Pigmented villonodular synovitis

Case contributed by Ahmed Abdrabou
Diagnosis almost certain

Presentation

Knee joint pain, swelling and limitation of movement over the last 3 months

Patient Data

Age: 60 years
Gender: Male
x-ray
Frontal
Lateral
Download
Info

An osteolytic lesion is noted at the medial femoral condyle associated with large amount of knee joint effusion. The joint space is preserved. 

This study is a stack
Axial
T1
This study is a stack
Axial
T2
This study is a stack
Coronal PD
fat sat
This study is a stack
Sagittal
Gradient Echo
This study is a stack
Axial
T1 C+
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Sagittal T1
C+ fat sat
Download
Info

Diffuse synovial thickening that forms intra articular masses, the largest one is irregular in shape, is noted anterior to the medial femoral condyle and displaying low signal on T2 and T2* sequences. Large amount of knee joint effusion. Synovial enhancement following contrast administration is seen. 

Case Discussion

The characteristic low T2 signal intensity of the nodular synovial thickening and masses is suggestive of pigmented villonodular synovitis (PVNS) due to hemosiderin deposition from repeated hemorrhage. A biopsy was taken from the sizable mass anterior to the medial femoral condyle and confirmed the diagnosis. 

Editor's note: Per the 2020 WHO Soft Tissue and Bone Tumors Classification (5th ed.), the recommended terminology is tenosynovial giant cell tumor with pigmented villonodular synovitis no longer recommended (although remains in common use).

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

:

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.