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Management of Pigmented Villonodular Synovitis (PVNS): an Orthopedic Surgeon’s Perspective


Purpose of Review

Pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor (TGCT) encompasses a wide spectrum of disease and is divided into localized and diffuse variants. Surgical resection remains the principal treatment for nearly all localized type disease and most diffuse type. Recent mechanistic understanding of the disease led to drug discovery that has opened new avenues for patients with recalcitrant disease. In this manuscript, we review the current treatment options for TGCT, presenting outcomes from traditional surgical approaches as well as those from nonsurgical approaches.

Recent Findings

Arthroscopic and/or open surgery remains the mainstay of treatment for TGCT for the vast majority of patients. While radiosynoviorthesis and external beam radiation have been used for recalcitrant disease, recent understanding of the colony stimulating factor 1 receptor (CSF1R) pathway and its paracrine and autocrine role in TGCT has led to the development of targeted inhibitors. Their optimal role and efficacy are unclear due to limited number of high-quality studies and contradictory results; however, recent and ongoing studies suggest there may be a role for their use, especially in diffuse and/or refractory disease.


Surgery remains the most common treatment for TGCT, however, there may be an increasing role for adjuvant therapies, including the new targeted agents. Weighing the side effects of these treatments against the symptomatic benefit on a patient-by-patient basis in this benign disease remains critical.

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Correspondence to Nicholas M. Bernthal.

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Conflict of Interest

Nicholas M. Bernthal has received research funding from the National Institutes of Health (NIH), and has received compensation from Zimmer Biomet, Daiichi Sankyo, and Onkos Surgical for service as a consultant. Chad R. Ishmael and Zachary D.C. Burke have no potential conflicts of interest to disclose.

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Bernthal, N.M., Ishmael, C.R. & Burke, Z.D.C. Management of Pigmented Villonodular Synovitis (PVNS): an Orthopedic Surgeon’s Perspective. Curr Oncol Rep 22, 63 (2020).

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  • Pigmented villonodular synovitis (PVNS)
  • Tenosynovial giant cell tumor (TGCT)
  • Orthopedic surgery
  • Radiosynoviorthesis
  • External beam radiotherapy
  • Oncology