Pigmented villonodular synovitis of the hip

Abstract

Pigmented villonodular synovitis (PVNS) is a rare disease that can affect any joint, bursa or tendon sheath.The hip is less frequently affected than the knee, and hence is less discussed in scientific journals.PVNS of the hip mainly occurs in young adults, requiring early diagnosis and adequate treatment to obtain good results.There is no consensus on the management of PVNS of the hip in current literature.We will discuss the options for surgical intervention in hip PVNS using a literature review of clinical, biological, etiological, histological and radiographic aspects of the disease. Cite this article: Steinmetz S, Rougemont A-L, Peter R. Pigmented villonodular synovitis of the hip. EFORT Open Rev 2016;1:260-266. DOI: 10.1302/2058-5241.1.000021.

Keywords: PVNS; hip; hyperplasia; pigmented villonodular synovitis.

Fig 1

Histology. a) Upon histological evaluation, the synovial villi are elongated and enlarged. b) Synoviocytes line the villi (arrow). c) The tumor is composed of sheets of mononuclear cells (black arrow), intermingled with osteoclast-like multinucleated giant (arrowhead) and siderophages (white arrow). (d) Sheets of xanthoma cells are also seen.

Fig 2

Radiography AP of the hip: at an advanced stage, the destructive nature of PVNS results in multiple and dispersed subchondral cysts.

Fig 3

CT of the hip: the small erosions like at the femoral neck.

Fig 4

MRI of the hip: the synovium is diffuse at the hip with bone invasion. Synovium appears as hyposignal on T1-weighted sequence and enhances after the gadolinium injection.

Fig 5

PVNS of the hip.