Villonodular synovitis (PVNS) of the spine
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
To describe the imaging features of spinal pigmented villonodular synovitis (PVNS).
Design and patients
We retrospectively reviewed 15 cases of pathologically proven spinal PVNS. Patient demographics and clinical presentation were reviewed. Radiologic studies were evaluated by consensus of two musculoskeletal radiologists for spinal location, spinal segments affected, lesion center, detection of facet origin and intrinsic characteristics on radiography (n =11), myelography (n =7), CT (n =6) and MR imaging (n =6).
Women (64%) were more commonly affected than men (36%) with an average age of 28 years. Clinical symptoms were pain (45%), neurologic (9%) or both (36%). Lesions most frequently affected the cervical spine (53%) followed by the thoracic (27%) and lumbar regions (20%). The majority of lesions (93%) were centered in the posterior elements with frequent involvement of the pedicle (67%), neural foramina (73%), lamina (67%) and facets (93%). No lesions showed calcification. Determination of a facet origin by imaging was dependent on imaging modality and lesion size. A facet origin could be determined in 45% of cases by radiography vs 67% of patients by CT (n=6) and MR (n=6). Large lesions (greater than 3 cm in at least one dimension) obscured the facet origin in all cases with CT and/or MR imaging (44%,n=4). Small lesions (less than 3 cm in any dimension) demonstrated an obvious facet origin in all cases by CT and/or MR imaging (56%,n=5). Low-to-intermediate signal intensity was seen in all cases on T2-weighted MR images resulting from hemosiderin deposition with “blooming effect” in one case with gradient echo MR images.
PVNS of the spine is rare. Large lesions obscure the facet origin and simulate an aggressive intraosseous neoplasm. Patient age, a solitary noncystic lesion centered in the posterior elements, lack of mineralization and low-to-intermediate signal intensity on all MR pulse sequences may suggest the diagnosis in these cases. Small lesions demonstrate a facet origin on CT or MR imaging. This limits differential considerations to synovial-based lesions and additional features of a solitary focus, lack of underlying disease or systemic arthropathy, no calcification as well as low-to-intermediate signal intensity on all MR images should allow spinal PVNS to be suggested as the likely diagnosis.
- Al-Nakshabandi NA, Ryan AG, Choudur H, et al. Pigmented villonodular synovitis. Clin Radiol 2004; 59:414–420.
- Flandry F, Hughston JC. Pigmented villonodular synovitis. J Bone Joint Surg Am 1987; 69:942–949.
- Jaffe H, Lichtenstein L. Pigmented villonodular synovitis, bursitis and tenosynovitis. Arch Pathol 1941; 31:731–765.
- Bravo SM, Winalski CS, Weissman BN. Pigmented villonodular synovitis. Radiol Clin North Am 1996; 34:311–326, x-xi.
- Llauger J, Palmer J, Roson N, Cremades R, Bague S. Pigmented villonodular synovitis and giant cell tumors of the tendon sheath: radiologic and pathologic features. AJR Am J Roentgenol 1999; 172:1087–1091.
- Ly JQ, Carlson CL, LaGatta LM, Beall DP. Giant cell tumor of the peroneus tendon sheath. AJR Am J Roentgenol 2003; 180:1442.
- Lin J, Jacobson JA, Jamadar DA, Ellis JH. Pigmented villonodular synovitis and related lesions: the spectrum of imaging findings. AJR Am J Roentgenol 1999; 172:191–197.
- Balsara ZN, Stainken BF, Martinez AJ. MR image of localized giant cell tumor of the tendon sheath involving the knee. J Comput Assist Tomogr 1989; 13:159–162.
- Huang GS, Lee CH, Chan WP, Chen CY, Yu JS, Resnick D. Localized nodular synovitis of the knee: MR imaging appearance and clinical correlates in 21 patients. AJR Am J Roentgenol 2003; 181:539–543.
- Jelinek JS, Kransdorf MJ, Shmookler BM, Aboulafia AA, Malawer MM. Giant cell tumor of the tendon sheath: MR findings in nine cases. AJR Am J Roentgenol 1994; 162:919–922.
- Kransdorf M, Murphey M. Imaging of soft tissue tumors. Philadelphia: Saunders, 1997; 57–101.
- Bruecks AK, Macaulay RJ, Tong KA, Goplen G. November 2000:13 year old girl with back pain and leg weakness. Brain Pathol 2001; 11:263–264.
- Bui-Mansfield LT, Youngberg RA, Coughlin W, Chooljian D. MRI of giant cell tumor of the tendon sheath in the cervical spine. J Comput Assist Tomogr 1996; 20:113–115. CrossRef
- Bullough PG. Pigmented villonodular synovitis and synovial cysts of the spine [comment]. AJNR Am J Neuroradiol 1992; 13:167–168.
