Khatri Arti, Mahajan Nidhi, Agarwal Anil, Gupta Neeraj
Department of Pathology, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India.
Department of Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India.
J Orthop Case Rep. 2019;9(4):22-25. doi: 10.13107/jocr.2019.v09.i04.1462.
Synovial lipomatosis is a rare disease entity and a very small number of cases have been reported so far. It is characterized by villous proliferation of the synovium with expansion by mature adipose tissue. The etiology is unclear, thought cases can be seen secondary to injury, inflammation, chronic degenerative changes and neoplasms. Etiopathogenesis is still unclear, however is seen secondary to injury, inflammation, chronic degenerative conditions and neoplasms.
An 8-year-old female child presented with pain and swelling in the left knee. Radiological examination suggested of a lytic lesion in upper tibia along with reactive synovial thickening. The lytic lesion was excised and an incisional biopsy was taken from the hyperplastic synovium. Histopathological examination of the synovial tissue showed villi-like structures with mature adipose tissue expanding the synovial lining along with the presence of mild chronic inflammatory cell infiltrate. The lytic lesion showed a cartilaginous tumor comprising mineralized chicken wire matrix surrounding the chondroblasts. A final diagnosis of synovial lipomatosis with chondroblastoma was made on histopathological examination.
This may be the first case report in medical literature of synovial lipomatosis coexisting with chondroblastoma in an adolescent girl. It also highlights the need for its increased awareness among young radiologists and pathologists so that an early diagnosis directs correct management and prevents further joint morbidity.
滑膜脂肪化生是一种罕见的疾病实体,迄今为止报道的病例数量很少。其特征是滑膜绒毛状增生并伴有成熟脂肪组织扩张。病因尚不清楚,不过有病例继发于损伤、炎症、慢性退行性变和肿瘤。发病机制仍不明确,但可见于继发于损伤、炎症、慢性退行性疾病和肿瘤。
一名8岁女童因左膝疼痛和肿胀就诊。影像学检查提示胫骨上段有溶骨性病变,伴有反应性滑膜增厚。切除溶骨性病变,并从增生的滑膜取组织进行切开活检。滑膜组织的组织病理学检查显示有绒毛样结构,成熟脂肪组织使滑膜内衬扩张,同时存在轻度慢性炎性细胞浸润。溶骨性病变显示为软骨肿瘤,由围绕成软骨细胞的矿化钢丝样基质组成。组织病理学检查最终诊断为滑膜脂肪化生合并成软骨细胞瘤。
这可能是医学文献中首例关于青春期女孩滑膜脂肪化生与成软骨细胞瘤并存的病例报告。它还强调了年轻放射科医生和病理科医生提高对此病认识的必要性,以便早期诊断能指导正确的治疗并防止进一步的关节病变。