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Schematic overview of synovial recesses in the knee. a-d Sagittal drawings from lateral (a) to medial (d). e-h axial drawings from superior (e) to inferior (h)
Source publication
Tenosynovial giant cell tumour (TGCT) is a rare soft-tissue tumour originating from synovial lining of joints, bursae and tendon sheaths. The tumour comprises two subtypes: the localised-type (L-TGCT) is characterised by a single, well-defined lesion, whereas the diffuse-type (D-TGCT) consists of multiple lesions without clear margins. D-TGCT was p...
Contexts in source publication
Context 1
... seen in the subgastrocnemius synovial recesses and Baker's cysts [18]. D-TGCT intra-articular forms are likely to spread diffusely, developing a multicompartmental growth pattern involving at least two contiguous intra-articular synovial recesses. In the knee, several recesses may be involved, as illustrated in the detailed description of Fig. 1. to inferior (h) Spierenburg et al. Insights into Imaging (2023) 14:22 D-TGCT's extra-articular growth pattern mainly occurs secondary to intra-articular extension through transcapsular fenestrations [8]. Mastboom et al. defined extra-articular extension as TGCT involvement outside the synovial lining of the joint. Furthermore, ...
Citations
... Tenosynovial giant cell tumor (TSGCT) is a benign yet locally aggressive neoplastic disorder affecting the synovium, which includes joints, bursae, and tendon sheaths [1]. The disorder encompasses intra-articular and extra-articular manifestations [2]. ...
... L-TSGCT constitutes the most common form and is located extra-articularly in 90% of cases. It frequently involves the tendon sheaths of the volar aspect of fingers (85%), followed by locations in the foot and knee (15%) [1,8]. The knee is the most common site when presenting as intra-articular mass [8]. ...
... The knee is the most common site when presenting as intra-articular mass [8]. This type typically manifests as a painless, slowly growing soft tissue mass without joint dysfunction [1]. On the other hand, D-TSGCT originates predominantly in the intra-articular space as a unilateral, mono-articular process, most commonly affecting large joints such as the knee (70%), followed by the hip (15%), ankle, shoulder, and elbow [6,9]. ...
Simple Summary
Tenosynovial giant cell tumor is a benign yet aggressive neoplasm of the synovium that predominantly affects young patients. The tumor comprises two subtypes: the localized type and diffuse type, with the diffuse type exhibiting significantly higher aggressiveness. MRI stands out as the most valuable imaging modality for both its diagnosis and planning its treatment. When interpreting the initial MRI for suspected tenosynovial giant cell tumor, it is imperative to consider: (i) the characteristic findings of tenosynovial giant cell tumor, (ii) the potential findings of the diffuse type, and (iii) the tumor’s resectability. In interpreting follow-up MRIs of the diffuse type after treatment, it is crucial to consider both local recurrence and the development of early osteoarthritis after surgery as well as the treatment response after systemic treatment. Recognizing the distinctive MRI findings of diffuse type tenosynovial giant cell tumor before and after treatment enhances radiologic evaluation, contributing to optimal patient management.
Abstract
Tenosynovial giant cell tumor (TSGCT) is a rare soft tissue tumor that involves the synovial lining of joints, bursae, and tendon sheaths, primarily affecting young patients (usually in the fourth decade of life). The tumor comprises two subtypes: the localized type (L-TSGCT) and the diffuse type (D-TSGCT). Although these subtypes share histological and genetic similarities, they present a different prognosis. D-TSGCT tends to exhibit local aggressiveness and a higher recurrence rate compared to L-TSGCT. Magnetic resonance imaging (MRI) is the preferred diagnostic tool for both the initial diagnosis and for treatment planning. When interpreting the initial MRI of a suspected TSGCT, it is essential to consider: (i) the characteristic findings of TSGCT—evident as low to intermediate signal intensity on both T1- and T2-weighted images, with a blooming artifact on gradient-echo sequences due to hemosiderin deposition; (ii) the possibility of D-TSGCT—extensive involvement of the synovial membrane with infiltrative margin; and (iii) the resectability and extent—if resectable, synovectomy is performed; if not, a novel systemic therapy involving colony-stimulating factor 1 receptor inhibitors is administered. In the interpretation of follow-up MRIs of D-TSGCTs after treatment, it is crucial to consider both tumor recurrence and potential complications such as osteoarthritis after surgery as well as the treatment response after systemic treatment. Given its prevalence in young adult patents and significant impact on patients’ quality of life, clinical trials exploring new agents targeting D-TSGCT are currently underway. Consequently, understanding the characteristic MRI findings of D-TSGCT before and after treatment is imperative.
