Presentation
Knee pain and swelling associated with limitation in flexion
Patient Data
There is diffuse irregular thickening and proliferation of the synovial lining of anterior and posterior recesses of knee joint forming nodular and villous projections associated with moderate joint effusion. These projections display low T1, intermediate T2, and bright STIR signal intensities with moderate enhancement after contrast administration. The synovial membrane as well as some of the nodular projections exhibit low T2 signal intensity suggesting possible hemosiderine deposition.
Some of the synovial masses imprint the surface of adjacent bone causing erosion best seen at the medial and lateral aspects of the lateral femoral condyle, the lateral aspect of the lateral tibial condyle, and the tibial plateau beneath the spine.
Case Discussion
PVNS is a chronic inflammatory lesion affecting the synovial membranes resulting in synovial hypertrophy, forming villous and nodular projections and causing pressure erosion of the adjacent bones. Although the appearance is radiologically classic for PVNS yet other differential diagnosis include siderotic synovitis, synovial osteochondromatosis and rheumatoid arthritis.
Editor's note: Per the 2020 WHO Soft Tissue and Bone Tumors Classification (5th ed.), the recommended terminology is tenosynovial giant cell tumor with pigmented villonodular synovitis no longer recommended (although remains in common use).
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