Pigmented Villonodular Synovitis: A Retrospective Multicenter Study of 237 Cases

Abstract

PurposeTo review clinical characteristics of pigmented villonodular synovitis (PVNS) in China.MethodsElectronic medical records (EMR) of four Chinese institutes were queried for patients with histologically proven PVNS between January 2005 and February 2014. Their data were collected including gender, age at diagnosis, clinical presentation, affected site, symptom duration, comorbidities, treatment strategy, recurrence and routine laboratories.ResultsA total of 237 patients with biopsy-proven PVNS were investigated. The gender ratio was 1.35 for a female predominance (101 males and 136 females). The average age was 36 years (range, 2 to 83 years). The median delay from initial clinical symptom to diagnosis was 18 months. Main affected areas were the knee (73.84%) and the hip (18.14%). Forty patients had a clear history of joint trauma. Six patients were concurrently diagnosed with PVNS and avascular necrosis (AVN). Five patients suffered from PVNS following implantation of orthopaedic devices including artificial prosthesis, plate and wire. One hundred and twenty-nine patients underwent arthroscopic synovectomy and 108 open synovectomy. Altogether 48 patients (26 males and 22 females) had recurrence of disease. The relapse rate was 24% (knee) and 6.98% (hip), 20.93% (open surgery) and 19.44% (arthroscopy), respectively. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) rate were elevated in 45.83% and 38.41% of the patients respectively.ConclusionsTo our knowledge, this study is the largest sample size of PVNS patients reported as well as the largest sample of PVNS with concurrent AVN reported to date. Our outcomes suggest that PVNS shows a female predominance, occurs mostly between 20–40 years and favors the knee and hip. Recurrence is frequent, particularly in the knee. Serum ESR and CRP may be elevated in some patients. Additionally, the present study supports the theory of an association between PVNS and orthopedic surgery, which is not limited to joint replacement.

Pigmented villonodular synovitis mimics metastases on fluorine 18 fluorodeoxyglucose position emission tomography-computed tomography

“…It primarily affects the knee with reports ranging from 66-80% of cases. Other sites include hips, ankle, shoulder and elbow in descending order of prevalence (6,8).…”

“…It is currently unknown how many, if any, patients with PVNS is often an incidental finding and the nonspecific nature of clinical symptoms often delays definitive diagnosis to an average of 2-3 years (8). Another reason for the delay in diagnosis lies in the fact that PVNS can mimic other conditions such as joint effusions, amyloidosis, severe osteoarthritis, myeloma and metastatic disease as well (6).…”

Multifocal pigmented villonodular synovitis in a child

“…[14–16] In the largest report, which involved 237 patients, the median delay from initial clinical symptoms to final diagnosis was ∼18 months. [16] Because PVNS has a much lower incidence in pediatrics, this disease is more easily misdiagnosed in children. PVNS requires radical treatment that combines prosthetic arthroplasty and synovectomy.…”

Intramuscular Cysts at the Proximal Calf: Two Case Reports and a Systematic Review of Literature

“…It is a benign but aggressive pathology of the synovium, often localized to the knee joint [45,46]. It is characterized by synovial proliferation and hemosiderin deposition inside the joints, tendon sheaths, and bursae.…”