Diffused Pigmented Vilonodular Synovitis / Diffuse Type Tenosynovial Giant Cell Tumour of the knee treated with arthroscopic synovectomy and adjuvant Yttrium local infiltration. A case report, a “safe treatment algorithm” and the peer literature
Pigmented villonodular synovitis (PVNS) is a unique mesenchymal lesion that arises from the synovial tissue of the joints. It is divided into a localized type (LPVNS) and a diffuse type (LPVNS) also known as Tenosynovial Giant Cell Tumor. The latter, is a predominantly intra-articular, aggressive, infiltrative process, characterized by both inflammatory or neoplastic properties and local destructive progression. A high recurrence rate is observed after surgical synovectomy alone. The positivity of colony-stimulated factor 1 (CSF1), its receptor (CSF1R), and receptor activator of nuclear factor kappa-B ligand (RANKL) with the clinical outcomes and the recurrence rates is a field of interest in therapeutic targeting with the use of biological factors/agents such as anti-TNFa. Adjuvant intra-articular injection of Yttrium-90 in the immediate post-operative period effectively reduces the rates of local recurrence. We present the case of a 59-year-old female patient with diffuse PVNS of the left knee treated with arthroscopic synovectomy and adjuvant Yttrium-90 local infiltration following a “safe treatment algorithm”.
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