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Joint Tumors

By Michael J. Joyce, MD, Associate Clinical Professor, Orthopaedic Surgery, Cleveland Clinic Lerner School of Medicine at Case Western Reserve University
Hakan Ilaslan, MD, Associate Professor of Radiology; Staff Radiologist, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University; Imaging Institute, Diagnostic Radiology

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Tumors rarely affect joints, unless by direct extension of an adjacent bone or soft-tissue tumor. However, 2 conditions—synovial chondromatosis and pigmented villonodular synovitis—occur in the lining (synovium) of joints. These conditions are benign but locally aggressive. Both usually affect one joint, most often the knee and second most often the hip, and can cause pain and effusion. Both are treated by synovectomy and removal of any intra-articular bodies.

Synovial chondromatosis

Synovial chondromatosis (previously called synovial osteochondromatosis) is considered metaplastic synovium. It is characterized by numerous calcified cartilaginous bodies in the synovium, which often become loose. Each body may be no larger than a grain of rice, in a swollen, painful joint. Malignant change is very rare. Recurrence is common.

Diagnosis of synovial chondromatosis is by imaging, usually CT or MRI.

Treatment of synovial chondromatosis may be symptomatic, but if mechanical symptoms are prominent, arthroscopic or open removal of the bodies or synovium is warranted.

Pigmented villonodular synovitis

Pigmented villonodular synovitis is considered neoplastic synovium. The synovium becomes thickened and contains hemosiderin, which gives the tissue its blood-stained appearance and characteristic appearance on MRI. This tissue tends to invade adjacent bone, causing cystic destruction and damage to the cartilage. Pigmented villonodular synovitis is usually monarticular but may be polyarticular.

Late management of pigmented villonodular synovitis, especially after recurrence, may require total joint replacement. On rare occasions after several synovectomies, radiation therapy is sometimes used.

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