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Case Report
Medwave 2019;19(4):e7641 doi: 10.5867/medwave.2019.04.7641
Arthroscopic treatment of pigmented villonodular synovitis of the ankle: a clinical case report and review
Soledad Salas González, Tomás Urrutia Jarpa, Jorge Filippi
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Key Words: synovitis, pigmented villonodular, arthritis

Abstract

Pigmented villonodular synovitis is a benign tumor of synovial tissue with a very low incidence. Ankle location is even less frequent. Early diagnosis and management are required to avoid irreversible functional and mechanical sequelae. The clinical presentation starts with edema or joint effusion and may progress with pain and advanced joint degenerative changes. Pigmented villonodular synovitis can be focal or diffuse, the latter being the type with the worst prognosis. When suspected, magnetic resonance imaging is performed, and the diagnosis confirmed with a biopsy in which synovial inflammatory tissue with hemosiderin deposits is observed. An open or arthroscopic synovectomy is preferred over surgical management. Recurrence is up to 40%, which is why biological coadjutant therapies and radiotherapy are described. This article presents the case of a 30-year-old man who presented with pain and claudication of the left ankle; the imaging study findings were compatible with diffuse pigmented villonodular synovitis of the ankle with extension to the subtalar joint, leading to arthroscopy for treatment and biopsy. This case report illustrates the results with this patient and a literature review of the subject.


 

Only Spanish version is available for this Case report.

 

Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

La sinovitis villonodular pigmentada es un tumor benigno del tejido sinovial de muy baja incidencia. El compromiso de tobillo es aún menos frecuente. Se requiere diagnóstico y manejo precoz para evitar secuelas funcionales y mecánicas irreversibles. Se manifiesta inicialmente con aumento de volumen de partes blandas, edema o derrame articular y puede evolucionar con dolor progresivo y daño articular avanzado. Existe una forma focal y una difusa, siendo esta última la de peor pronóstico. El examen diagnóstico de elección es la resonancia magnética, confirmándose por biopsia en la que se observa tejido sinovial inflamatorio con depósitos de hemosiderina. El tratamiento es quirúrgico y consiste en sinovectomía abierta o artroscópica. La recurrencia es de hasta un 40%, por lo que están descritas terapias coadyuvantes biológicas y radioterapia. Este artículo expone el caso de un hombre de 30 años que consulta por dolor y claudicación del tobillo izquierdo, encontrándose en el estudio imagenológico (resonancia magnética) hallazgos compatibles con sinovitis villonodular pigmentada difusa del tobillo, con extensión a la articulación subtalar, por lo que se realiza artroscopía para tratamiento y biopsia. En este reporte de caso se ilustran los resultados con este paciente y una revisión bibliográfica del tema.

Authors: Soledad Salas González[1], Tomás Urrutia Jarpa[2], Jorge Filippi[2,3]

Affiliation:
[1] Escuela de Medicina. Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
[2] Departamento de Ortopedia y Traumatologia, Facultad de Medicin, Pontificia Universidad Catolica de Chile, Santiago, Chile.
[3] Equipo Cirugía de Tobillo y Pie, Clínica Las Condes, Santiago Chile

E-mail: jlfilippi@gmail.com

Author address:
[1] Departamento de Ortopedia y Traumatología
Pontificia Universidad Católica de Chile
Diagonal Paraguay 362, 3er piso
Cod. Postal: 833007

Citation: Salas González S, Urrutia Jarpa T, Filippi J. Arthroscopic treatment of pigmented villonodular synovitis of the ankle: a clinical case report and review. Medwave 2019;19(4):e7641 doi: 10.5867/medwave.2019.04.7641

