Department of Orthopaedics, Chulabhorn Hospital, Chulabhorn Royal Academy, 906 Kampangpetch 6 Street, Lak Si, Bangkok, Thailand.
Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, 906 Kampangpetch 6 Street, Lak Si, Bangkok, Thailand.
BMC Musculoskelet Disord. 2024 Jul 25;25(1):584. doi: 10.1186/s12891-024-07708-3.
Synovial hemangiomas are rare benign vascular anomalies surrounded by a synovial lining and were first described by Bouchut in 1856. These neoplasms can develop in the intra-articular region, resulting in effusions and knee pain. However, their cause remains unknown. Prompt diagnosis and intervention are critical to prevent chondral damage. Histopathological examination is used to achieve the diagnosis, which is often delayed because of a lack of specific clinical signs. This report describes a unique case in which a painful infrapatellar mass was diagnosed as a synovial hemangioma. The absence of typical magnetic resonance imaging (MRI) findings highlights the importance of arthroscopic excision for diagnosis and symptom relief.
A 20-year-old woman presented with persistent anterior left knee pain that became exacerbated when she climbed stairs. Despite previous pain management and physical therapy, she developed a painful lump beneath her patella that worsened over time. She had also undergone arthrocentesis, but this did not relieve her pain. Physical examination revealed a palpable, immobile 5-cm mass along the patellar tendon with limited knee flexion and extension and normal ligament stability. T1-weighted fat-saturated MRI of the left knee with gadolinium-based contrast revealed a lobulated intra-articular mass in Hoffa's fat pad that resembled a soft tissue chondroma. A biopsy of the mass was performed to provide histopathological evidence, confirming the benign nature of the mass. The subsequent excisional arthroscopy, combined with incision enlargement for mass removal, confirmed the histopathologic diagnosis of synovial hemangioma based on the presence of numerous dilated blood vessels and venous proliferation within sections of the synovium. Recovery was complete, and no residual tumor was detected on follow-up MRI after 1 year.
This case study emphasizes the importance of arthroscopic excision over open surgery for patients with synovial hemangioma. The minimally invasive nature of arthroscopy combined with the well-encapsulated nature and location of the mass facilitates complete resection.
滑膜血管瘤是一种罕见的良性血管性病变，由滑膜衬里包围，于 1856 年由 Bouchut 首次描述。这些肿瘤可发生在关节内区域，导致关节积液和膝关节疼痛。然而，其病因尚不清楚。及时诊断和干预对于预防软骨损伤至关重要。组织病理学检查用于诊断，但由于缺乏特异性临床体征，往往会延迟诊断。本报告描述了一例独特的病例，患者的髌下疼痛性肿块被诊断为滑膜血管瘤。缺乏典型的磁共振成像（MRI）表现突出了关节镜切除对于诊断和缓解症状的重要性。
一名 20 岁女性因持续性左膝前痛就诊，爬楼梯时疼痛加剧。尽管之前进行了疼痛管理和物理治疗，但她的髌下出现了一个疼痛性肿块，且随着时间的推移逐渐加重。她还接受了关节穿刺术，但并未缓解疼痛。体格检查发现髌腱旁可触及、不可移动的 5cm 肿块，伴有膝关节屈伸受限，且韧带稳定性正常。左膝关节 T1 加权脂肪饱和 MRI 加钆造影显示 Hoffa 脂肪垫内呈分叶状的关节内肿块，类似于软组织软骨瘤。对肿块进行了活检以提供组织病理学证据，证实了肿块的良性性质。随后进行的关节镜下切除术，结合肿块切除的扩大切口，根据滑膜内多个扩张的血管和静脉增生的存在，明确了滑膜血管瘤的组织病理学诊断。患者完全康复，1 年后随访 MRI 未发现肿瘤残留。
本病例研究强调了关节镜下切除对于滑膜血管瘤患者优于开放性手术。关节镜的微创性结合肿块的良好包裹性和位置，有利于实现完全切除。
