVNP e relatar uma apresentação de forma bilateral e localizada rara na região supra-patelar. Foi realizada uma revisão dos bancos de dados do Pubmed Clinical Queries, MeSH e unitermos relacionados com SVNP e tumor de células gigantes tenossinoviais. RESULTADOS: Dois casos de SVNP bilateral e local foram descritos anteriormente. No entanto, nenhum deles foi localizado no compartimento supra-patelar. Até onde sabemos, este relato é o primeiro caso descrito de SVNP bilateral localizada supra-patelar. Apresentamos uma mulher de 28 anos com SVNP bilateral no recesso supra-patelar do joelho. A RM mostrou baixo sinal dos nódulos nas imagens ponderadas em T1 e T2, associados ao pigmento hemossiderina. CONCLUSÃO: O achado mais importante está relacionado à raridade e localização. A histopatologia confirmou um caso raro de pigmento de hemossiderina no nódulo da cápsula com conteúdo viloso não pigmentado internamente. O diagnóstico diferencial com lipoma arborescens na forma supra-patelar é necessário devido à localização comum. Nível de Evidência IV; Série de casos.

RESUMO

ABSTRACT Objectives Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary. Methods The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor. Results Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28 -year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1- and T2-weighted images. These were associated with hemosiderin pigmentation. Conclusion The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site. Level of Evidence IV; Case series.

RESUMO Objetivos Diversos casos de sinovite vilonodular pigmentada difusa bilateral (SVNP) ou tumor de células gigantes tenossinoviais foram descritos na literatura. Entretanto, algumas apresentações são raras e o diagnóstico diferencial é necessário. Métodos O objetivo do estudo foi realizar uma revisão da literatura relacionada à SVNP e relatar uma apresentação de forma bilateral e localizada rara na região supra-patelar. Foi realizada uma revisão dos bancos de dados do Pubmed Clinical Queries, MeSH e unitermos relacionados com SVNP e tumor de células gigantes tenossinoviais. Resultados Dois casos de SVNP bilateral e local foram descritos anteriormente. No entanto, nenhum deles foi localizado no compartimento supra-patelar. Até onde sabemos, este relato é o primeiro caso descrito de SVNP bilateral localizada supra-patelar. Apresentamos uma mulher de 28 anos com SVNP bilateral no recesso supra-patelar do joelho. A RM mostrou baixo sinal dos nódulos nas imagens ponderadas em T1 e T2, associados ao pigmento hemossiderina. Conclusão O achado mais importante está relacionado à raridade e localização. A histopatologia confirmou um caso raro de pigmento de hemossiderina no nódulo da cápsula com conteúdo viloso não pigmentado internamente. O diagnóstico diferencial com lipoma arborescens na forma supra-patelar é necessário devido à localização comum. Nível de Evidência IV; Série de casos.

RESUMO

Resumen: Introducción: La sinovitis villonodular pigmentada (SNVP) es una entidad clínica poco frecuente, con un incidencia mayor en las mujeres (3:1) y una edad de presentación entre los 20 y 40 años. La cadera es un sitio poco común de ocurrencia, estando involucrada en tan solo 15% de todos los casos. Reporte de caso: Masculino de 47 años con cuadro de 10 años de evolución caracterizado por limitación de los arcos de movilidad, dolor asociado a aumento de volumen y acortamiento del miembro pélvico; los estudios de imagen mostraron destrucción de la articulación coxofemoral y extensión a la pelvis; el reporte histopatológico describió sinovitis villonodular pigmentada. Fue manejado con hemipelvectomía externa izquierda. Discusión: La presentación de la sinovitis villonodular pigmentada difusa en la cadera tiene una incidencia baja y comportamiento localmente agresivo. Es necesario tener en cuenta diagnósticos diferenciales que incluyan neoplasias malignas. El estándar de tratamiento es quirúrgico.

