Camillieri Gianluca, Di Sanzo Vincenzo, Ferretti Matteo, Calderaro Cosma, Calvisi Vittorio
Department of Orthopaedic Surgery, University of L’Aquila, L’Aquila, Italy.
Orthopedics. 2012 Jul 1;35(7):e1116-8. doi: 10.3928/01477447-20120621-34.
Tenosynovial giant cell tumors originate from the synovial tissue of the joints, tendon sheaths, mucosal bursas, and fibrous tissues adjacent to tendons. The disease presents in localized and diffused forms. Large joints, such as the knee, are not frequently affected. Magnetic resonance imaging has been reported to be the best noninvasive technique to diagnose these tumors. Magnetic resonance imaging diagnosis has to be confirmed by histopathological examination. Few reports exist of tenosynovial giant cell tumors arising from the posterior cruciate ligament. This article describes a case of an 18-year-old man with no history of trauma but with a 2-year history of mild, ongoing, and worsening right knee pain and swelling localized in the popliteal region. Clinical examination of the knee was negative. Magnetic resonance imaging revealed an intra-articular mass measuring 4.8×2.1×2.7 cm in the posterior region of the knee attached to the posterior cruciate ligament. Arthroscopy was performed using the posterior approach through the posterolateral and posteromedial portals. A specimen of the lesion was removed arthroscopically for histopathological examination, and a wide resection of the mass was performed with a shaver and a radiofrequency ablation device. Histopathological examination confirmed the diagnosis of a tenosynovial giant cell tumor. No recurrence had occurred at 2-year follow-up. Magnetic resonance imaging and histopathological examination may help in achieving a correct diagnosis, and arthroscopic excision using a posterior approach may be the treatment of choice by surgeons.
腱鞘巨细胞瘤起源于关节的滑膜组织、腱鞘、黏膜滑囊以及肌腱相邻的纤维组织。该疾病有局限性和弥漫性两种表现形式。诸如膝关节等大关节较少受累。据报道,磁共振成像(MRI)是诊断这些肿瘤的最佳无创技术。MRI诊断必须通过组织病理学检查来证实。关于后交叉韧带起源的腱鞘巨细胞瘤的报道很少。本文描述了一例18岁男性患者,无外伤史,但有2年右膝轻度、持续性且逐渐加重的疼痛和肿胀病史,疼痛和肿胀局限于腘窝区域。膝关节临床检查结果为阴性。MRI显示膝关节后方有一个关节内肿块,大小为4.8×2.1×2.7厘米,附着于后交叉韧带。通过后外侧和后内侧入路采用后入路进行关节镜检查。通过关节镜切除病变标本进行组织病理学检查,并用刨削器和射频消融设备对肿块进行广泛切除。组织病理学检查确诊为腱鞘巨细胞瘤。2年随访未出现复发。MRI和组织病理学检查可能有助于做出正确诊断,而后入路关节镜切除术可能是外科医生的首选治疗方法。