Submission date: 12/12/2018

Acceptance date: 2/5/2019

Publication date: 27/5/2019

Origin: not commissioned

Type of review: reviewed by two external peer reviewers, double-blind

PubMed record

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  1. Cattelan M, Bonnomet F, Bierry G, Di Marco A, Brinkert D, Adam P, et al. Villonodular synovitis of the ankle. Analysis of the risk of recurrence. Orthop Traumatol Surges. 2016 Sep;102(5):639-44. | CrossRef | PubMed |
  2. Stephan SR, Shallop B, Lackman R, Kim TW, Mulcahey MK. Pigmented Villonodular Synovitis: A Comprehensive Review and Proposed Treatment Algorithm. JBJS Rev. 2016 Jul 19;4(7). pii: 01874474-201607000-00005. | CrossRef | PubMed |
  3. Gouin F, Noailles T. Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis). Orthop Traumatol Surg Res. 2017 Feb;103(1S):S91-S97. | CrossRef | PubMed |
  4. Stevenson JD, Jaiswal A, Gregory JJ, Mangham DC, Cribb G, Cool P. Diffuse pigmented villonodular synovitis (diffuse-type giant cell tumour) of the foot and ankle. Bone Joint J. 2013 Mar;95-B(3):384-90. | CrossRef | PubMed |
  5. Cheng XG, You YH, Liu W, Zhao T, Qu H. MRI features of pigmented villonodular synovitis (PVNS). Clin Rheumatol. 2004 Feb;23(1):31-4. Epub 2004 Jan 9. | PubMed |
  6. Garner HW, Ortiguera CJ, Nakhleh RE. Pigmented villonodular synovitis. Radiographics. 2008 Sep-Oct;28(5):1519-23. | CrossRef | PubMed |
  7. Guo Q, Shi W, Jiao C, Xie X, Jiang D, Hu Y. Results and recurrence of pigmented villonodular synovitis of the ankle: does diffuse PVNS with extra-articular extension tend to recur more often? Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3118-3123. | CrossRef | PubMed |
  8. Kubat O, Bojanić I, Smoljanović T. Localized pigmented villonodular synovitis of the ankle: Expect the unexpected. Foot Ankle Surg. 2017 Mar;23(1):68-72. | CrossRef | PubMed |
  9. Aurégan J, Klouche S, Bohu Y, Lefèvre N, Herman S, Hardy P, et al. Treatment of Pigmented Villonodular Synovitis of the Knee. Arthrosc J Arthrosc Relat Surg. 2014;30(10):1327-41. | CrossRef | PubMed |
  10. Chin KR, Brick GW. Extraarticular pigmented villonodular synovitis: a cause for failed knee arthroscopy. Clin Orthop Relat Res. 2002 Nov;(404):330-8. | PubMed |
  11. Korim MT, Clarke DR, Allen PE, Richards CJ, Ashford RU. Clinical and oncological outcomes after surgical excision of pigmented villonodular synovitis at the foot and ankle. Foot Ankle Surg. 2014 Jun;20(2):130-4. | CrossRef | PubMed |
  12. Li X, Xu Y, Zhu Y, Xu X. Surgical treatment for diffused-type giant cell tumor (pigmented villonodular synovitis) about the ankle joint. BMC Musculoskelet Disord. 2017 Nov 14;18(1):450. | CrossRef | PubMed |
  13. Mollon B, Lee A, Busse JW, Griffin AM, Ferguson PC, Wunder JS, et al. The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee: an individual patient meta-analysis. Bone Joint J. 2015 Apr;97-B(4):550-7. | CrossRef | PubMed |
  14. Bickels J, Isaakov J, Kollender Y, Meller I. Unacceptable complications following intra-articular injection of yttrium 90 in the ankle joint for diffuse pigmented villonodular synovitis. J Bone Joint Surg Am. 2008 Feb;90(2):326-8. | CrossRef | PubMed |
  15. Brahmi M, Vinceneux A, Cassier PA. Current Systemic Treatment Options for Tenosynovial Giant Cell Tumor/Pigmented Villonodular Synovitis: Targeting the CSF1/CSF1R Axis. Curr Treat Options Oncol. 2016 Feb;17(2):10. | CrossRef | PubMed |
  16. Peyraud F, Cousin S, Italiano A. CSF-1R Inhibitor Development: Current Clinical Status. Curr Oncol Rep. 2017 Sep 5;19(11):70. | CrossRef | PubMed |
  17. Castro Corredor D, Bravo WRM, Huaranga MAR, Mateos Rodríguez JJ, Rebollo Giménez AI, Anino Fernández J, et al. Radioisotope Synoviorthesis in the Control of Refractory Synovitis in Castilla-La Mancha. A 10-year Experience. Reumatol Clin. 2019 Jan 25. pii: S1699-258X(18)30238-9. | CrossRef | PubMed |
Cattelan M, Bonnomet F, Bierry G, Di Marco A, Brinkert D, Adam P, et al. Villonodular synovitis of the ankle. Analysis of the risk of recurrence. Orthop Traumatol Surges. 2016 Sep;102(5):639-44. | CrossRef | PubMed |

