Diagnostic Imaging and Management of Common Intra-articular and Peri-articular Soft Tissue Tumors and Tumorlike Conditions of the Knee

Abstract

Intra-articular (IA) and peri-articular (PA) tumors of the knee are frequently encountered by orthopaedic surgeons. Nonetheless, due to the possibility of great morbidity and potential mortality, it is important to recognize and differentiate between benign and malignant lesions in a timely manner. Therefore, the purpose of this article is to provide a concise, practical, and updated review of commonly encountered IA and PA tumors including intratendinous gout, synovial chondromatosis, schwannoma, pigmented villonodular synovitis, and synovial sarcoma, and a detailed description of differentiating features to include various imaging modalities.

Keywords

musculoskeletal oncology - intra-articular - tumor - review - orthopaedics

• References

• 1 Cronin KA, Lake AJ, Scott S. , et al. Annual Report to the Nation on the Status of Cancer, part I: National cancer statistics. Cancer 2018; 124 (13) 2785-2800
• 2 Smith E, Hoy DG, Cross M. , et al. The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014; 73 (08) 1462-1469
• 3 Rodas G, Pedret C, Català J, Soler R, Orozco L, Cusi M. Intratendinous gouty tophus mimics patellar tendonitis in an athlete. J Clin Ultrasound 2013; 41 (03) 178-182
• 4 Colberg RE, Henderson RG. Diagnosis and treatment of gouty tophi in the patellar tendon using ultrasound-guided needle barbotage: a case presentation. PM R 2017; 9 (09) 938-942
• 5 Gililland JM, Webber NP, Jones KB, Randall RL, Aoki SK. Intratendinous tophaceous gout imitating patellar tendonitis in an athletic man. Orthopedics 2011; 34 (03) 223
• 6 Li TJ, Lue KH, Lin ZI, Lu KH. Arthroscopic treatment for gouty tophi mimicking an intra-articular synovial tumor of the knee. Arthroscopy 2006; 22 (08) 910.e1-910.e3
• 7 Bloch C, Hermann G, Yu TF. A radiologic reevaluation of gout: a study of 2,000 patients. Am J Roentgenol 1980; 134 (04) 781-787
• 8 Girish G, Glazebrook KN, Jacobson JA. Advanced imaging in gout. Am J Roentgenol 2013; 201 (03) 515-525
• 9 Kransdorf MJ, Murphey MD. Imaging of Soft Tissue Tumors. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkens; 2006
• 10 Yu KH, Lien LC, Ho HH. Limited knee joint range of motion due to invisible gouty tophi. Rheumatology (Oxford) 2004; 43 (02) 191-194
• 11 Coursey CA, Nelson RC, Boll DT. , et al. Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging?. Radiographics 2010; 30 (04) 1037-1055
• 12 Yu Z, Mao T, Xu Y. , et al. Diagnostic accuracy of dual-energy CT in gout: a systematic review and meta-analysis. Skeletal Radiol 2018;
• 13 Singh S, Neelakandan K, Sood C, Krishnan J. Disseminated synovial chondromatosis of the knee treated by open radical synovectomy using combined anterior and posterior approaches. J Clin Orthop Trauma 2014; 5 (03) 157-160
• 14 Larbi A, Viala P, Cyteval C. , et al. Imaging of tumors and tumor-like lesions of the knee. Diagn Interv Imaging 2016; 97 (7-8): 767-777
• 15 Habusta SF, Tuck JA. Synovial chondromatosis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2018
• 16 Ho YY, Choueka J. Synovial chondromatosis of the upper extremity. J Hand Surg Am 2013; 38 (04) 804-810
• 17 Yao MS, Chang CM, Chen CL, Chan WP. Synovial chondrosarcoma arising from synovial chondromatosis of the knee. JBR-BTR 2012; 95 (06) 360-362
• 18 Milgram JW. Synovial osteochondromatosis: a histopathological study of thirty cases. J Bone Joint Surg Am 1977; 59 (06) 792-801
• 19 Neumann JA, Garrigues GE, Brigman BE, Eward WC. Synovial chondromatosis. JBJS Rev 2016; 4 (05) 01874474-201605000-00005
• 20 Kramer J, Recht M, Deely DM. , et al. MR appearance of idiopathic synovial osteochondromatosis. J Comput Assist Tomogr 1993; 17 (05) 772-776
• 21 Wittkop B, Davies AM, Mangham DC. Primary synovial chondromatosis and synovial chondrosarcoma: a pictorial review. Eur Radiol 2002; 12 (08) 2112-2119
• 22 Norman A, Steiner GC. Bone erosion in synovial chondromatosis. Radiology 1986; 161 (03) 749-752
• 23 Albert P, Patel J, Badawy K. , et al. Peripheral nerve schwannoma: a review of varying clinical presentations and imaging findings. J Foot Ankle Surg 2017; 56 (03) 632-637
• 24 Kim SM, Seo SW, Lee JY, Sung KS. Surgical outcome of schwannomas arising from major peripheral nerves in the lower limb. Int Orthop 2012; 36 (08) 1721-1725
• 25 Gosk J, Gutkowska O, Urban M, Wnukiewicz W, Reichert P, Ziółkowski P. Results of surgical treatment of schwannomas arising from extremities. BioMed Res Int 2015; 2015: 547926
