Surgical Assessment of Diffuse Pigmented Villonodular Synovitis

Yıl 2012, Cilt: 45 Sayı: 1, 5 - 9, 01.04.2012

Güray Toğral Murat Arıkan Meftun Karataş Erdem Aktaş Şafak Güngör

https://doi.org/10.5505/aot.2012.43434

Öz

OBJECTIVE: One bilateral totally 16 diffuse pigmented villonodular synovitis of the knee cases was examined in terms of clinical presentations, histopathological findings and surgical outcome.METHODS: 16 patients with the diagnosis of DPVNS were retrospectively analyzed with a period of 4 years. The mean age was 30 years (16-44). 10 patients were male and 6 patients were female. Nine patients left and 7 patients right knees were affected. Pain, swelling and pressure symptoms caused by mass effect were the most common clinical findings.RESULTS: The most common physical examination finding was suprapatellar swelling (40%). Effusion in the knee joint was detected in 95% of the patients. There was mean of 1.5 cm thigh atrophy in 11 patients. Flexion contracture about 10 degrees in the affected knee was noted in 12 patients. Three of 8 patients that knee aspiration was performed have characteristic sero-hemorrhagic fluid.CONCLUSION: We think that physical examination and history is very important in diagnosis of patients with PVNS. Aspiration of the joint should be avoided. Open or arthroscopic syneviectomy is the primary treatment of PVNS.

Anahtar Kelimeler

Pigmented villonodular synovitis, Hemorrhagic effusion; Knee; Synovial membrane

Diffüz Pigmente Villonodüler Sinovite Cerrahi Yaklaşım

Öz

AMAÇ: Diz ekleminde diffüz pigmente villonodüler sinovit tanısı alan biri bilateral 16 olgu klinik, histopatolojik bulgular ve cerrahi tedavi sonuçları açısından incelenmiştir.YÖNTEMLER: Diffüz pigmente villonodüler sinovit (DPVNS) tanısı alan 16 olgunun 4 yıllık takip sonuçları retrospektif olarak incelenmiştir. Yaş aralığı 16 ile 44 (ortalama 30) olan hastaların 10'u erkek, 6'sı kadındı. 9 hastada sol, 7 hastada sağ diz eklem tutulumu mevcuttu. Ağrı, şişlik ve kitle etkisi ile oluşan bası semptomları varlığı en sık görülen semptomlardı.BULGULAR: Fizik muayenede en sık bulgu (%40) özellikle suprapatellar bölgede görülen şişlik idi. Hastaların %95'inde klinik olarak diz ekleminde efüzyon mevcuttu. Hastaların 11'inde ortalama 1.5 cm olarak ölçülen uyluk atrofisi vardı. Oniki hastada ise tutulan eklemde 10 dereceye varan fleksiyon kontraktürü mevcuttu. 8 hastaya başvuru öncesi tanı amaçlı diz eklem içi aspirasyon yapılmıştı ve sadece 3 hastada aspirasyonda karakteristik sero-hemorojik sıvı içeriği gözlendi.SONUÇ: Biz DPVNS'de hastaların tanısında fizik muayene bulguları ve anamnezlerinin çok önemli olduğunu düşünmekteyiz. Ayrıca bu hastalarda öncelikli olarak hastalığın akla getirilmesi ve ön planda artrosenteze başvurulmaması gerektiği kanısındayız. PVNS'nin hala günümüzde primer tedavisi açık veya artroskopik olarak yapılan sinovyektomidir.

Anahtar Kelimeler

Pigmente villonodüler sinovit, Hemorajik efüzyon; Diz; Sinovyal membran

Kaynakça

• Jaffe HL, Lichtenstein L, Sutro CJ. Pigmented villonodular synovitis. bursitis and tenosynovitis: Arch. Pathol 1941;31:731-65
• Myers BW, Masi AT. Pigmented villonodular synovitis and tenosynovitis: A clinical epidemiologic study of 166 cases and literature review. Medicine (Baltimore) 1980;59:223-38
• Kay RM, Eckardt JJ, Mirra MM. Multifocal Pigmented Villonodular Synovitis in a Child. Clin Orthop 1996;322:194-7
• Klammer G, Betz M, Delaloye B, Farshad M, Peter KP. synovitis of the knee. J Knee Surg. 2013;26 Suppl 1:S67-71 pigmented villonodular
• Ma X, Shi G, Xia C, Liu H, He J, Jin W. Pigmented villonodular synovitis: a retrospective study of seventy five cases (eighty one joints). Int Orthop 2013;37:1165-70
• Byers PD, Cotten RE, Deacon 0W, et al. The diagnosis and treatment of pigmented villonodular synovitis. J Bone Joint Surg 1968;50:290-3
• Jobe CM, Raza A, Zuckerman L. Pigmented villonodular synovitis: extrasynovial recurrence. Arthroscopy 2011;27:1449-51
• Vigorita VJ: Pigmented villonodular synovitislike lesions in association with rare cases of rheumatoid arthritis, osteonecrosis. and advanced degenerative joint disease. Report of five cases. Clin Orthop 1984;183:l-15
• Palumbo RC, Matthews LS, Reuben JM. Localized pigmented villonodular synovitis of the patellar fat pad: a report of two cases. Arthroscopy 1994;10:400- 3
• Schwartz HS1, Unni KK, Pritchard DJ. Pigmented villonodular synovitis. A retrospective review of affected large joints. Clin Orthop Relat Res 1989;247:243-55
• Verspoor FG, Zee AA, Hannink G, van der Geest IC, Veth RP, Schreuder HW. Long-term follow-up results villonodular synovitis. Rheumatology (Oxford). 2014;53:2063-70 recurrent pigmented
• Chung SMK, Janes JM. Diffuse pigmented villonodular synovitis of the hip. Revievv of the literatüre and report of four cases. J Bone Joint Surg 1965;47:293-303
• Van Meter CD, Rowdon GA. Localized pigmented villonodular synovitis presenting as a locked lateral meniscal bucket handle tear: a case report and review of the literature. Arthroscopy 1994;10:309-12
• Bronstein RD, Sebastianelli WJ, DeHaven KE. Localized presenting as a loose body in the knee. Arthroscopy 1993;9:596-8 villonodular synovitis