Abstract: Introduction: Pigmented villonodular synovitis (PVNS) is a rare clinical entity with higher incidence in women (3:1) and an age of presentation between 20 and 40 years. The hip is a rare site of appearance, being involved in only 15% of all cases. Case report: 47-year-old male with 10 years of evolution characterized by a limited range of motion, pain associated with an increase in volume and shortening of the pelvic limb. Imaging studies showed destruction of the hip joint and extension to the pelvis. The histopathology report described pigmented villonodular synovitis. His final treatment was left hemipelvectomy. Discussion: The presentation of the diffuse pigmented villonodular synovitis of the hip has a lower incidence and a locally aggressive behavior. It is necessary to consider differential diagnoses that include malignant neoplasms. The standard treatment is surgical.

Assuntos

RESUMO

Pigmented villonodular synovitis is a rare proliferative condition of the synovium. Although the condition can present in any joint, the knee is the most commonly affected site. Despite being a benign condition, pigmented villonodular synovitis is often aggressive, with marked extra-articular extension in some cases. Monoarticular involvement occurs in two forms: localized and diffuse. The latter is more common, with a high recurrence rate. There is no standard method of management of this lesion. Open surgery is a classical and effective method for treatment. Arthroscopic synovectomy, however, has gained popularity, and has several advantages over the open technique particularly in exclusively articular cases. The combined approach is suggested in cases with extra-articular involvement. Synovectomy through any approach may prevent secondary osteoarthritis and subsequent joint arthroplasty. Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy appears to decrease the rate of local recurrence in diffuse cases. The authors observed a great heterogeneity in reporting of functional results, and specific conclusions should not be drawn. Each patient should be managed in accordance with his/her particular condition.

A sinovite vilonodular pigmentada é uma rara condição proliferativa da membrana sinovial. Apesar de a doença poder estar presente em qualquer articulação, o joelho é o local mais frequentemente afetado. Ainda que doença benigna, geralmente tem comportamento agressivo, pode ter extensão extra-articular em alguns casos. O acometimento monoarticular ocorre em duas formas: localizada ou difusa. A forma difusa é mais comum e tem alta taxa de recorrência. Não há método padronizado para o manejo dessa lesão. O tratamento cirúrgico aberto é o método clássico e efetivo. A sinovectomia artroscópica, entretanto, tem ganhado popularidade e tem diversas vantagens sobre a técnica aberta, principalmente em casos exclusivamente articulares. A abordagem combinada é sugerida em casos com envolvimento extra-articular. A sinovectomia pode prevenir a osteoartrose secundária e o subsequente tratamento reconstrutivo. A radioterapia usada como tratamento adjuvante à sinovectomia parece diminuir a taxa de recorrência local na forma difusa da doença. Os autores encontraram grande heterogeneidade na forma como os resultados funcionais foram reportados e não se deve chegar a conclusões específicas. Cada paciente deve ser manejado de acordo com suas particularidades.

RESUMO

Abstract Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.

Resumo Tumor de células gigantes tenossinovial do tipo difuso (TCGT-d) ou sinovite vilonodular pigmentada (SVP) é uma lesão localmente agressiva que afeta principalmente as articulações dos ossos longos. Tumor de células gigantes tenossinovial condroide (TCGTC) ou SVP com metaplasia condroide é um tipo distinto e raro de tumor sinovial que tem a predileção pela articulação temporomandibular (ATM). Nós relatamos um caso raro de TCGTC da ATM, inicialmente diagnosticado, equivocadamente, como disfunção temporomandibular (DTM). Uma mulher de 51 anos foi encaminhada ao cirurgião com a queixa principal de dor na ATM por 5 anos, e uma história de tratamento de DTM sem sucesso. O exame extrabucal revelou discreto aumento de volume preauricular e movimentação mandibular restrita. A radiografia panorâmica e a tomografia computadorizada evidenciaram destruição da fossa mandibular e côndilo. Histologicamente, o tumor era composto por células mononucleares grandes, com amplo citoplasma eosinofílico e núcleo sulcado, pequenas células histiocitoides, células multinucleadas semelhantes a osteoclastos, pigmentação acastanhada e áreas de metaplasia condroide. As características morfológicas e imuno-histoquímicas levaram ao diagnóstico final de TCGTC. A raridade desta lesão pode estar associada ao seu não reconhecimento, sendo casos diagnosticados como condroblastoma, condromatose sinovial ou condrossarcoma. A paciente recebeu reconstrução imediata e recorrência foi observada 22 meses após a intervenção inicial. TCGT-d e TCGTC da ATM podem apresentar sintomas similares à DTM, mas os clínicos devem diferenciar ambas as lesões por meio do exame clínico completo, exames de imagem e, quando necessário, avaliação histopatológica.