Stephan SR, Shallop B, Lackman R, Kim TW, Mulcahey MK. Pigmented Villonodular Synovitis: A Comprehensive Review and Proposed Treatment Algorithm. JBJS Rev. 2016 Jul 19;4(7). pii: 01874474-201607000-00005. | CrossRef | PubMed |

Gouin F, Noailles T. Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis). Orthop Traumatol Surg Res. 2017 Feb;103(1S):S91-S97. | CrossRef | PubMed |

Stevenson JD, Jaiswal A, Gregory JJ, Mangham DC, Cribb G, Cool P. Diffuse pigmented villonodular synovitis (diffuse-type giant cell tumour) of the foot and ankle. Bone Joint J. 2013 Mar;95-B(3):384-90. | CrossRef | PubMed |

Cheng XG, You YH, Liu W, Zhao T, Qu H. MRI features of pigmented villonodular synovitis (PVNS). Clin Rheumatol. 2004 Feb;23(1):31-4. Epub 2004 Jan 9. | PubMed |

Garner HW, Ortiguera CJ, Nakhleh RE. Pigmented villonodular synovitis. Radiographics. 2008 Sep-Oct;28(5):1519-23. | CrossRef | PubMed |

Guo Q, Shi W, Jiao C, Xie X, Jiang D, Hu Y. Results and recurrence of pigmented villonodular synovitis of the ankle: does diffuse PVNS with extra-articular extension tend to recur more often? Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3118-3123. | CrossRef | PubMed |

Kubat O, Bojanić I, Smoljanović T. Localized pigmented villonodular synovitis of the ankle: Expect the unexpected. Foot Ankle Surg. 2017 Mar;23(1):68-72. | CrossRef | PubMed |

Aurégan J, Klouche S, Bohu Y, Lefèvre N, Herman S, Hardy P, et al. Treatment of Pigmented Villonodular Synovitis of the Knee. Arthrosc J Arthrosc Relat Surg. 2014;30(10):1327-41. | CrossRef | PubMed |

Chin KR, Brick GW. Extraarticular pigmented villonodular synovitis: a cause for failed knee arthroscopy. Clin Orthop Relat Res. 2002 Nov;(404):330-8. | PubMed |

Korim MT, Clarke DR, Allen PE, Richards CJ, Ashford RU. Clinical and oncological outcomes after surgical excision of pigmented villonodular synovitis at the foot and ankle. Foot Ankle Surg. 2014 Jun;20(2):130-4. | CrossRef | PubMed |

Li X, Xu Y, Zhu Y, Xu X. Surgical treatment for diffused-type giant cell tumor (pigmented villonodular synovitis) about the ankle joint. BMC Musculoskelet Disord. 2017 Nov 14;18(1):450. | CrossRef | PubMed |

Mollon B, Lee A, Busse JW, Griffin AM, Ferguson PC, Wunder JS, et al. The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee: an individual patient meta-analysis. Bone Joint J. 2015 Apr;97-B(4):550-7. | CrossRef | PubMed |

Bickels J, Isaakov J, Kollender Y, Meller I. Unacceptable complications following intra-articular injection of yttrium 90 in the ankle joint for diffuse pigmented villonodular synovitis. J Bone Joint Surg Am. 2008 Feb;90(2):326-8. | CrossRef | PubMed |

Brahmi M, Vinceneux A, Cassier PA. Current Systemic Treatment Options for Tenosynovial Giant Cell Tumor/Pigmented Villonodular Synovitis: Targeting the CSF1/CSF1R Axis. Curr Treat Options Oncol. 2016 Feb;17(2):10. | CrossRef | PubMed |

Peyraud F, Cousin S, Italiano A. CSF-1R Inhibitor Development: Current Clinical Status. Curr Oncol Rep. 2017 Sep 5;19(11):70. | CrossRef | PubMed |

Castro Corredor D, Bravo WRM, Huaranga MAR, Mateos Rodríguez JJ, Rebollo Giménez AI, Anino Fernández J, et al. Radioisotope Synoviorthesis in the Control of Refractory Synovitis in Castilla-La Mancha. A 10-year Experience. Reumatol Clin. 2019 Jan 25. pii: S1699-258X(18)30238-9. | CrossRef | PubMed |