Localized intra-articular tenosynovial giant cell tumor - knee

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Acute knee pain with effusion.

Patient Data

Age: 35 years
Gender: Female
Frontal
Lateral
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Moderate suprapatellar effusion but no acute fracture or malalignment is identified.

This study is a stack
Axial PD
fat sat
This study is a stack
Coronal PD
fat sat
This study is a stack
Sagittal
PD fat sat
This study is a stack
Coronal
T1
This study is a stack
Sagittal
T1
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Large joint effusion with evidence of chronic synovitis.

Heterogeneous mass within the anterolateral aspect of the knee joint.

No Baker's cyst. Menisci are intact. No parameniscal cyst. Cruciate and collateral ligaments are intact. Posterolateral corner structures are normal.

Lateral patellar subluxation. Marked hyperintensity of the superolateral aspect of Hoffa's fat pad. Partial and full thickness medial and lateral patellar facet chondral fissuring with subchondral edema.

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Pathology report. 

Case Discussion

In retrospect, there was an opacity on the lateral knee x-ray overlying Hoffa's fat pad. Non-traumatic causes of acute knee pain are uncommon but should always be kept in the back of one's mind. Pigmented nodular synovitis (PVNS) is now termed tenosynovial giant cell tumor - this is a localized intra-articular subtype.

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