... There are two forms of the disease: diffuse and localized. The knee joint is more frequently affected than others [3]. Typically, only one joint is pathologically altered, though polyarticular lesion can develop. ...
... Chronic inflammation can also lead to synovial hyperplasia, making the synovial tissue more susceptible to injuries. Most authors assign PVNS to the group of tenosynovial giant cell tumors [3,4,8]. Some authors distinguish three forms of this pathology: localized form or nodular tenosynovitis, diffuse (extra-articular) giant cell tumor, and PVNS [1,3]. ...
... Most authors assign PVNS to the group of tenosynovial giant cell tumors [3,4,8]. Some authors distinguish three forms of this pathology: localized form or nodular tenosynovitis, diffuse (extra-articular) giant cell tumor, and PVNS [1,3]. Diffuse tenosynovial tumor can either be purely extra-articular, located exclusively in the soft tissues, or it can be an extra-articular component of PVNS. ...
Pigmented villonodular synovitis is a rare proliferative disease of the synovial membrane, which most often affects the knee joints. Being a benign disease, at the same time, this pathology is often aggressive, and in some cases spreads to the soft tissues outside the joint. There are two forms of monoarticular damage: localized and diffuse. The diffuse form gives frequent relapses. To date, there are no standards for the management of this disease, just as there are no early markers for the detection of pigmented villonodular synovitis. This joint lesion has a long asymptomatic course, or it has symptoms of non-specific recurrent arthritis, so the patients can later be referred for magnetic resonance imaging, which is the only non-invasive method of diagnosing this pathology. At the same time, in modern conditions, most patients with recurrent synovitis will undergo an ultrasound examination of the joint according to the diagnostic standards. Ultrasonography made for abovementioned synovitis is insufficiently described in the medical literature. The aim of our study was to highlight the current data on the diagnosis and management of patients with pigmented villonodular synovitis and to describe our own clinical case. A feature of our clinical case was the detection of characteristic symptoms using ultrasonography. Irregular thickening of the synovial membrane with nodular formations and villous growths, with the length of villi up to 7 mm near the patella with single loci of blood flow, was revealed by ultrasound examination and power Doppler mapping. Shear wave elastometry of the synovial membrane was performed. It demonstrated a significant increase in the stiffness of the synovial membrane, which can be a pathognomonic symptom of this pathology. The diagnosis of villonodular synovitis was confirmed histologically after surgical treatment. Subsequently, the patient had a recurrence of the pigmented villonodular synovitis, which was also detected by ultrasound diagnostics. Thus, pigmented villonodular synovitis of the knee joint is a rather rare pathology that requires differential diagnosis with inflammatory joint diseases. The final diagnosis is based on histological examination. MRI and ultrasound diagnostics are non-invasive methods that can detect this pathology with high accuracy. The advantage of ultrasonography is its availability and non-invasiveness. The increase in stiffness of the synovial membrane along with its proliferation, which we found, can serve as an additional criterion of villonodular synovitis, and, according to the data available to us, has not been described in the literature so far.
... For example, typical manifestations of D-TGCT by gradient-echo sequence MRI are irregular synovial thickening (>5 mm), which is generally described as "frond-like" with villous or nodular morphology, joint effusion, and extra-articular invasion, among others. 20 L-TGCTs in children are solid, tough, and nodular or lobular with a yellowish-brown gross appearance (Figure 3(b)). Microscopy shows multinucleated giant cells, monocytes, and collagen fibers (Figure 4), and immunohistochemical staining detects the expression of different antibodies, such as CD68, CD163, and CD45. ...
