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Case Reports
. 2022 Dec;40(4):270-275.
doi: 10.3857/roj.2022.00122. Epub 2022 Dec 26.

Diffuse pigmented villonodular synovitis of the knee joint: 3-year follow-up of a case report

Antonios A Koutalos  1 , Dimitrios Ragias  2 , Emmanouel Rizniotopoulos  3 , Konstantinos Tsanadis  3 , Emmanouil Xydias  2 , Nikolaos Tsoukalas  4 , Nikolaos Charalampakis  5 , Nikolaos Trogkanis  6 , Maria Ioannou  7 , Konstantinos N Malizos  1 , Maria Tolia  8
Affiliations
Case Reports

Diffuse pigmented villonodular synovitis of the knee joint: 3-year follow-up of a case report

Antonios A Koutalos et al. Radiat Oncol J. 2022 Dec.

Abstract

Pigmented villonodular synovitis (PVNS) is a proliferative, recurrent and locally invasive disease of the synovium. The symptoms of the disorder are not typical and thus it is very often misdiagnosed. Most of the times, magnetic resonance imaging presents the nodular model of development and sets the basis for the diagnosis. The final diagnosis will be set by the pathological evaluation of the lesion's biopsy. PVNS may be localized (nodule with a clear boundary with/without presence of single pedicle) or diffuse (extensive involvement of the adjacent nerves and vessels). Depending on the extension of the PVNS, a different management approach is performed, lesion excision vs. resection, followed by radiotherapy respectively. We report a case of diffuse PVNS in the knee joint, treated with surgical excision and adjuvant radiotherapy as well as follow-up imaging after a time period of 3 years.

Keywords: Pigmented villonodular synovitis; Radiotherapy; Surgery; Treatment.

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Conflict of interest statement

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
(A) Plain anterior-posterior radiograph of the knee. No significant abnormalities. (B) Sagittal view of the left knee with three-dimensional fast spoiled gradient-echo (FSPGR) sequence. Extensive diffuse pigmented villonodular synovitis occupying the posterior and anterior part of the knee joint with extra-articular extension demonstrated with low to medium signal and blooming artifact due to hemosiderin (white arrows).
Fig. 2.
Fig. 2.
Diffuse pigmented villonodular synovitis. (A) Histological examination of tissue samples taken from the lesion (H&E staining, original magnification ×20). Synoviocyte hyperplasia, a lot of hemosiderin granules and intense inflammatory infiltration of lymphocytes, plasmatocytes, many histiocytes/macrophages and a few multinucleated giant cells. (B) Immunohistochemical staining of tissue samples taken from the lesion with the anti-CD68 antibody (original magnification ×20). CD68-positive mononuclear cells and multinucleated giant cells detected—CD68 stain in the cytoplasm of those cells.
Fig. 3.
Fig. 3.
(A, B, C) Target volume of the treated area. (D) Dose volume histogram and radiation treatment planning system information.
Fig. 4.
Fig. 4.
Magnetic resonance imaging after 3 years. No local recurrence of pigmented villonodular synovitis is noticed.
See this image and copyright information in PMC

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