Kwon Minsung, Bang Jin-Young, Nam Kyung Han
Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea.
Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea.
Int J Surg Case Rep. 2020;77:138-142. doi: 10.1016/j.ijscr.2020.10.128. Epub 2020 Nov 1.
Pigmented villous nodular synovitis is an uncommon proliferative disease of the joints, and rarely reported in the shoulder. It can become symptomatic when proliferating soft tissue infiltrates a joint, causing arthritic changes including bone erosion. The literature has described the disease progression as indolent. Here we report on a case of PVNS of the shoulder joint which rapidly lead to significant bone damage and was subsequently treated by shoulder arthroplasty.
We report here on a 71-year old female patient who presented with a 6 month history of aggravating shoulder pain. Radiography imaging over a one month period indicated rapid joint destruction. Magnetic resonance imaging suggested the presence of PVNS of the shoulder joint and significant bone erosion. The patient was subsequently treated by shoulder arthroplasty performed by authors. Histological examination confirmed the PVNS diagnosis. Shoulder pain significantly decreased during the follow up period, and the patient was able to resume daily activities.
Comparing to Milwaukee shoulder syndrome or a joint infection, PVNS is known to progress indolently. However, our case clearly showed that PVNS could also cause radical destruction of the joint. Previous reports showed the high recurrence rate of PVNS after joint preserving surgery. In our experience hemiarthroplasty could be the choice of treatment with the low recurrence rate and high functional outcome.
Physicians should include PVNS in the differential diagnosis when they are presented with evidence of rapid destruction of the shoulder joint. Hemiarthroplasty could be treatment option for PVNS of shoulder joint.
色素沉着绒毛结节性滑膜炎是一种罕见的关节增生性疾病，在肩部很少见。当增生的软组织侵入关节，导致包括骨侵蚀在内的关节炎改变时，可出现症状。文献将该疾病的进展描述为进展缓慢。在此，我们报告一例肩关节色素沉着绒毛结节性滑膜炎病例，该病例迅速导致严重的骨损伤，随后接受了肩关节置换术治疗。
我们在此报告一名71岁女性患者，她有6个月的肩部疼痛加重病史。为期1个月的放射影像学检查显示关节迅速破坏。磁共振成像提示存在肩关节色素沉着绒毛结节性滑膜炎及明显的骨侵蚀。该患者随后接受了作者实施的肩关节置换术。组织学检查证实了色素沉着绒毛结节性滑膜炎的诊断。在随访期间，肩部疼痛明显减轻，患者能够恢复日常活动。
与密尔沃基肩综合征或关节感染相比，色素沉着绒毛结节性滑膜炎已知进展缓慢。然而，我们的病例清楚地表明，色素沉着绒毛结节性滑膜炎也可导致关节的严重破坏。先前的报告显示，保关节手术后色素沉着绒毛结节性滑膜炎的复发率很高。根据我们的经验，半关节置换术可能是复发率低且功能预后良好的治疗选择。
当医生面对肩关节迅速破坏的证据时，应将色素沉着绒毛结节性滑膜炎纳入鉴别诊断。半关节置换术可能是肩关节色素沉着绒毛结节性滑膜炎的治疗选择。