Background
To investigate the clinical characteristics and surgical efficacy of localized tenosynovial giant cell tumors in children.
Methods
The clinical data, surgery, and follow-up results of 17 children with localized tenosynovial giant cell tumors who visited our hospital from 2011 to 2021 were collected for statistical analysis.
Results
The median patient age was 7 years and 8 months, and the ratio of males to females was 1.43 (10/7). The predilection of disease was similar in hands and feet, and the common presenting symptom was mass. One patient experienced recurrence after surgery, and one child had postoperative functional limitations.
Conclusion
Extremities are common sites of localized tenosynovial giant cell tumors in children. Complete surgical resection helps reduce the recurrence rate.
Level of evidence
Level III
... [2] ey originate from the synovial lining of joints, tendon sheaths, and bursae. [4] e usual presentation is that of a slow-growing firm mass in the vicinity of a joint which may be associated with pain and limitation of joint movement. e etiopathogenesis involves both neoplastic and inflammatory components. ...
... Based on its growth pattern, it can be classified as L-TSGCT or D-TSGCT, the latter being rarer with an incidence rate of 5 per million and more aggressive nature with frequent recurrences after excision (14-55%). [4,5] e L-TSGCT is most prevalent and usually follows an indolent course, frequently affecting the joints of the hands. D-TSGCT, formerly known as pigmented villonodular synovitis, on the contrary, is much less common and affects the knee joint most commonly followed by the hip or shoulder. ...
... Finally, with the advent of CSF 1-receptor inhibitors, a novel therapy for patients with tumor relapse or inoperability, MRI plays a key role in assessing treatment response as well as in follow-up imaging in recurrence of D-TSGCT. [4] CONCLUSION D-TSGCT is a very rare neoplasm in the ankle and foot and should be taken into consideration as a differential diagnosis for soft-tissue tumors in this region. MRI plays a pivotal role in diagnosing the disease and assessing its extent, thus enabling clinicians for optimal treatment planning. ...
Tenosynovial giant cell tumor (TSGCT) is a rare tumor originating from the synovial lining of joints, tendon sheaths, and bursae. It is categorized into localized and diffuse types. The diffuse-type TSGCT (D-TSGCT), formerly called pigmented villonodular synovitis, although benign, can be locally aggressive. Magnetic resonance imaging is the modality of choice for diagnosing and assessing the severity of the disease. The lesions demonstrate characteristic “blooming” on gradient echo sequences. Histopathology reveals villous, nodular, or villonodular components and hemosiderin deposition. Here, we report the case of a 28-year-old man with a huge D-TSGCT in the left ankle.
... However, DWI has some pitfalls, including T2 shine-through and T2 black-out effects, due to the interaction between DWI and T2-weighted images [63]. Many review articles have included mentions of these pitfalls [64][65][66][67], but they have been noted as cautions rather than emphasizing their clinical usefulness. While these pitfalls should be interpreted with caution, they can be useful in diagnosing certain musculoskeletal diseases, as many lesions in the musculoskeletal system exhibit markedly hyperintense (i.e., ganglion cyst) or hypointense lesions (i.e., hematoma, fibrous tumor, fatty lesion, mineraliazation) on T2-weighted images. ...
Diffusion-weighted imaging (DWI) with an apparent diffusion coefficient (ADC) value is a relatively new magnetic resonance imaging (MRI) sequence that provides functional information on the lesion by measuring the microscopic movement of water molecules. While numerous studies have evaluated the promising role of DWI in musculoskeletal radiology, most have focused on tumorous diseases related to cellularity. This review article aims to summarize DWI-acquisition techniques, considering pitfalls such as T2 shine-through and T2 black-out, and their usefulness in interpreting musculoskeletal diseases with imaging. DWI is based on the Brownian motion of water molecules within the tissue, achieved by applying diffusion-sensitizing gradients. Regardless of the cellularity of the lesion, several pitfalls must be considered when interpreting DWI with ADC values in musculoskeletal radiology. This review discusses the application of DWI in musculoskeletal diseases, including tumor and tumor mimickers, as well as non-tumorous diseases, with a focus on lesions demonstrating T2 shine-through and T2 black-out effects. Understanding these pitfalls of DWI can provide clinically useful information, increase diagnostic accuracy, and improve patient management when added to conventional MRI in musculoskeletal diseases.
