Tumefactive pigmented villonodular synovitis

Tumefactive

Pigmented Synovitis

Villonodular

JOHN J. TOMA, M.D.,Beverly Hills, CaliJornia From he Hospital of the University Philadelphia, Pennsylvania.

of Pennsylvania,

J

AFFE, Lichtenstein and Sutro’ in 1941 proposed the term “pigmented viIIonoduIar synovitis” for a synoviaI Iesion showing focal colIections of Iarge polyhedral cells, which in turn give rise to foam ceIIs, hemosiderin ceIIs and muItinucIear giant cells.’ The etioiogy of this synovial lesion showing the cytoIogic and proIiferative compIex demarcation in some instances from a neoplastic type of Iesion was interpreted by Jaffe et a1. as “inflammatory in type.” However, prior to the present accepted terminoIogy, “pigmented viIIonodular synovitis,” other authors (Geschicter and Copeland, DeSanto and WiIson,3 and Marsden 4 the latter reporting on IOO consecutive operations on the knee) cIassified this synovia1 Iesion as neopIastic in character. In October, 1944, at a conference, Lichtenstein presented a tumor-Iike mass removed from a

FIG. side&

IB. Photomicrograph phagocytes;

FIG. IA. Tumor-Iike

of synoviai Lesion. A, SynoviaI clefts; c, foam ceIIs; D, poIyhedraI ~11s; E, giant cells.

B,

mass.

hemo-

Toma

2. The lesion on the anterior right knee.

FIG.

Iateral surface nbovc

FIG. 4. SynoviaI tumor mass; note the retraction of peroneat nerve.

FIG. 7. Postoperative

FIG. 3. The lesion on the posterior

FIG. 3. Tumor mass imbeded muscIe substance.

scar on the posterior

into

FIG. 6. Diffuse synovia1 tumor with portions of muscIe.

FIG. 8. Shows anterior

surface.

1014

surface below knee.

IateraI postoperative

scar.

Tumefactive knee

joint; this

mass

was

Pigmented

diagnosed

ns \-ill+

IA.) The man\’ names applied to this lesion \%cre as follo~vs: ranthoma, giant cell tumor, fibroheniosideric sarcoma and pot!-rnorl>hocelluI~lr tumor. In Figure rK can be seen foam cells (a, E), nodular

SJ novitis.

hemosideric giant

(Fig.

cells

(n,

c),

and

multinuclear

cells ((1, D).

From :I cytologic interpretation, these cells are derivctl from basic connective tissue. The tlifl‘usc and proliferative quality of the cells in this c:tse should be classified as tumefactivc rather than inflammatory. There arc no tlistinc.ti\re cell differentiations. CASE REPORT 1% B., a fifty-four year old white woman, entered the Orthopedic Service of the HospitaI of the University of PennsyIvania on March I& complaining of sweIling about the knee of the right leg. This sweIling had been progressive for npproximateIy seven years. Two months prior to admission the patient had noticed some restriction of motion. There was nodular slvelling on the anterolaterat aspect above the knee joint and swelling on the posterior aspect and below the knee joint. (Figs. 2 and 3.) According to the histor?;, there m-as onI> slight limitation of (lesion and increased painless swelling. Physical examination revealed a firm nodular mass on the anterolatera1 and posteromedial aspects of the knee joint. X-rags showed no bony changes. AII laboratory studies were essentialI! normal. Aspiration biopsy with :I

ViIIonodular

Synovitis

13 gage needle failed to give an>- type of specimen for Iaborntory stud&. A fe\v da> s after admission a large synoviaI proliferative mass which \vns embedded in muscle s~ibstancc in nian~- places V+YI~ remo\-ed. (Figs. 4 and 3.) Two weeks foIlowing the operation a similar but larger mass \vas removed from the anterior surface of the right Ieg. The pathologic specimens are shown in Figure 6. The patient made an uneventful reco\‘er> and kvas again seen tm-0 months following surgerh-. Figures 7 and 8 shoiv the postoperative .sc’:Irs ~. SUMMAR I. A case is presented of a diffuse proliferasynovial lesion of the knee. This lesion was intra- and extra-articujar, and was of seven years’ duration. 2. The longevity of the lesion with no transition of ceI1 structural changes other than that indicated by multiplicit>; of the cytologic pattern \vould classif\- this type (“pigmented villonodulnr s?-novitis”) as tumefactivc.

tive

REFERENCES JAFI:E, H. L., LICHTENSTEIN, L. and Surw,

C. J. Pigmented vilIonoduIar synovitis, bursitis and tenosynovitis. Arch. Path., 3 I : 73 1~765, 194 1. GESCHICTLK, C. F. and COPELAND, ;\I. D. Tumors of Bow, 3rd cd., pp. 703-706. PhiIadelphi;r, 105 I. J. P. Lippincott Co. DESANTO, D. A. and WILSOU, P. D. Xnnthomntous tumors of joints. J. Bone (r+Joint Surg., 2 I : 53 I

55% ‘939.

\IARSDEU.C. IV. Analysis of 1oo consecutive operations on the knee and report on xanthoma. J. RI,v.

Arml/ h’f. Cor&Y., 89: 20-37, 1947.