Localized Pigmented Villonodular Synovitis in the Shoulder: Report of a Case Treated through Arthroscopy

Abstract

Pigmented villonodular synovitis (PVNS) is rare in the shoulder, with few descriptions in the literature. We present the case of a 58-year-old female patient with no history of trauma. The patient reported pain for 2 months with no limb irradiation and presented lifting strength loss and progressive limitation of active and passive mobility. She underwent unsupervised physical therapy and there was no improvement in symptoms. A magnetic resonance imaging (MRI) scan of the shoulder showed an oval structure of approximately 2 cm in diameter in the anteroinferior region of the glenohumeral joint with internal hypointense signal foci. We performed the arthroscopic treatment, with marginal resection of the lesion and tenotomy of the long bicipital head. The anatomopathological report confirmed the diagnosis of PVNS. Four years and five months after the surgery, the patient is pain-free, with full recovery of the left shoulder function. A follow-up MRI showed no recurrence, demonstrating the effectiveness of the arthroscopic treatment in this case.

Keywords

arthroscopy - giant cell tumor of tendon sheath - shoulder injuries - shoulder joint

Work carried out at the Santa Rita de Cássia Hospital, Vitória, ES, Brazil.

Publikationsverlauf

Eingereicht: 04. Mai 2022

Angenommen: 29. Mai 2023

Artikel online veröffentlicht:
22. April 2024

• Referências

• 1 Fałek A, Niemunis-Sawicka J, Wrona K, Szczypiór G, Rzepecka-Wejs L, Cięszczyk K. et al. Pigmented villonodular synovitis. Folia Med Cracov 2018; 58 (04) 93-104
• 2 Noailles T, Brulefert K, Briand S, Longis P-M, Andrieu K, Chalopin A, Gouin F. Giant cell tumor of tendon sheath: Open surgery or arthroscopic synovectomy? A systematic review of the literature. Orthop Traumatol Surg Res 2017; 103 (05) 809-814
• 3 Serra TQ, Morais J, Gonçalves Z, Agostinho F, Melo G, Henriques M. An unusual case of diffuse pigmented villonodular synovitis of the shoulder: A multidisciplinary approach with arthroscopic synovectomy and adjuvant radiotherapy. Eur J Rheumatol 2017; 4 (02) 142-144
• 4 Karami M, Soleimani M, Shiari R. Pigmented villonodular synovitis in pediatric population: review of literature and a case report. Pediatr Rheumatol Online J 2018; 16 (01) 6
• 5 Gumina S, Carbone S, Campagna V, Castagna A, Della Rocca C, Giannicola G. Pigmented villonodular synovitis of the shoulder associated with massive rotator cuff tear treated by arthroscopic synovectomy and debridement [published correction appears in Musculoskelet Surg 2013;97(2):187. Rocca, C D [corrected to Della Rocca, C]]. Musculoskelet Surg 2013; 97 (Suppl. 01) 79-84
• 6 Madruga Dias J, Costa MM, Duarte A, Pereira da Silva JA. Localized Pigmented Villonodular Synovitis of the shoulder: a rare presentation of an uncommon pathology. Acta Med Port 2013; 26 (04) 459-462
• 7 Botez P, Sirbu PD, Grierosu C, Mihailescu D, Savin L, Scarlat MM. Adult multifocal pigmented villonodular synovitis–clinical review. Int Orthop 2013; 37 (04) 729-733
• 8 Mahieu X, Chaouat G, Blin JL, Frank A, Hardy P. Arthroscopic treatment of pigmented villonodular synovitis of the shoulder. Arthroscopy 2001; 17 (01) 81-87
• 9 Chiang ER, Ma HL, Wang ST, Hung SC, Chen TH. Arthroscopic treatment for pigmented villonodular synovitis of the shoulder associated with massive rotator cuff tear. Arthroscopy 2009; 25 (07) 716-721
• 10 Costallat BL, Montagner S, Amstalden EMI, Ferreira DM, Zoppi Filho A, Costallat LTL. Um caso de sinovite vilonodular do ombro em adolescente: diagnóstico por imagem e anatomopatológico. Rev Bras Reumatol 2009; 49 (01) 70-80
• 11 Müller LP, Bitzer M, Degreif J, Rommens PM. Pigmented villonodular synovitis of the shoulder: review and case report. Knee Surg Sports Traumatol Arthrosc 1999; 7 (04) 249-256
• 12 Temponi EF, Barros AAG, Paganini VO, Barbosa VAK, Badet R, Carvalho Júnior LH. Diffuse pigmented villonodular synovitis in knee joint: diagnosis and treatment. Rev Bras Ortop 2017; 52 (04) 450-457
• 13 O'Sullivan B, Cummings B, Catton C, Bell R, Davis A, Fornasier V, Goldberg R. Outcome following radiation treatment for high-risk pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys 1995; 32 (03) 777-786
• 14 Park G, Kim YS, Kim JH, Lee S-W, Song SY, Choi EK. et al. Low-dose external beam radiotherapy as a postoperative treatment for patients with diffuse pigmented villonodular synovitis of the knee: 4 recurrences in 23 patients followed for mean 9 years. Acta Orthop 2012; 83 (03) 256-260
• 15 Heyd R, Seegenschmiedt MH, Micke O. [The role of external beam radiation therapy in the adjuvant treatment of pigmented villonodular synovitis]. Z Orthop Unfall 2011; 149 (06) 677-682
• 16 Brahmi M, Vinceneux A, Cassier PA. Current systemic treatment options for tenosynovial giant cell tumor/pigmented villonodular synovitis: Targeting the CSF1/CSF1R Axis. Curr Treat Options Oncol 2016; 17 (02) 10
• 17 Bernthal NM, Ishmael CR, Burke ZDC. Management of Pigmented Villonodular Synovitis (PVNS): an Orthopedic Surgeon's Perspective. Curr Oncol Rep 2020; 22 (06) 63
• 18 Tap WD, Gelderblom H, Palmerini E, Desai J, Bauer S, Blay JY. et al; ENLIVEN investigators. Pexidartinib versus placebo for advanced tenosynovial giant cell tumour (ENLIVEN): a randomised phase 3 trial. Lancet 2019; 394 (10197): 478-487