Diffuse pigmented villonodular synovitis of the foot and ankle treated with surgery and radiotherapy

Abstract

We followed up seven patients with histologically confirmed diffuse pigmented villonodular synovitis in a prospective study between 1992 and 2001. The mean age at diagnosis was 30.7 years. The patients underwent synovectomy, followed by radiotherapy with a total dose of 35 Gy in 20 fractions. In all cases, the excision was considered incomplete when examined histologically. At an average follow up of 24 (18-36) months, six patients reported better function and reduced levels of pain. One patient remained symptomatic but did not have a recurrence. We conclude that a combined approach to a primary pigmented villonodular synovitis of the foot and ankle may reduce the risk of recurrence without functional impairment.Résumé Nous avons suivi sept malades avec une synovite villonodulaire pigmentée diffuse confirmé histologiquement dans une étude prospective entre 1992 et 2001. L'âge moyen au diagnostic était de 30,7 ans. Les malades ont subi une synovectomie suivie d'une radiothérapie avec une dose totale de 35 Gy en 20 fractions. Dans tous les cas, la résection a été considérée incomplète à l'examen histologique. À une moyenne de suivi de 24 (18-36) mois, six malades ont une meilleure fonction et un niveau réduit de douleur. Un malade est resté symptomatique, mais sans récidive. Nous concluons qu'un traitement combiné d'une synovite villonodulaire pigmenté du pied et de la cheville peut réduire le risque de récidive sans dégrada-tion fonctionnelle.

Adult multifocal pigmented villonodular synovitis—clinical review

“…In 1969, Gehweiler and Wilson showed the presence of multifocal villonodular synovitis in two patients, aged 56 and 60 years, involving both knees and respectively, knee and hip [6]. Other cases of the polyarticular form of the disease were reported, the most frequent being the symmetrical bifocal form affecting the knee, hip, shoulder, wrists, ankle and foot [7][8][9][10][11][12][13][14][15][16][17]. In 2006, Mukkopadhyay presented a case that he had been following for the past 25 years.…”

Pigmented Villonodular Synovitis Great Toe

“…Most of the cases are monoarticular and do not metastasize though they may be locally destructive [8]. MRI has been found to be the most useful investigating tool in diagnosing PVNS [7,8]. PVNS has been found to have substantial recurrence rates [7,8].…”

“…About 2.5 % cases occur in the foot and ankle. Granovitz and Mankin divided PVNS into two forms: (a) nodular and (b) diffuse [8]. Both forms can occur in the foot and ankle.…”

“…Earlier this disease was considered a low-grade synovial malignancy, which is now considered a benign disease [8]. Most of the cases are monoarticular and do not metastasize though they may be locally destructive [8]. MRI has been found to be the most useful investigating tool in diagnosing PVNS [7,8].…”

“…Our patient had nodular variety of the great toe lesion. Earlier this disease was considered a low-grade synovial malignancy, which is now considered a benign disease [8]. Most of the cases are monoarticular and do not metastasize though they may be locally destructive [8].…”