Abstract
Treatment of extensive diffuse pigmented villonodular synovitis (PVNS) of large joints by isolated surgical resection is unsatisfactory, with high rates of local recurrence. Post-synovectomy adjuvant treatment with external beam radiation therapy or intra-articular injection of radioactive material as yttrium-90 (90Y) yielded better results. Between January 2005 and January 2007, 12 patients (eight men and four women aged 19–49 years) with extensive diffuse PVNS of the knee were treated. All patients had an adjuvant post-operative external beam radiation therapy (2,600–3,000 cGy) conventionally fractionated 200 cGy/fraction, five fractions/week, 6–8 weeks after surgery. Mean follow-up time was 27 months (range from 20 to 36 months). All patients were followed up using clinical assessment, magnetic resonance imaging, and plain X-ray. In all patients, neither evidence of disease recurrence nor progression of bone or articular destruction was noted. No complications were noticed after surgery or after post-operative external beam radiation therapy. A combination of debulking surgery using anterior and posterior approach with adjuvant post-operative external beam radiation therapy for extensive diffuse PVNS of the knee joint is a reliable treatment method, with good results in regard to the incidence of local recurrence and functional outcome.
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Jaffe HL, Lichtenstein L, Sutro CJ (1941) Pigmented villonodular synovitis: bursitis and tenosynovitis. Arch Pathol 31:731–765
Flandry FC, Hughston JC (1987) Current concepts review: pigmented villonodular synovitis. J Bone Joint Surg 69:942
Dorwart RH, Genant HK, Johnston WH et al (1984) Pigmented villonodular synovitis of synovial joints: clinical, pathologic and radiologic features. AJR Am J Roentgenol 143:877–885
Ray RA, Morton CC, Lipinski KK et al (1991) Cytogenetic evidence of clonality in a case of pigmented villonodular synovitis. Cancer 67:121–125 doi:10.1002/1097-0142(19910101)67:1<121::AID-CNCR2820670122>3.0.CO;2-P
Rao AS, Vigorita VJ (1984) Pigmented villonodular synovitis (giant cell tumor of the tendon sheath and synovial membrane). A review of 81 cases. J Bone Joint Surg Am 66:76–94
Bravo SM, Winalski CS, Weissman BN (1996) Pigmented villonodular synovitis. Radiol Clin North Am 34:311–326
Schwartz HS, Unni KK, Pritchard DJ (1989) Pigmented villonodular synovitis. A retrospective review of affected large joints. Clin Orthop 247:243–255
Sakkers RJ, deJong D, van der Heul RO (1991) X-chromosome inactivation in patients who have pigmented villonodular synovitis. J Bone Joint Surg Am 73:1532–536
Choong PF, Willen H, Nilbert M et al (1995) Pigmented villonodular synovitis. Monoclonality and metastasis—a case for neoplastic origin? Acta Orthop Scand 66:64–68
Ohjimi Y, Iwasaki H, Ishiguro M et al (1996) Short arm of chromosome 1 aberration recurrently found in pigmented villonodular synovitis. Cancer Genet Cytogenet 90:80–85 doi:10.1016/0165-4608(96)00064-7
Franssen MJ, Boerbooms AM, Karthaus RP, Buijs WC et al (1989) Treatment of pigmented villonodular synovitis of the knee with yttrium-90 silicate: prospective evaluations by arthroscopy, histology and 99 mTc pertechnetate uptake measurements. Ann Rheum Dis 48:1007–1013 doi:10.1136/ard.48.12.1007
Enneking WF, Dunham W, Gebhardt MC et al (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 286:241–246
Adem C, Sebo TJ, Riehle DL et al (2002) Recurrent and non-recurrent pigmented villonodular synovitis. Ann Pathol Dec 22(6):448–452
Kat S, Kutz R, Elbracht T et al (2000) Radiosynovectomy in pigmented villonodular synovitis. Nucl Med 39(7):209–213
Shabat S, Kollender Y, Merimsky O et al (2002) The use of surgery and yttrium 90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints. Rheumatology (Oxford) 41(10):1113–1118, Oct
Franke C (2000) Value of radiosynovectomy in rheumatology and orthopedics. Schweiz Med Wochenschr 130:77–83
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Level of evidence: level IV—retrospective case series
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Nassar, W.A.M., Bassiony, A.A. & Elghazaly, H.A. Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee with Combined Surgical and Radiosynovectomy. HSS Jrnl 5, 19–23 (2009). https://doi.org/10.1007/s11420-008-9104-5
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DOI: https://doi.org/10.1007/s11420-008-9104-5