Gokhale Nikhil, Purohit Shaligam, Bhosale Pradeep B
Department of Orthopaedic, KEM hospital, Parel, Mumbai-12. India.
J Orthop Case Rep. 2015 Jul-Sep;5(3):63-5. doi: 10.13107/jocr.2250-0685.311.
Pigmented villonodular synovitis is an uncommon disease characterized by hyperplastic synovium, large effusions and bone erosions. It commonly mimics other conditions. As a result, the diagnosis may remain elusive, as the classic signs of tenderness and effusion are not specific. Occasionally, PVNS presents as a popliteal cyst, which may divert attention from intra-articular pathology. In this article, we describe a case of pigmented villonodular synovitis that presented with a popliteal cyst as the chief problem.
A twelve year old boy presented to us with a history of a gradually enlarging mass in the left popliteal fossa since eighteen months. He complained of restriction of terminal knee flexion, but he had no pain. After clinical examination and imaging the mass was interpreted as being either a popliteal cyst or chronic hematoma without ruling out the possibility of soft tissue sarcoma. An open excisional biopsy of the lesion was performed which revealed a reddish-brown cystic-nodular mass communicating with the knee joint. The histology was consistent with that of pigmented villonodular synovitis. We performed an arthroscopic synovectomy 3 weeks later. Abnormal synovium found in all compartments of the knee was removed. Histology from the intra-articular lesion was also consistent with a diagnosis of pigmented villonodular synovitis.
A swelling in the popliteal region may be due to various etiologies. The cause should be thoroughly investigated. Along with clinical examination and imaging the tissue must be subjected to histopathological examination. Pigmented villonodular synovitis can rarely present as a popliteal cyst. In such a situation, treatment consists of dealing with intra-articular and extra-articular pathology.
色素沉着绒毛结节性滑膜炎是一种罕见疾病，其特征为滑膜增生、大量积液和骨质侵蚀。它常与其他病症相似。因此，由于压痛和积液等典型体征并不具有特异性，诊断可能仍然难以明确。偶尔，色素沉着绒毛结节性滑膜炎表现为腘窝囊肿，这可能会使人们的注意力从关节内病变上转移。在本文中，我们描述了一例以腘窝囊肿为主要问题的色素沉着绒毛结节性滑膜炎病例。
一名12岁男孩自18个月前起，左腘窝出现逐渐增大的肿块，并前来就诊。他主诉膝关节终末屈曲受限，但无疼痛。经过临床检查和影像学检查，该肿块被诊断为腘窝囊肿或慢性血肿，但未排除软组织肉瘤的可能性。对该病变进行了开放性切除活检，结果显示为一个与膝关节相通的红棕色囊性结节肿块。组织学检查结果与色素沉着绒毛结节性滑膜炎相符。3周后，我们进行了关节镜下滑膜切除术。切除了膝关节所有腔室中发现的异常滑膜。关节内病变的组织学检查结果也符合色素沉着绒毛结节性滑膜炎的诊断。
腘窝区域的肿胀可能由多种病因引起。应彻底调查病因。除了临床检查和影像学检查外，还必须对组织进行组织病理学检查。色素沉着绒毛结节性滑膜炎很少表现为腘窝囊肿。在这种情况下，治疗包括处理关节内和关节外病变。