- Campbell AJ, Wells IP. Pigmented villonodular synovitis of a lumbar vertebral facet joint. J Bone Joint Surg Am 1982; 64:145–146.
- Clark LJ, McCormick PW, Domenico DR, Savory L. Pigmented villonodular synovitis of the spine. Case report. J Neurosurg 1993; 79:456–459.
- Clerc D, Berge E, Benichou O, Paule B, Quillard J, Bisson M. An unusual case of pigmented villonodular synovitis of the spine: benign aggressive and/or malignant? Rheumatology (Oxford) 1999; 38:476–477.
- Gezen F, Akay KM, Aksu AY, Beduk A, Seber N. Spinal pigmented villonodular synovitis: a case report. Spine 1996; 21:642–645. CrossRef
- Giannini C, Scheithauer BW, Wenger DE, Unni KK. Pigmented villonodular synovitis of the spine: a clinical, radiological, and morphological study of 12 cases. J Neurosurg 1996; 84:592–597.
- Graham EJ, Kuklo TR, Kyriakos M, Rubin DA, Riew KD. Invasive pigmented villonodular synovitis of the atlantoaxial joint: a case report. J Bone Joint Surg Am 2002; 84:1856–1860.
- Karnezis TA, McMillan RD, Ciric I. Pigmented villonodular synovitis in a vertebra. A case report. J Bone Joint Surg Am 1990; 72:927–930.
- Khoury GM, Shimkin PM, Kleinman GM, Mastroianni PP, Nijensohn DE. Computed tomography and magnetic resonance imaging findings of pigmented villonodular synovitis of the spine. Spine 1991; 16:1236–1237.
- Parmar HA, Sitoh YY, Tan KK, Teo J, Ibet SM, Hui F. MR imaging features of pigmented villonodular synovitis of the cervical spine. AJNR Am J Neuroradiol 2004; 25:146–149.
- Pulitzer DR, Reed RJ. Localized pigmented villonodular synovitis of the vertebral column. Arch Pathol Lab Med 1984; 108:228–230.
- Savitz MH. Pigmented villonodular synovitis. J Neurosurg 1994; 80:956–958.
- Titelbaum DS, Rhodes CH, Brooks JS, Goldberg HI. Pigmented villonodular synovitis of a lumbar facet joint. AJNR Am J Neuroradiol 1992; 13:164–166.
- Weidner N, Challa VR, Bonsib SM, Davis CH, Jr., Carrol TJ, Jr. Giant cell tumors of synovium (pigmented villonodular synovitis) involving the vertebral column. Cancer 1986; 57:2030–2036.
- Furlong MA, Motamedi K, Laskin WB, et al. Synovial-type giant cell tumors of the vertebral column: a clinicopathologic study of 15 cases, with a review of the literature and discussion of the differential diagnosis. Hum Pathol 2003; 34:670–679. CrossRef
- Chevrot A, Vallee C. Imaging of degenerative disk diseases. Curr Opin Radiol 1992; 4:103–114.
- Gorey MT, Hyman RA, Black KS, Scuderi DM, Cinnamon J, Kim KS. Lumbar synovial cysts eroding bone. AJNR Am J Neuroradiol 1992; 13:161–163.
- Savitz MH, Katz SS, Goldstein H, Worcester D. Hypertrophic synovitis of the lumbar facet joint in two cases of herniated intervertebral disc. Mt Sinai J Med 1982; 49:434–437.
- Savitz MH, Katz SS, Goldstein HB, Worcester D. Hypertrophic synovitis of the facet joint forming a para-articular mass in cases of herniated intervertebral disc. Spine 1987; 12:509–510.
- Sachdev VP, Savitz MH, Hindi AI, Goldstein HB. Synovial cysts of the lumbar facet joint. Mt Sinai J Med 1991; 58:125–128.
- Unni KK. Pigmented villonodular synovitis (comment). J Neurosurg 1994; 80:958.
- McCormick PW. Pigmented villonodular synovitis (comment). J Neurosurg 1994; 80:957–958.
- Flemming DJ, Murphey MD, Carmichael BB, Bernard SA. Primary tumors of the spine. Semin Musculoskelet Radiol 2000; 4:299–320. CrossRef
- Lucas DR, Unni KK, McLeod RA, O’Connor MI, Sim FH. Osteoblastoma: clinicopathologic study of 306 cases. Hum Pathol 1994; 25:117–134. CrossRef
- Kroon HM, Schurmans J. Osteoblastoma: clinical and radiologic findings in 98 new cases. Radiology 1990; 175:783–790.
