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
Keywords:
Pigmented Villonodular Synovitis, Arthroscopic Synovectomy, Biological factors, Yttrium-90 infiltrationAbstract
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”.
Downloads
References
2. Dorwart DH, Genant HK, Johnston WH, et al. Pigmented villonodular synovitis of synovial joints: clinical, pathologic, and radiologic features. Am J Roentgenol. 1984 Oct;143(4):877-885.
3. Temponi EF , Barros AA, Paganini VO, et al. Diffuse pigmented villonodular synovitis in knee joint: diagnosis and treatment. Rev Bras Ortop. 2017 Jun-Jul; 52(4): 450–457.
4. Byers PD, Cotton RE, Deacon OW, et al: The diagnosis and treatment of pigmented villonodular synovitis. J Bone Joint Surg Br 1968; 50:290-305.
5. Fiocco U, Sfriso P, Lunardi F, et al. Molecular pathways involved in synovial cell inflammation and tumoral proliferation in diffuse pigmented villonodular synovitis. Autoimmune Rev 2010; 9(11):780-784.
6. Ota T, Uarkawa H, Kozawa E, et al. Expression of colony-stimulating factor 1 is associated with occurrence of osteochondral change in pigmented villonodular synovitis. Tumour Biol. 2015 Jul; 36(7): 5361–5367.
7. Kroot E-J am Smeet TJM, Maas M, et al. Tumour necrosis factor blockade in treatment resistant pigmented villonodular synovitis. Annals of Rheumatic Diseases 2005; 64(3): 497-499.
8. Auregan JC, Klouche S, Bohu Y, et al. Treatment of pigmented villonodular synovitis of the knee. Arthroscopy 2014;30(10):1327-1341.
9. Patel KH, Gikas PD, Pollock RC, et al. Pigmented villonodular synovitis of the knee: A retrospective analysis of 214 cases at a UK tertiary referral center. Knee 2017 Aug.24(4):808-815.
10. Zalewska J, Węgierska M, Barczyńska T, et al. Efficacy of radiation synovectomy (radiosynovectomy or radiosynoviorthesis) with yttrium-90 in exudative inflammation of synovial membrane of knee joints in patients with rheumatic diseases - preliminary report. Reumatologia. 2016;54(1):3-9.
11. Chojnowski MM, Felis-Giemza A, Kobylecka M. Radionuclide synovectomy – essentials for rheumatologists. Reumatologia. 2016; 54(3): 108–116.
12. Turkmen C. Safety of radiosynovectomy in hemophilic synovitis: it is time to re-evaluate. J Coagul Dis 2009; 1:1–8.
13. Boerbooms AM, Buijs W, Danen M, et al. Radio-synovectomy in chronic synovitis of the knee joint in patients with rheumatoid arthritis. Eur J Nucl Med 1985; 10:446–449.
14. Kollender Y, Bender B, Nirkin A, et al. Intra-articular Yttrium 90 injection as an adjuvant following resection of diffused pigmented villonodular synovitis. Orthopaedic Proceedings 2018; 87-B, Supp III..
15. Oztemür Z, Bulut O, Korkmaz O, et al. Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis. Rheumatol Int. 2013 May;33(5):1321-1326.
16. Karaman I, Guney A, Dogar F, et al. Comparison of Arthroscopic, Radioactive and Combined Synovectomy in the Treatment of Chronic Non-Specific Knee Synovitis. Med Princ Pract 2014 Nov; 23(6): 551–555.
17. Brahmi M, Vinceneux A, Cassier PA. Current Systemic Treatment Options for Tenosynovial Giant Cell Tumor/Pigmented Villonodular Synovitis: Targeting the CSF1/CSF1R Axis. Curr Treat Options Oncol 2016 Feb;17(2):10.