Assuntos

RESUMO

ABSTRACT Pigmented villonodular synovitis is a rare proliferative condition of the synovium. Although the condition can present in any joint, the knee is the most commonly affected site. Despite being a benign condition, pigmented villonodular synovitis is often aggressive, with marked extra-articular extension in some cases. Monoarticular involvement occurs in two forms: localized and diffuse. The latter is more common, with a high recurrence rate. There is no standard method of management of this lesion. Open surgery is a classical and effective method for treatment. Arthroscopic synovectomy, however, has gained popularity, and has several advantages over the open technique particularly in exclusively articular cases. The combined approach is suggested in cases with extra-articular involvement. Synovectomy through any approach may prevent secondary osteoarthritis and subsequent joint arthroplasty. Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy appears to decrease the rate of local recurrence in diffuse cases. The authors observed a great heterogeneity in reporting of functional results, and specific conclusions should not be drawn. Each patient should be managed in accordance with his/her particular condition.

RESUMO A sinovite vilonodular pigmentada é uma rara condição proliferativa da membrana sinovial. Apesar de a doença poder estar presente em qualquer articulação, o joelho é o local mais frequentemente afetado. Ainda que doença benigna, geralmente tem comportamento agressivo, pode ter extensão extra-articular em alguns casos. O acometimento monoarticular ocorre em duas formas: localizada ou difusa. A forma difusa é mais comum e tem alta taxa de recorrência. Não há método padronizado para o manejo dessa lesão. O tratamento cirúrgico aberto é o método clássico e efetivo. A sinovectomia artroscópica, entretanto, tem ganhado popularidade e tem diversas vantagens sobre a técnica aberta, principalmente em casos exclusivamente articulares. A abordagem combinada é sugerida em casos com envolvimento extra-articular. A sinovectomia pode prevenir a osteoartrose secundária e o subsequente tratamento reconstrutivo. A radioterapia usada como tratamento adjuvante à sinovectomia parece diminuir a taxa de recorrência local na forma difusa da doença. Os autores encontraram grande heterogeneidade na forma como os resultados funcionais foram reportados e não se deve chegar a conclusões específicas. Cada paciente deve ser manejado de acordo com suas particularidades.

Assuntos

RESUMO

INTRODUCTION: Pigmented villonodular synovitis (PVNS) is a rare clinical entity with higher incidence in women (3:1) and an age of presentation between 20 and 40 years. The hip is a rare site of appearance, being involved in only 15% of all cases. CASE REPORT: 47-year-old male with 10 years of evolution characterized by a limited range of motion, pain associated with an increase in volume and shortening of the pelvic limb. Imaging studies showed destruction of the hip joint and extension to the pelvis. The histopathology report described pigmented villonodular synovitis. His final treatment was left hemipelvectomy. DISCUSSION: The presentation of the diffuse pigmented villonodular synovitis of the hip has a lower incidence and a locally aggressive behavior. It is necessary to consider differential diagnoses that include malignant neoplasms. The standard treatment is surgical.

INTRODUCCIÓN: La sinovitis villonodular pigmentada (SNVP) es una entidad clínica poco frecuente, con un incidencia mayor en las mujeres (3:1) y una edad de presentación entre los 20 y 40 años. La cadera es un sitio poco común de ocurrencia, estando involucrada en tan solo 15% de todos los casos. REPORTE DE CASO: Masculino de 47 años con cuadro de 10 años de evolución caracterizado por limitación de los arcos de movilidad, dolor asociado a aumento de volumen y acortamiento del miembro pélvico; los estudios de imagen mostraron destrucción de la articulación coxofemoral y extensión a la pelvis; el reporte histopatológico describió sinovitis villonodular pigmentada. Fue manejado con hemipelvectomía externa izquierda. DISCUSIÓN: La presentación de la sinovitis villonodular pigmentada difusa en la cadera tiene una incidencia baja y comportamiento localmente agresivo. Es necesario tener en cuenta diagnósticos diferenciales que incluyan neoplasias malignas. El estándar de tratamiento es quirúrgico.