- McLeod RA, Dahlin DC, Beabout JW. The spectrum of osteoblastoma. Am J Roentgenol 1976; 126:321–325.
- Shives TC, McLeod RA, Unni KK, Schray MF. Chondrosarcoma of the spine. J Bone Joint Surg Am 1989; 71:1158–1165.
- Camins MB, Duncan AW, Smith J, Marcove RC. Chondrosarcoma of the spine. Spine 1978; 3:202–209.
- Hermann G, Sacher M, Lanzieri CF, Anderson PJ, Rabinowitz JG. Chondrosarcoma of the spine: an unusual radiographic presentation. Skeletal Radiol 1985; 14:178–183.
- Bjornsson J, Wold LE, Ebersold MJ, Laws ER. Chordoma of the mobile spine. A clinicopathologic analysis of 40 patients. Cancer 1993; 71:735–740.
- de Bruine FT, Kroon HM. Spinal chordoma: radiologic features in 14 cases. AJR Am J Roentgenol 1988; 150:861–863.
- Firooznia H, Golimbu C, Rafii M, Reede DL, Kricheff, 2nd, Bjorkengren A. Computed tomography of spinal chordomas. J Comput Tomogr 1986; 10:45–50. CrossRef
- Koci TM, Mehringer CM, Yamagata N, Chiang F. Aneurysmal bone cyst of the thoracic spine: evolution after particulate embolization. AJNR Am J Neuroradiol 1995; 16:857–860.
- Kumar R, Guinto FC, Jr., Madewell JE, David R, Shirkhoda A. Expansile bone lesions of the vertebra. Radiographics 1988; 8:749–769.
- Murphey MD, Andrews CL, Flemming DJ, Temple HT, Smith WS, Smirniotopoulos JG. From the archives of the AFIP. Primary tumors of the spine: radiologic pathologic correlation. Radiographics 1996; 16:1131–1158.
- Beltran J, Noto AM, Chakeres DW, Christoforidis AJ. Tumors of the osseous spine: staging with MR imaging versus CT. Radiology 1987; 162:565–569.
- Schwimer SR, Bassett LW, Mancuso AA, Mirra JM, Dawson EG. Giant cell tumor of the cervicothoracic spine. AJR Am J Roentgenol 1981; 136:63–67.
- Bidwell JK, Young JW, Khalluff E. Giant cell tumor of the spine: computed tomography appearance and review of the literature. J Comput Tomogr 1987; 11:307–311. CrossRef
- Staub-Schmidt T, Chaouat A, Rey D, Bloch JG, Christmann D. Spinal involvement in gout. Arthritis Rheum 1995; 38:139–141.
- Resnick D, editor. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: Saunders, 2002.
- Fenton P, Young S, Prutis K. Gout of the spine. Two case reports and a review of the literature. J Bone Joint Surg Am 1995; 77:767–771.
- Kinoshita T, Maruoka S, Yamazaki T, Sakamoto K. Tophaceous pseudogout of the cervical spine: MR imaging and bone scintigraphy findings. Eur J Radiol 1998; 27:271–273. CrossRef
- Crotty JM, Monu JU, Pope TL, Jr. Synovial osteochondromatosis. Radiol Clin North Am 1996; 34:327–342, xi.
- Burrafato V, Campanacci DA, Franchi A, Capanna R. Synovial chondromatosis in a lumbar apophyseal joint. Skeletal Radiol 1998; 27:385–387.
- Kaplan P, Resnick D, Murphey M, et al. Destructive noninfectious spondyloarthropathy in hemodialysis patients: a report of four cases. Radiology 1987; 162:241–244.
- Ito M, Hayashi K, Noguchi M, Kitamori H. Evaluation of spinal bone changes in patients with chronic renal failure by CT and MR imaging with pathologic correlation. Acta Radiol 1994; 35:291–295.
- Villonodular synovitis (PVNS) of the spine
Volume 34, Issue 4 , pp 185-195
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Facet joints
- Industry Sectors
- Author Affiliations
- 1. Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC, 20306-6000, USA
- 7. Department of Radiology (Section of Musculoskeletal Radiology), David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 165–59, Los Angeles, CA, 90095-6952, USA
- 4. Department of Radiology and Nuclear Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
- 5. Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
- 2. Department of Soft Tissue Pathology, Armed Forces Institute of Pathology, Washington, DC, 20306, USA
- 3. Department of Orthopedic Pathology, Armed Forces Institute of Pathology, Washington, DC, 20306, USA
- 6. Department of Surgical Pathology, Northwestern Memorial Hospital, Chicago, IL, USA