Pigmeted Villonodular Synovitis: Difference between revisions
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== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
The symptoms by patients with PVNS are sporadic or slowly progressive [5]. Some may experience pain, swelling, warmth and stiffness in the joint [5][8]. Locking and instability, mechanical symptoms, may develop [5]. PVNS in the spine may cause back pain, tenderness, and neurological dysfunction leading to acute paralysis [13]. | |||
PVNS is characterized by a unique gross and histologic structure consisting of brownish villous and nodular masses arising on the surface of synovial tissue and consisting of fibrous elements, hemosiderin containing macrophages, lipid-filled foam cells, multinucleated giant cells, and some inflammatory cells [1][5][7][9]. Hemosiderin is an iron-rich pigment, responsible for the brownish rusty colour [2][5][14]. <br>Bilateral is rare, PVNS mostly occurs only in one joint (monoarticular) [1][8][9][6].<br>These characteristics count for both localized and diffuse PVNS [5][9].<br>The disease has a high risk of recurrence, but also a variant recurrence rate of 8% to 60% [1][11].<br> | |||
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== Differential Diagnosis == | == Differential Diagnosis == | ||
Revision as of 21:29, 25 September 2012
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Search Strategy[edit | edit source]
Databases:
• PubMed
• Web of Knowledge (Web of Science)
• Books
• Internet
Keywords:
• (Localized/Diffuse) Pigmented Villonodular Synovitis
• Treatment
• Physiotherapy (Physical Therapy)
• Postoperative Therapy
Time Line:
• 2000 – 2011
Definition/Description[edit | edit source]
Pigmented Villonodular Synovitis, also known as PVNS, is a rare idiopathic proliferative disorder of the synovium that leads to villous and or nodular formations within joints, tendon sheaths and bursae [5][6][9]. It affects adults between twenty and sixty years old, independent of the gender [1][12]. It may also uncommonly appear in children [8]. Despite the disease is benign, PVNS can be aggressive, spreading to surrounding synovial tissues and invading adjacent soft tissue structures and bone, resulting in effusions and bony erosion [9][11]. PVNS does not exhibit cellular atypia, but there is recent evidence of cytogenetic abnormalities [5], which may suggest a neoplastic origin [7]. In an early description were three forms of this disease defined [9]: an isolated lesion involving the tendon sheaths (giant cell tumour of the tendon sheath); a solitary intraarticular nodule (localized PVNS); and a diffused villous and pigmented lesion involving synovial tissue (diffuse PVNS) [5]. But more recently, PVNS is subdivided into two forms: isolated nodular lesions (localized form) and those with diffuse joint involvement (diffuse form) [9]. The localized form is also called ‘giant cell tumour of tendon sheath’ [4][8]. Both forms share the same histological characteristics [5][9], but it is essential to distinguish localized from diffuse because their clinical management differ, as do their responses to treatment [4].
Clinically Relevant Anatomy[edit | edit source]
Any joint can be affected but PVNS occurs mostly in the knee (80%), followed by the hip and the ankle (foot). To a lesser degree in the wrist, shoulder and elbow [1][5][8][9]. It may also appear in the spine, but it is infrequent [13].
The synovium, tendon sheaths, bursae and bone can be involved by patients with PVNS. In the spine, the disease originates from the vertebral articular facet joints [13].
Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
The symptoms by patients with PVNS are sporadic or slowly progressive [5]. Some may experience pain, swelling, warmth and stiffness in the joint [5][8]. Locking and instability, mechanical symptoms, may develop [5]. PVNS in the spine may cause back pain, tenderness, and neurological dysfunction leading to acute paralysis [13].
PVNS is characterized by a unique gross and histologic structure consisting of brownish villous and nodular masses arising on the surface of synovial tissue and consisting of fibrous elements, hemosiderin containing macrophages, lipid-filled foam cells, multinucleated giant cells, and some inflammatory cells [1][5][7][9]. Hemosiderin is an iron-rich pigment, responsible for the brownish rusty colour [2][5][14].
Bilateral is rare, PVNS mostly occurs only in one joint (monoarticular) [1][8][9][6].
These characteristics count for both localized and diffuse PVNS [5][9].
The disease has a high risk of recurrence, but also a variant recurrence rate of 8% to 60% [1][11].
Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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