Background and Aim
A tenosynovial giant cell tumor (TGCT) is a proliferative lesion of the synovial membrane of the joints, tendon sheaths and/or bursae. There are two described subtypes, including the localized and diffuse forms. A TGCT can also be intraarticular or extraarticular. An intraarticular localized tenosynovial giant cell tumor (L-TGCT) of the knee is characterized by nodular hyperplasic synovial tissue that can remain asymptomatic for a long time, but as the mass grows, it may cause mechanical symptoms that may require surgical treatment. The aim of our study is to present a rare case of an L-TGCT of the knee joint treated with an arthroscopic excision.
Case Report
We describe the case of a 17-year-old female with pain, swelling and knee locking in the absence of trauma. The magnetic resonance imaging (MRI) displayed a well-circumscribed small mass in the anterior medial compartment, adherent to the infrapatellar fat pad. The lesion presented the typical MRI characteristics of an intraarticular localized TGCT. The patient was treated with an arthroscopic mass removal and partial synovectomy. The gross pathology showed an ovoid nodule that was covered by a fibrous capsule; a histopathology examination confirmed the diagnosis. The patient was able to return to normal daily activities one month after surgery; at the three-year follow-up, she was free of symptoms with no evidence of disease on the MRI.
Conclusion
In patients with a small-dimension L-TGCT in the anterior compartment of the knee that presents an MRI pattern and causes mechanical symptoms, an arthroscopic en-bloc excision can be performed that results in good outcomes and a rapid return to preinjury levels.
Purpose of review
Pigmented villonodular synovitis (PVNS) is a rare diagnosis in pediatric patients and commonly presents with symptoms of swelling and pain. Early diagnosis is important to prevent secondary degeneration into the subchondral bone. This review will analyze the etiology, clinical signs/symptoms, diagnosis, treatment, and recent literature on PVNS in the pediatric population.
Recent findings
Many theories of PVNS etiology have been described in the literature; however, an inflammatory response has been most widely accepted. PVNS can occur in any joint, but most commonly in the knee. The most common treatment for PVNS is synovectomy, and long-term follow-up is necessary to detect disease persistence or recurrence.
Summary
Although uncommon, PVNS does occur in the pediatric population and this diagnosis should be included in the differential of atraumatic joint swelling and pain.
Tenosynovial giant cell tumor (TGCT) is a rare, benign, locally aggressive synovial based neoplastic process that can result in functional debilitation and end‐stage arthrtitis. Although surgical resection is the primary treatment modality, novel systemic therapies are emerging as part of the multimodal armamentarium for patients with unresectable or complex disease burden. This review discusses the pathogenesis of TGCT, potential druggable targets and therapeutic approaches. It also evaluates the safety and efficacy of different systemic therapies.
Background and purpose: Localized tenosynovial giant cell tumors represent a rare benign proliferative disorder of the synovial and surrounding tissue. This condition has insidious and unspecific symptoms that make its diagnosis challenging. In most cases, localized tenosynovial giant cell tumors are described in the hand and are infrequent in larger joints. In the rare cases that affect the knee, the mass described in previous reports is located almost exclusively in the anterior compartment and meniscocapsular junction. The aim of the current study was to present a rare case of localized tenosynovial giant cell tumor. Case description: The paper describes the case of a twenty-eight years old Caucasian man with a localized tenosynovial giant cell tumor in the posterior compartment of the knee. Conclusion: The current study has identified a rare form of localized tenosynovial giant cell tumor. The findings of the presentation have a significant value for the differential diagnosis of the masses in the posterior knee compartment.
