Extra-articular pigmented villonodular synovitis in distal tibia - Case report -

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1 Extra-articular pigmented villonodular synovitis in distal tibia - Case report - Jun-Beom, Kim M.D, Jong-Geun, Lee M.D, Taek-Su, Jeon M.D*, Young-Phil, Yun M.D** Foot and Ankle Clinics, Department of Orthopedics, Sun General Hospital, Daejeon, Korea Department of Orthopedics, Centum Hospital, Daejeon, South Korea* Department of Orthopedics, Se-uri Hospital, Daejeon, South Korea**

2 Extra-articular pigmented villonodular synovitis in distal tibia - Case report - Jun-Beom, Kim M.D My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Introduction I Pigment villonodular synovitis is a relatively rare disease known that as a disease similar tumors originating large joints of knee joint and hip joint, mainly. It is characterized in synovial membrane to grow gradually to gradually in Bursitis and Tenosynovitis. Sometimes the small joints are affected have been reported, that occurs mainly hand part is almost and very rare if it occurs in a small joints of the foot.

4 Introduction II However, the authors had experienced PVNS which had developed in the extra-articular, distal tibia shaft lesion. We`d report the rare case with the literature

5 Case 44 years old / Male Chief complain palpable mass, for 10years on anterior tibia lesion, left. Past Medical Hx. ; Hyperlipidemia - no medication HTN/DM/TBc (-/-/-) Physical Exam. Mass : firmly and immovable, 3*2 Cm Laboratory test : WNL

6 Radiologic Evaluation Plain X-ray shows the radio-opaque lesion in anterior distal tibia shaft. In MRI, enhanced pretibial mass, hemangioma, and lipoma is suspected, by radiologist.

7 Intra-operative findings There are well-defined, yellow-tan soft tissue solid mass Histological Findings There are hemosiderin-laden foam cells and multinucleated giant cells.

8 Result We performed total excisional biopsy for tumor eventually. We was diagnosed with pingmented villonodular synovitis by pathological findings, which showed hemosiderin-laden foam cells and multinucleated giant cells. Additional treatments such as radiation therapy were not performed At 2 years after surgery, there was no recurrence and complication.

9 Discussion I Differential diagnosis of the clinical and radiological features of PVNS synovial proliferative disorders : Hemosiderotic synovitis, synovial chondromatosis, crystal synovitis, synovial hemangioma, synovial sarcoma, rheumatoid arthritis, osteoarthritis, infections, gout, and familial Mediterranean fever Confirmed with histopathological examination fibrous stroma, deposition of hemosiderin,nodules of proliferating collagen-producing polyhedral epithelioid cells, and multinucleated giant cells in the synovial membrane

10 Discussion II The important message is that the physicians can face such cases of PVNS presenting with unusual extraarticular location. Histologic and radiologic examinations stand as the major objective criteria in reaching the diagnosis.

11 References Martin RC II, Osborne DL, Edwards MJ, Wrightson W, McMasters M. Giant cell tumor of the tendon sheath, tenosynovial giant cell tumor and pigmented villonodular synovitis defining the presentation, surgical therapy and recurrence. Oncol Rep 2000;(2): Robinson DL, Blair DW, Lee SS. Pigmented villonodular synovitis presenting as a lateral knee mass a case report and review of literature. Orthop Rev 1988;17(1): Dorwart RH, Genant HK, Johnston WH, Morris JM. Pigmented villonodular synovitis of synovial joints clinical, pathologic and radiological features. Am J Roentgenol 1984;143(4): Arthand JB. Pigmented villonodular synovitis report of 11 lesions in non-articular locations. Am J Clin Pathol 1972;58: Looi KP, Lou CK, Yap YM. Extra-articular villonodular synovitis of the tendoachilles a case report. Ann Acad Med Singapore 1996;Jul 28(4): Goldman AB, DiCarlo EF. Pigmented villonodular synovitis diagnosis and differential diagnosis. Radiol Clin North Am 1988;26(6): Frassica FJ, Khanna JA, McCarthy EF. The role of MR imaging in soft tissue tumor evaluation: perspective of the orthopaedic oncologist and musculoskeletal pathologist. Magn Reson Imaging Clin N Am 2000;8(4);