Assuntos

RESUMO

This case concerns a male patient complaining of pain and discomfort in his right elbow, associated with decreased range of motion. Elbow radiography showed an osteolytic lesion in the metaphyseal region of the distal humerus and magnetic resonance imaging showed intra-articular tumor formation with swelling that suggested pigmented villonodular synovitis. Arthroscopic treatment was performed in order to obtain a synovial biopsy and then to carry out total synovectomy. Anatomopathological examination confirmed the diagnosis. The patient presented excellent progress through the physiotherapeutic rehabilitation proposed and continued to be asymptomatic 12 months after the operation.

O caso diz respeito a um paciente do sexo masculino com queixa de dor e desconforto no cotovelo direito associados a diminuição da amplitude de movimento. Apresentava radiografia do cotovelo com lesão osteolítica da região metafisária do úmero distal e ressonância magnética que mostrava tumoração intra-articular com aumento de volume que sugeria sinovite vilonodular pigmentada. Foi feito tratamento artroscópico para biópsia sinovial e sinovectomia total. O estudo anatomopatológico confirmou o diagnóstico. O paciente apresentou ótima evolução com reabilitação fisioterápica proposta, até 12 meses de pós-operatorio apresentava-se assintomático.

RESUMO

ABSTRACT This case concerns a male patient complaining of pain and discomfort in his right elbow, associated with decreased range of motion. Elbow radiography showed an osteolytic lesion in the metaphyseal region of the distal humerus and magnetic resonance imaging showed intra-articular tumor formation with swelling that suggested pigmented villonodular synovitis. Arthroscopic treatment was performed in order to obtain a synovial biopsy and then to carry out total synovectomy. Anatomopathological examination confirmed the diagnosis. The patient presented excellent progress through the physiotherapeutic rehabilitation proposed and continued to be asymptomatic 12 months after the operation.

RESUMO O caso diz respeito a um paciente do sexo masculino com queixa de dor e desconforto no cotovelo direito associados a diminuição da amplitude de movimento. Apresentava radiografia do cotovelo com lesão osteolítica da região metafisária do úmero distal e ressonância magnética que mostrava tumoração intra-articular com aumento de volume que sugeria sinovite vilonodular pigmentada. Foi feito tratamento artroscópico para biópsia sinovial e sinovectomia total. O estudo anatomopatológico confirmou o diagnóstico. O paciente apresentou ótima evolução com reabilitação fisioterápica proposta, até 12 meses de pós-operatorio apresentava-se assintomático.

Assuntos

RESUMO

OBJETIVO: Mostrar los hallazgos imagenológicos en la resonancia magnética (RM) de la sinovitis vellonodular pigmentada (SVP) y el tumor de células gigantes de la vaina sinovial (TCGVS), dado que son entidades que representan un diverso grupo de alteraciones en la proliferación de la sinovial. MATERIALES Y MÉTODOS: Entre mayo de 2011 y junio de 2013, se estudiaron en nuestra institución 25 casos con diagnóstico histológico de proliferación de la sinovial. Se destacaron los distintos tipos de presentación en imágenes a través de una RM 1.5 Tesla. Los resultados fueron analizados y comparados con la literatura. RESULTADOS: La RM mostró características similares para esta patología en todos los pacientes. No obstante, se distinguieron 4 patrones principales de presentación, dependiendo de la morfología, la localización de la lesión y las características radiológicas diferenciales. Estos fueron: como dominante, el tumor de células gigantes de la vaina sinovial (n = 10), todos de localización extraarticular; la sinovitis vellonodular pigmentada de localización bursal (n = 2); la sinovitis vellonodular pigmentada de forma intraarticular focal (n = 5); y la sinovitis vellonodular pigmentada difusa (n = 8). CONCLUSIÓN: La sinovitis vellonodular pigmentada y el tumor de células gigantes de la vaina sinovial se consideran entidades similares desde el punto de vista anatomopatológico. La RM fue de gran utilidad para objetivar tanto las características radiológicas comunes como las diferenciales. Estas últimas, junto con la localización, nos permitieron clasificar 4 patrones de presentación. Su reconocimiento posibilita un adecuado seguimiento de la patología y un óptimo manejo terapéutico.

