Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA.
Department of Neurosurgery, Tulane Medical Center, New Orleans, LA, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Saudi Arabia.
Clin Neurol Neurosurg. 2021 Mar;202:106489. doi: 10.1016/j.clineuro.2021.106489. Epub 2021 Jan 12.
Pigmented villonodular synovitis (PVNS) is a lesion of uncertain etiology that involves the synovial membranes of joints or tendon sheaths, representing a diffuse and non-encapsulated form of the more common giant cell tumors of the synovium (GCTTS). PVNS was reclassified to denote a diffuse form of synovial giant cell tumor (TSGCT), while 'giant cell tumor of the tendon sheath (GCTTS)' was used for localized lesions. These pathologies rarely affect the axial skeleton. We provide an unprecedented and extensive systematic review of both lesions highlighting presentation, diagnostic considerations, treatment, prognosis, and outcomes, and we report a short case-series.
We describe two-cases and conduct a systematic review in accordance with PRISMA guidelines.
PVNS was identified in most of the cases reviewed (91.6 %), manifesting predominantly in the cervical spine (40 %). Patients commonly presented with neck pain (59 %), back pain (53 %), and lower back pain (81.2 %) for cervical, thoracic, and lumbar lesions, respectively. GTR occurred at rates of 94 %, 80 %, and 87.5 %. Recurrence was most common in the lumbar region (30.7 %). GCTTS cases (8%) manifested in the cervical and thoracic spine at the same frequency. We reported first case of GCTTS in the lumbosacral region. Both poses high rate of facet and epidural involvements.
Spinal PVNS and GCTTS are rare. These lesions manifest most commonly as PVNS within the cervical spine. Both types have a high rate of facet and epidural involvement, while PVNS has the highest rate of recurrence within the lumbar spine. The clinical and radiological features of these lesions make them difficult to differentiate from others with similar histogenesis, necessitating tissue diagnosis. Proper management via GTR resolves the lesion, with low rates of recurrence.
色素绒毛结节性滑膜炎（PVNS）是一种病因不明的病变，累及关节或腱鞘的滑膜，代表更常见的滑膜巨细胞瘤（GCTTS）的弥漫性和非包膜形式。PVNS 被重新分类为表示弥漫性滑膜巨细胞瘤（TSGCT），而“腱鞘巨细胞瘤（GCTTS）”用于局部病变。这些病变很少影响轴骨骼。我们提供了这两种病变的空前广泛的系统综述，重点介绍了表现、诊断注意事项、治疗、预后和结果，并报告了一系列简短的病例。
我们描述了两个病例，并根据 PRISMA 指南进行了系统评价。
在大多数回顾的病例中都发现了 PVNS（91.6%），主要表现为颈椎（40%）。患者通常表现为颈痛（59%）、背痛（53%）和腰痛（81.2%），分别用于颈椎、胸椎和腰椎病变。GTR 的发生率分别为 94%、80%和 87.5%。复发最常见于腰椎（30.7%）。GCTTS 病例（8%）在颈椎和胸椎的发生率相同。我们报告了首例发生在腰骶部的 GCTTS 病例。两者均具有高发生率的小关节和硬膜外受累。
脊柱 PVNS 和 GCTTS 较为罕见。这些病变最常见于颈椎内表现为 PVNS。这两种类型都有很高的小关节和硬膜外受累发生率，而 PVNS 在腰椎内的复发率最高。这些病变的临床和影像学特征使其难以与具有相似组织发生的其他病变区分开来，需要组织诊断。通过 GTR 进行适当的治疗可以解决病变，复发率低。
