Bilateral lipoma arborescens with osteoarthritis knee: Case report and literature review

Abstract

LipomaMagnetic resonance imaging a b s t r a c t Lipoma arborescens is villous proliferation of synovium and is often unilateral in the absence of any systemic disease. We report a case of 54 year old male presenting with bilateral lipoma arborescens associated with osteoarthritis. The diagnosis is often difficult due to similar symptomatology of lipoma arborescens and osteoarthritis.

An unusual case of lipoma arborescens

“…This positioning of the bursa causes increased pressure, and that forceful pronation and mechanical trauma can create bicipitoradial bursitis. 1 In our case, the hypertrophied radial tuberosity may also have contributed to increased microtrauma in the region from raised pressures, leading to lipoma arborescens in the bicipitoradial bursa. 6 Lipoma arborescens does not appear to resolve over time and we recommend excision with synovectomy.…”

“…It is most commonly reported in the knee joint and lower limb, and less commonly in the shoulder, elbow, hip, ankle and wrist joints. 1 The case reported here illustrates a rare clinical presentation of anterior elbow pain associated with clinical features of distal biceps tendon irritation. There are two main types of lipoma arborescens: primary and secondary.…”

“…4 These characteristic features help to exclude other intraarticular synovial lesions such as rheumatoid arthritis, focal synovial lipoma, pigmented villonodular synovitis, synovial chondromatosis and synovial haemangioma (Table 1). 1,3,5 Anatomically, the bicipital bursa lies between the biceps tendon and radial cortex, with the superficial and deep radial nerve as nearby structures, making these susceptible to compression when the bursa is inflamed and distended. With greater distension, the median nerve can also be affected, as in our patient.…”

“…The exact aetiology remains unknown, the main hypothesis being a response to chronic inflammatory or traumatic stimuli. 1 Lipoma arborescens rarely affects the elbow; based on our MEDLINE ® and Embase™ search, only a few cases have been described to date. Reports involving the bicipitoradial bursa included a radiological description but none have reported a combination of gross pathology, histology and imaging.…”

Lipoma Arborescens

“…PVNS show many giant cells with haemosiderin pigments, Synovial chondromatosis show atypical chondrocytes in the synovium Rheumatoid arthritis show lymphoplasmacytic infiltrate with variable germinal centers, in contrast to Lipoma arborescences. [3] Lipoma arborescences is a rare intra articular tumor with benign indolent course, awareness of its clinical and imaging findings and possible differential diagnosis is essential for early diagnosis and treatment, as well as to avoid misinterpretation with other aggressive articular masses.…”