• 26 Siqueira MG, Socolovsky M, Martins RS. , et al. Surgical treatment of typical peripheral schwannomas: the risk of new postoperative deficits. Acta Neurochir (Wien) 2013; 155 (09) 1745-1749
• 27 Oberle J, Kahamba J, Richter HP. Peripheral nerve schwannomas--an analysis of 16 patients. Acta Neurochir (Wien) 1997; 139 (10) 949-953
• 28 Beaman FD, Kransdorf MJ, Menke DM. Schwannoma: radiologic-pathologic correlation. Radiographics 2004; 24 (05) 1477-1481
• 29 Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics 1999; 19 (05) 1253-1280
• 30 Banks KP. The target sign: extremity. Radiology 2005; 234 (03) 899-900
• 31 Bhargava R, Parham DM, Lasater OE, Chari RS, Chen G, Fletcher BD. MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign. Pediatr Radiol 1997; 27 (02) 124-129
• 32 Broski SM, Johnson GB, Howe BM. , et al. Evaluation of (18)F-FDG PET and MRI in differentiating benign and malignant peripheral nerve sheath tumors. Skeletal Radiol 2016; 45 (08) 1097-1105
• 33 Warbey VS, Ferner RE, Dunn JT, Calonje E, O'Doherty MJ. [18F]FDG PET/CT in the diagnosis of malignant peripheral nerve sheath tumours in neurofibromatosis type-1. Eur J Nucl Med Mol Imaging 2009; 36 (05) 751-757
• 34 Mollon B, Lee A, Busse JW. , et al. The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee: an individual patient meta-analysis. Bone Joint J 2015; 97-B [phone]
• 35 Aurégan JC, Klouche S, Bohu Y, Lefèvre N, Herman S, Hardy P. Treatment of pigmented villonodular synovitis of the knee. Arthroscopy 2014; 30 (10) 1327-1341
• 36 Ravi V, Wang WL, Lewis VO. Treatment of tenosynovial giant cell tumor and pigmented villonodular synovitis. Curr Opin Oncol 2011; 23 (04) 361-366
• 37 Gu HF, Zhang SJ, Zhao C, Chen Y, Bi Q. A comparison of open and arthroscopic surgery for treatment of diffuse pigmented villonodular synovitis of the knee. Knee Surg Sports Traumatol Arthrosc 2014; 22 (11) 2830-2836
• 38 Colman MW, Ye J, Weiss KR, Goodman MA, McGough III RL. Does combined open and arthroscopic synovectomy for diffuse PVNS of the knee improve recurrence rates?. Clin Orthop Relat Res 2013; 471 (03) 883-890
• 39 Atilgan HI, Sadic M, Ozsoy A. , et al. Evaluation of patients with diffuse pigmented villonodular synovitis of knee with functional scoring systems after surgery and radiosynovectomy. Nucl Med Biomed Imaging 2016 10.15761/NMBI.1000107
• 40 Dorwart RH, Genant HK, Johnston WH, Morris JM. Pigmented villonodular synovitis of synovial joints: clinical, pathologic, and radiologic features. Am J Roentgenol 1984; 143 (04) 877-885
• 41 Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics 2008; 28 (05) 1493-1518
• 42 Jelinek JS, Kransdorf MJ, Utz JA. , et al. Imaging of pigmented villonodular synovitis with emphasis on MR imaging. Am J Roentgenol 1989; 152 (02) 337-342
• 43 Bitar R, Leung G, Perng R. , et al. MR pulse sequences: what every radiologist wants to know but is afraid to ask. Radiographics 2006; 26 (02) 513-537
• 44 Eilber FC, Dry SM. Diagnosis and management of synovial sarcoma. J Surg Oncol 2008; 97 (04) 314-320
• 45 Gresswell SD, Corsini AA, Balsamo LH, Miles EF. Intra-articular synovial sarcoma treated with a transfemoral amputation: a case report and review of the literature. Mil Med 2013; 178 (08) e956-e962
• 46 Nordemar D, Öberg J, Brosjö O, Skorpil M. Intra-articular synovial sarcomas: incidence and differentiating features from localized pigmented villonodular synovitis. Sarcoma 2015; 2015: 903873
• 47 Jamshidi K, Yahyazadeh H, Bagherifard A. Unusual presentation of synovial sarcoma as meniscal cyst: a case report. Arch Bone Jt Surg 2015; 3 (04) 296-299
• 48 El Beaino M, Araujo DM, Lazar AJ, Lin PP. Synovial sarcoma: advances in diagnosis and treatment identification of new biologic targets to improve multimodal therapy. Ann Surg Oncol 2017; 24 (08) 2145-2154
• 49 Bakri A, Shinagare AB, Krajewski KM. , et al. Synovial sarcoma: imaging features of common and uncommon primary sites, metastatic patterns, and treatment response. Am J Roentgenol 2012; 199 (02) W208-15
• 50 Murphey MD, Gibson MS, Jennings BT, Crespo-Rodríguez AM, Fanburg-Smith J, Gajewski DA. From the archives of the AFIP: imaging of synovial sarcoma with radiologic-pathologic correlation. Radiographics 2006; 26 (05) 1543-1565
• 51 Emory CL. CORR Insights^®: Developing an Evidence-Based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression. Clin Orthop Relat Res 2017; 475 (03) 839-841