Non-pigmented villonodular synovitis of knee joint in a 11-year-old boy on long term steroids: a case report
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20222720Keywords:
PVNS, Pediatric, Steroid, Yellow fatty, Arthroscopic synovectomyAbstract
Pigmented villonodular synovitis (PVNS) is a rare condition, commonly affecting the knee joint and hip joint. It is seldomly seen in pediatric age group. Aetiology is unknown. Magnetic resonance imaging (MRI) is the imaging modality of choice. Managed by surgical resection of the synovium performed with an open, arthroscopic or combined approach. Post-operative adjuvant external beam radiotherapy have reduced recurrence rate. In this case report we are going to present a rare case of eleven-year-old boy on long term steroid intake, who presented with a history of pain and swelling of right knee joint with restriction of range of movements. MRI suggested extensive villonodular synovitis of knee joint. Diagnostic arthroscopy showed extensive villonodular synovitis of suprapatellar pouch, medial gutter, lateral gutter, intercruciate space, posterior-medial and posterior-lateral compartments and villi had atypical yellow fatty appearance. Extensive arthroscopic synovectomy was done and histopathology showed chronic synovitis. Post-operatively pain and swelling reduced and range of movements improved. Arthroscopic synovectomy is the most effective line of management for villonodular synovitis.
References
Sitati FC. Pigmented villonodular synovitis of the knee: a case report. East Afr Orthop J. 2010;4(1).
Myers BW, Masi AT. Pigmented villonodular synovitis and tenosynovitis: a clinical epidemiologic study of 166 cases and literature review. Medicine (Balt). 1980;59:223-38.
Xie GP, Jiang N, Liang CX. Pigmented villonodular synovitis: a retrospective multicenter study of 237 cases. PloS One. 2015;10(3):e0121451.
Ramesh B, Shetty S, Bastawrous SS. Pigmented villonodular synovitis of the knee in a patient on oral anticoagulation therapy: a case report. J Med Case Rep. 2009;3(1):1-3.
Pearse OE, Klass B, Bendall SP. Pigmented villonodular synovitis of the ankle occurring in a patient on anticoagulation therapy. J Surg Orthop Adv. 2004;13(4):217-9.
Matsui H, Takahashi Y, Matsunaga T, Tanaka-Horie T, Minowa H, Sugimoto M et al. Successful arthroscopic treatment of pigmented villonodular synovitis of the knee in a patient with congenital deficiency of plasminogen activator inhibitor-1 and recurrent haemarthrosis. Haemostasis. 2001;31:106-12.
Rodriguez-Merchan EC. Review article: open versus arthroscopic synovectomy for pigmented villonodular synovitis of the knee. J Orthop Surg. 2014;22:406-8.
Park G, Kim YS, Kim JH. Low-dose external beam radiotherapy as a postoperative treatment for patients with diffuse pigmented villonodular synovitis of the knee: 4 recurrences in 23 patients followed for mean 9 years. Acta Orthop. 2012;83:256-60.
Brenner JS. Pigmented villonodular synovitis causing painless chronic knee swelling in an adolescent. Clinical pediatrics. 2007;46(3):268-71.
Monu J, Elvey S. Pigmented Villonodular Synovitis. eMedicine April 1, 2002. Available at: http://emedicine. com/radio/topic553.htm. Accessed on May 30, 2005.
Haims A, Jokl P. Pigmented villonodular synovitis. In: Johnson TR, Steinbach LS, eds. Essentials of Musculoskeletal Imaging. Rosemont, IL: Am Academy Orthop Surgeons. 2004;533-4.
Tyler WK, Vidal AF, Williams RJ, Healey JH. Pigmented villonodular synovitis. J Am Acad Orthop Surg. 2006;14:376-85.
Lynskey SJ, Pianta MJ. MRI and thallium features of pigmented villonodular synovitis and giant cell tumours of tendon sheaths: a retrospective single centre study of imaging and literature review. Br J Radiol. 2015;88:20150528.
Goldman AB, DiCarlo EF. Pigmented villonodular synovitis. Diagnosis and differential diagnosis. Radiol Clin North Am. 1988;26:1327-47.
Monu JU, Oka M. Synovial osteochondromatosis. eMedicine. 2004. Available at: http://www.emedicine. com/radio/topic667.htm. Accessed on May 30, 2005.
Johnston JO. Synovial sarcoma. In: Johnson TR, Steinbach LS, eds. Essentials of Musculoskeletal Imaging. Rosemont, Ill. Am Academy Orthop Surgeons. 2004;166-70.
Ramseier L, Exner G. Arthropathy of the knee joint caused by synovial hemangioma. J Pediatr Orthop. 2004;24:83-86.
Ogilvie-Harris D, McLean J, Zarnett M. Pigmented villonodular synovitis of the knee: arthroscopic synovectomy, partial arthroscopic synovectomy, and arthroscopic local excision. J Bone Joint Surg. 1992;74:119-23.
Flandry F, Hughston J, Jacobson K, Barrack R, McCann S, Kurtz D. Surgical treatment of diffuse pigmented villonodular synovitis of the knee. Clin Orthop. 1994;300:183-92.
Chin K, Barr S, Winalski C, Zurakowski D, Brick G. Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg. 2002;84:2192-2202.
Poutoglidou F, Metaxiotis D, Mpeletsiotis A. Pigmented villonodular synovitis of the knee joint in a 10-year-old patient treated with an all-arthroscopic synovectomy: A case report. Cureus. 2020;12(12).