PURPOSE: To show the resonance magnetic imaging (MRI) findings of pigmented villonodular synovitis (PVNS) and giant cell tumor of the tendon sheath (PVNTS), entities with similar histology but differences in clinical and some radiological manifestations. MATERIALS AND METHODS: We studied 25 cases with histologically benign synovial proliferation in intra and extraarticular location of the extremities. It highlighted with a 1.5T MRI unit the different types of images presentation. The results were analyzed and compared with the literature. RESULTS: MRI displayed very specific imaging features in all patients. However, we were able to distinguish 4 main patterns of presentation depending on the morphology, location of the lesion and radiological differential. These were: as dominant presentation, pigmented villonodular synovitis localized form (n=10); pigmented villonodular synovitis bursal form (n=2); pigmented villonodular synovitis focal (n =5); and pigmented villonodular synovitis diffuse (n = 8). CONCLUSION: 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 radiological features in common, such as the differential, which along with the location, allow us to classify patterns into 4 individual presentations. This recognition involves adequate radiological evaluation and is important for optimal management.

Assuntos

RESUMO

Objetivo: Mostrar los hallazgos imagenológicos en la resonancia magnética (RM) de la sinovitis vellonodular pigmentada (SVP) y el tumor de células gigantes de la vaina sinovial (TCGVS), dado que son entidades que representan un diverso grupo de alteraciones en la proliferación de la sinovial. Materiales y métodos: Entre mayo de 2011 y junio de 2013, se estudiaron en nuestra institución 25 casos con diagnóstico histológico de proliferación de la sinovial. Se destacaron los distintos tipos de presentación en imágenes a través de una RM 1.5 Tesla. Los resultados fueron analizados y comparados con la literatura. Resultados: La RM mostró características similares para esta patología en todos los pacientes. No obstante, se distinguieron 4 patrones principales de presentación, dependiendo de la morfología, la localización de la lesión y las características radiológicas diferenciales. Estos fueron: como dominante, el tumor de células gigantes de la vaina sinovial (n = 10), todos de localización extraarticular; la sinovitis vellonodular pigmentada de localización bursal (n = 2); la sinovitis vellonodular pigmentada de forma intraarticular focal (n = 5); y la sinovitis vellonodular pigmentada difusa (n = 8). Conclusión: La sinovitis vellonodular pigmentada y el tumor de células gigantes de la vaina sinovial se consideran entidades similares desde el punto de vista anatomopatológico. La RM fue de gran utilidad para objetivar tanto las características radiológicas comunes como las diferenciales. Estas últimas, junto con la localización, nos permitieron clasificar 4 patrones de presentación. Su reconocimiento posibilita un adecuado seguimiento de la patología y un óptimo manejo terapéutico.(AU)

Purpose: To show the resonance magnetic imaging (MRI) findings of pigmented villonodular synovitis (PVNS) and giant cell tumor of the tendon sheath (PVNTS), entities with similar histology but differences in clinical and some radiological manifestations. Materials and methods: We studied 25 cases with histologically benign synovial proliferation in intra and extraarticular location of the extremities. It highlighted with a 1.5T MRI unit the different types of images presentation. The results were analyzed and compared with the literature. Results: MRI displayed very specific imaging features in all patients. However, we were able to distinguish 4 main patterns of presentation depending on the morphology, location of the lesion and radiological differential. These were: as dominant presentation, pigmented villonodular synovitis localized form (n=10); pigmented villonodular synovitis bursal form (n=2); pigmented villonodular synovitis focal (n =5); and pigmented villonodular synovitis diffuse (n = 8). Conclusion: 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 radiological features in common, such as the differential, which along with the location, allow us to classify patterns into 4 individual presentations. This recognition involves adequate radiological evaluation and is important for optimal management.(AU)

RESUMO

This case concerned a female patient with a complaint of pain in the anterior region of her left knee during and after sports activities, followed by joint blockage three months ago. From imaging examinations, simple radiography of the knee was normal and magnetic resonance showed a solid expansive mass, possibly corresponding to soft-tissue chondroma or focal nodular synovitis. Arthroscopic resection of the lesion was performed, and the diagnosis of diffuse giant cell tumor resembling localized pigmented villonodular synovitis (PVNS) was made from the result of the anatomopathological examination. The patient presented good clinical evolution, with disappearance of symptoms and return to physical activities.

