Subacromial pigmented villonodular synovitis: case report and review

Abstract

Pigmented villonodular synovitis (PVNS) is a non-neoplastic proliferative process that involves synovial tissue in the joints, tendon sheaths and bursae. It usually occurs in young adults, aged 20–50 years, is characteristically monoarticular and of slow progression. Clinical symptoms are nonspecific, and joint stiffness and pain are common in long-term cases. Shoulder PVNS is known to be extremely rare, especially when affecting the subacromial bursal region without joint involvement. Magnetic resonance is the imaging modality of choice in PVNS and is useful for diagnosis, surgical planning and monitoring. Complete surgical synovectomy remains the treatment of choice, and all pathological synovial tissue should be removed. Patients who are not properly treated can progress to joint destruction. We describe a case of PVNS in the subacromial bursa of a 15-year-old patient, with exuberant symptoms and 2 years of evolution, treated with extensive synovectomy and good clinical results in the 1-year follow-up.

Clinical outcomes of patients with pigmented villonodular synovitis of the shoulder after arthroscopic synovectomy

“…PVNS is a rare benign tumor characterized by synovial proliferation [ 5 ]. Shoulder PVNS is rather rarer [ 2 ]. This retrospective case series proved the low ratio of shoulder PVNS in all PVNS cases, which is as low as 2.6%.…”

“…Nevertheless, the patient refused further follow-up so that the outcome of a long-term follow-up is unavailable. To our knowledge, although only 5 patients and 8 surgeries were enrolled, this study is still one of the studies with the most cases of shoulder PVNS compared to previous case reports and case series focusing on shoulder PVNS [ 1 , 2 , 14 , 15 , 17 , 21 – 23 ]. Furthermore, the mean follow-up time of this study is also one of the longest.…”

“…Though a rare condition, this benign, highly proliferative neoplasm may result in massive joint destruction [1,5]. What is more, patients reported by previous studies suggests that shoulder PVNS is often accompanied with massive rotator cuff tear [1,2]. The poor rotator cuff condition would not only further impair the function of shoulder joint and seriously reduces the patients' life quality, but also strongly influence the final clinical outcomes.…”

“…Pigmented villonodular synovitis (PVNS) is an unusual clinical condition characterized by benign tissue proliferation that involves synovium, tendon sheath, and bursa [ 1 , 2 ]. The most affected joints are the knee and the hip [ 3 ].…”

“…Shoulder PVNS is known to be extremely rare, accounting for about 2.0% to 8.0% in all PVNS cases [2,5,6]. Accordingly, few studies have focused on this situation, and, as a result, there is no accepted guideline for the treatment of PVNS as far as we know.…”