A rare case of giant synovial osteochondromatosis of the thigh

Abstract

Rationale: Giant synovial osteochondromatosis of the thigh is a highly unusual disease without standard diagnosis and curative managements so far. Our focus is to report a very rare case of giant synovial osteochondromatosis successfully operated by surgical treatment. The management of these unique cases has certain educational significance in clinical practice. Patient concerns: A 63-year-old previously healthy man presented to our institution with a 4-year history of continuous progressive hip pain and local numbness of right side in January 2018. One month ago, the patient felt that the above symptoms were aggravated, and the right hip and proximal thigh were significantly swollen. Diagnosis: Computed tomography and magnetic resonance imaging of the hip revealed the irregular mass in his right thigh. Post-operative pathology confirmed the diagnosis of synovial osteochondromatosis of the thigh. Interventions: Considering the large volume of the mass and possibility of malignancy, the patient underwent surgical exploration and complete tumor resection. Outcomes: The patient's neurological deficits and symptoms improved significantly after the surgery, and the postoperative period was uneventful at the 1-year follow-up visit. There were no complications associated with the operation during the follow-up period. Lessons: Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Synovial osteochondromatosis of the thigh, although rare, should be part of the differential diagnosis when the patient presents with local pain, numbness, swelling or other symptoms. We recommend surgical treatment for the occupying lesion when the tumor has caused symptoms or neurological deficits.

A Recurrent Synovial Osteochondromatosis of the Knee: A Case Report

“… 10 There is a chance of malignant transformation so any patients with rapid late deterioration of symptoms should be evaluated for chondrosarcoma or synovial sarcoma. 11 , 12 The treatment is surgical, it includes complete excision of any intra-articular body and resection of the synovial membranes involved, although complete removal is tough at times causing early recurrences. 2 Numerous surgeons agree on the complete evacuation of every single body with subtotal synovectomy.…”

“…Synovial osteochondromatosis in the knee region is a rare pathology, nevertheless, it should not be left out in the differential diagnosis with patients with swelling, pain, and other symptoms. 11 As the excision was not completely evacuated previously, it led to recurrence with more severity. We recommend surgical management with total synovectomy and complete excision of the occupying lesions including every single free body when the lesion causes symptoms and neurological deficits.…”

Massive Synovial Osteochondriomatosis of The Shoulder: A Case Report and Review of The Literature

“…It can be primary or secondary to a pre-existing chondromatosis. [1][2][3][4][5][6][7][8] It is an uncommon entity with a worldwide incidence of 1:100,000 with greater involvement of males up to 3 times higher. It usually affects people between 30 and 50 years of age, and although its etiology is unknown, it has been associated with chromosomal effects.…”

“…In studies published between 1996 and 2002, structural alterations were found, which showed a rearrangement of bands 1p13-p22. 1,2,3,9,10,11 The clinical symptoms are nonspecific, among which we can find pain, signs of local inflammation, limitation in range of The injured tissue can be seen macroscopically as ovoid bodies or blue-white nodules, and its size can vary from millimeters to centimeters in diameter. Histologically, hyaline cartilage covered by a fibrous cap and synovial lining cells can be found.…”

“…It is used as a complementary therapy to surgical procedures to obtain optimal results, reducing the use of analgesics in addition to facilitating intraoperative en bloc resection of the affected synovial membrane. 1,7,16,17.…”