RESUMO

O caso em questão é o de uma paciente do sexo feminino que apresentava queixa de dor na região anterior do joelho esquerdo durante e após atividades esportivas, seguidas de bloqueio articular havia três meses. Exames de imagem: radiografias simples do joelho normais e ressonância magnética mostrando formação expansiva sólida podendo corresponder a condroma de partes moles ou a sinovite nodular focal. Realizada ressecção artroscópica da lesão com diagnóstico de tumor de células gigantes difuso símile/sinovite vilonodular pigmentada localizada (SVNPL) após resultado do exame anatomopatológico. A paciente apresenta boa evolução clínica com desaparecimento dos sintomas e retorno às atividades físicas.

This case concerned a female patient with a complaint of pain in the anterior region of her left knee during and after sports activities, followed by joint blockage three months ago. From imaging examinations, simple radiography of the knee was normal and magnetic resonance showed a solid expansive mass, possibly corresponding to soft-tissue chondroma or focal nodular synovitis. Arthroscopic resection of the lesion was performed, and the diagnosis of diffuse giant cell tumor resembling localized pigmented villonodular synovitis (PVNS) was made from the result of the anatomopathological examination. The patient presented good clinical evolution, with disappearance of symptoms and return to physical activities.

Assuntos

RESUMO

Fundamento: los tumores afectan el tejido sinovial de la rodilla se presentan de forma muy similar independientemente de su tipo histológico por lo que en ocasiones su diagnóstico preciso es muy difícil. Desarrollo: se realizó una revisión bibliográfica sobre los tumores benignos y malignos que afectan el tejido sinovial de la rodilla. Se mostraron los aspectos más importantes de cada tipo de tumor como aspectos generales, presentación clínica, exámenes diagnósticos y tratamiento, comenzando por los benignos como el hemangioma sinovial, lipoma arborescens, condromatosis sinovial, sinovitis vellonodular pigmentada y concluimos con el sarcoma sinovial. Conclusiones: el tratamiento definitivo de estos tumores esta en dependencia de su tipo histológico y diagnóstico oportuno.

Background: tumors affect synovial tissue of the knee, they are presented independently in a very similar way of their histological type for what in occasions their precise diagnosis is very difficult. Development: a bibliographical review on benign and malignant tumors that affect synovial tissue of knee was carried out. The most important aspects in each tumor type were shown as general aspects, clinical presentation, diagnostic examination and treatment, beginning with the benign ones as the synovial hemangioma, lipoma arborescens, synovial chondromatosis, pigmented villonodular synovitis and we conclude with synovial sarcoma. Conclusions: the definitive treatment of these tumors depends on their histological type and opportune diagnostic.

RESUMO

INTRODUCTION: Pigmented villonodular synovitis (PVNS) is a benign idiopathic proliferative disorder that results in villous or nodular formation in the joints, tendons sheaths, and bursae. As PVNS is a rare pathology in children, diagnosis is often delayed. In this study, we analyze the therapeutic methods used and results obtained in the treatment of this pathology. MATERIALS AND METHODS: All patients with PVNS of the knee seen between January 1988 and June 2006 were evaluated. We assessed the form of presentation, time to diagnosis, previous diagnosis, type of treatment, relapse, and the need for subsequent treatment. RESULTS: Nine patients with age range 2-15 years and a mean follow-up of 8.5 years were evaluated. Four patients had the diffuse form and four had the localized or nodular form; all of them were intra-articular. In only three cases were preoperative radiographic findings observed. The mean delay in diagnosis was 18 months. Open resection was performed in five patients and arthroscopic resection in four. Joint function was satisfactory in 78% of the patients at the last follow-up and there were no postoperative recurrences. CONCLUSIONS: Magnetic resonance imaging (MRI) is a useful diagnostic tool and the way to detect relapse, and allows accurate determination of the tumor extent. Surgery is the treatment of choice. Worse results are directly related to delay in diagnosis.