Abstract
Sarcoidosis is a systemic inflammatory disorder characterized by non-caseating granulomas, predominantly involving lung, mediastinal lymph nodes and other organs. Synovium involvement is infrequent, and as far as we know, involvement of a periprosthetic membrane has not been reported in the English literature. Intra-articular diffuse tenosynovial giant cell tumor (“conventional diffuse pigmented villonodular synovitis”) is an uncommon, locally aggressive neoplasm with few previous case reports in which it arose in periprosthetic tissues after knee arthroplasty. We describe a unique case of an intraarticular mass next to a total knee prosthesis implanted 6 years ago in a patient with a history of pulmonary sarcoidosis. Clinically, this 67-year-old gentleman presented with progressive left knee pain, effusion and marked instability. MRI showed a large complex effusion with synovial thickening in the supra patella recess and the medial and lateral gutters. In addition, a large multilobulated mass with mixed low and high signal intensity was present in the posterior joint space, extending into the popliteal area. A two-stage operation was performed. Histologically, the mass from the posterior joint space showed characteristic features of diffuse tenosynovial giant cell tumor, while the synovium from the anterior compartment demonstrated sarcoidal granulomatous inflammation. Orthopaedic wear debris was found within the giant cells of these sarcoidal granulomata. The histologic features are different from those “usual” macrophage reactions to the particles of debris. In this article, we also included two optional links (highlighted in blue in the figures) to digital whole slide image (WSI), which allow the readers to navigate the entire microscope slides.
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Iannuzzi MC, Fontana JR. Sarcoidosis: clinical presentation, immunopathogenesis, and therapeutics. JAMA. 2011;305(4):391–9.
Morgenthau AS, Iannuzzi MC. Recent advances in sarcoidosis. Chest. 2011;139(1):174–82.
Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager Jr H, Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001;164(10 Pt 1):1885–9.
Kobak S. Sarcoidosis: a rheumatologist’s perspective. Ther Adv Musculoskelet Dis. 2015;7(5):196–205.
Fletcher CD, Bridge JA, Hogendoorn PCW, Mertens F. WHO classification of tumours of soft tissue and bone, 4th Edition, IARC. 2013.
Lucas DR. Tenosynovial giant cell tumor: case report and review. Arch Pathol Lab Med. 2012;136(8):901–6.
Moller E, Mandahl N, Mertens F, Panagopoulos I. Molecular identification of COL6A3-CSF1 fusion transcripts in tenosynovial giant cell tumors. Genes Chromosomes Cancer. 2008;47(1):21–5.
Nilsson M, Hoglund M, Panagopoulos I, Sciot R, Dal Cin P, Debiec-Rychter M, et al. Molecular cytogenetic mapping of recurrent chromosomal breakpoints in tenosynovial giant cell tumors. Virchows Arch. 2002;441(5):475–80.
Panagopoulos I, Brandal P, Gorunova L, Bjerkehagen B, Heim S. Novel CSF1-S100A10 fusion gene and CSF1 transcript identified by RNA sequencing in tenosynovial giant cell tumors. Int J Oncol. 2014;44(5):1425–32.
West RB, Rubin BP, Miller MA, Subramanian S, Kaygusuz G, Montgomery K, et al. A landscape effect in tenosynovial giant-cell tumor from activation of CSF1 expression by a translocation in a minority of tumor cells. Proc Natl Acad Sci. 2006;103(3):690–5.
Chung BJ, Park YB. Pigmented villonodular synovitis after TKA associated with tibial component loosening. Orthopedics. 2011;34(8):e418–20.
Ma XM, Xia CY, Fu PL, Liu HM, Yu HY, He J. Unusual cases of pigmented villonodular synovitis after arthroplasty. Int J Clin Exp Med. 2014;7(4):1150–4.
Al-Ani Z, Oh TC, Macphie E, Woodruff MJ. Sarcoid tenosynovitis, rare presentation of a common disease: case report and literature review. J Radiol Case Rep. 2015;9(8):16–23.
Glennas A, Kvien TK, Melby K, Refvem OK, Andrup O, Karstensen B, et al. Acute sarcoid arthritis: occurrence, seasonal onset, clinical features and outcome. Br J Rheumatol. 1995;34(1):45–50.
Torralba KD, Quismorio Jr FP. Sarcoid arthritis: a review of clinical features, pathology and therapy. Sarcoidosis Vasc Diffuse Lung Dis. 2003;20(2):95–103.
Mahony J, Helms SE, Brodell RT. The sarcoidal granuloma: a unifying hypothesis for an enigmatic response. Clin Dermatol. 2014;32(5):654–9.
Post J, Hull P. Tattoo reactions as a sign of sarcoidosis. CMAJ. 2012;184(4):432.
Bauer TW, Schils J. The pathology of total joint arthroplasty. II. Mechanisms of implant failure. Skeletal Radiol. 1999;28(9):483–97.
Hughes TH, Sartoris DJ, Schweitzer ME, Resnick DL. Pigmented villonodular synovitis: MRI characteristics. Skeletal Radiol. 1995;24(1):7–12.
Lynskey SJ, Pianta MJ. MRI and thallium features of pigmented villonodular synovitis and giant cell tumours of tendon sheaths: a retrospective single centre study of imaging and literature review. Br J Radiol. 2015;88(1056):20150528.
Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics. 2008;28(5):1493–518.
Nicolaou S, Liang T, Murphy DT, Korzan JR, Ouellette H, Munk P. Dual-energy CT: a promising new technique for assessment of the musculoskeletal system. AJR Am J Roentgenol. 2012;199(5 Suppl):S78–86.
Becce F, Federau C, Letovanec I, Grandjean A, So AK, Rudiger HA. Dual-energy computed tomography molecular imaging of pigmented villonodular synovitis. Rheumatology (Oxford). 2015;54(3):457.
Omoumi P, Verdun FR, Guggenberger R, Andreisek G, Becce F. Dual-energy CT: basic principles, technical approaches, and applications in musculoskeletal imaging (part 2). Semin Musculoskelet Radiol. 2015;19(5):438–45.
Narvaez JA, Narvaez J, Ortega R, De Lama E, Roca Y, Vidal N. Hypointense synovial lesions on T2-weighted images: differential diagnosis with pathologic correlation. AJR Am J Roentgenol. 2003;181(3):761–9.
Tap WD, Wainberg ZA, Anthony SP, Ibrahim PN, Zhang C, Healey JH, et al. Structure-guided blockade of CSF1R kinase in tenosynovial giant-cell tumor. N Engl J Med. 2015;373(5):428–37.
Cassier PA, Italiano A, Gomez-Roca CA, Le Tourneau C, Toulmonde M, Cannarile MA, et al. CSF1R inhibition with emactuzumab in locally advanced diffuse-type tenosynovial giant cell tumours of the soft tissue: a dose-escalation and dose-expansion phase 1 study. Lancet Oncol. 2015;16(8):949–56.
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;17(2):10.
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Zhang, Y., Joyce, M., Schils, J. et al. Coexisting sarcoidal granulomatous inflammation and diffuse tenosynovial giant cell tumor of the knee after a total knee replacement: a case report. Skeletal Radiol 45, 1735–1740 (2016). https://doi.org/10.1007/s00256-016-2492-6
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DOI: https://doi.org/10.1007/s00256-016-2492-6