Extra-articular Synovial Chondromatosis Eroding and Penetrating the Acromion.
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ABSTRACT:
SUBMITTER: El Rassi G
PROVIDER: S-EPMC4661792 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Synovial chondromatosis is a rare, benign monoarticular condition characterized by the metaplastic formation of cartilaginous nodules from the synovium of joints (intra-articular), tendons and bursae (extra-articular). These nodules have the potential to detach and form loose bodies within the joint space. The most common locations are the large joints such as the knees, hips, elbows, and shoulders, with less common locations being the foot and ankle joints. Synovial chondromatosis primarily occurs in men between the third and fifth decades of life, and it typically presents as chronic joint pain with swelling, decreased joint range of motion, and osteoarthritis. Treatment is usually centered on excision and retrieval of nodules and loose bodies. Prognosis is usually good with a low-moderate likelihood of recurrence.We report the very rare case of a 27-year-old male with recurrent intra- and extra-articular ankle synovial chondromatosis, who also reported symptoms consistent with tarsal tunnel syndrome. His initial presentation was left ankle pain which was managed by open surgical debridement. Two years after, he re-presented with continued pain and tingling along the plantar aspect of his foot. On his second presentation, a dual approach was taken with arthroscopic as well as open debridement. He reported resolution of his symptoms postoperatively as well as at 3 years of follow-up.Simultaneous extra- and intra-articular chondromatosis of the ankle is very rare and can be difficult to treat. It is important to recognize this disease as a rare but plausible cause of tarsal tunnel syndrome. Treatment may be complicated with early or late recurrence despite complete excision, highlighting the need for intentional follow-up of all cases.
| S-EPMC5553839 | biostudies-other
Project description:Synovial chondromatosis (SC) is a rare benign cartilaginous neoplasm in which recurrent fibronectin 1 (FN1) and activin receptor 2A (ACVR2A) gene rearrangements have been recently reported. Triggered by a case of malignant transformation in SC (synovial chondrosarcoma) showing a novel KMT2A-BCOR gene fusion by targeted RNA sequencing, we sought to evaluate the molecular abnormalities in a cohort of 27 SC cases using a combined methodology of fluorescence in situ hybridization (FISH) and/or targeted RNA sequencing. Results showed that FN1 and /or ACVR2A gene rearrangements were noted in 18 cases (67%), with an FN1-ACVR2A fusion being confirmed in 15 (56%) cases. Two cases showed only FN1 gene rearrangement, without other abnormalities. A novel FN1-NFATc2 gene fusion was noted in one case by RNA sequencing. The remaining nine cases showed no abnormalities in FN1 and ACVR2A genes. No additional cases showed BCOR gene alterations. In conclusion, this study confirms that FN1-ACVR2A fusion is the leading pathogenetic event in SC, at even higher frequency than previously reported. FISH methodology emerges as an appropriate tool in the identification of FN1 and ACVR2A gene abnormalities, which can be used in challenging cases. Further studies are needed to determine the recurrent potential of BCOR abnormalities in this disease.
| S-EPMC7147082 | biostudies-literature
Project description:Hip arthroscopy is an important diagnostic and therapeutic tool in the management of synovial chondromatosis. Removal of osteochondral fragments (OCFs) from the central and peripheral compartments is crucial for the relief of mechanical symptoms and subsequent joint destruction. Direct access to the central compartment is often limited because of the ball-and-socket morphology and limitation of traction. We present our surgical technique for removing OCFs and a new method for the removal of a large loose body using a nitinol stone retrieval basket. The technique facilitates removal of difficult-to-access fragments from the central compartment. Moreover, this technique allows removal of far-medial OCFs from the peripheral compartment.
| S-EPMC4314557 | biostudies-literature
Project description:Tenosynovial chondromatosis is a very rare disease. The most common symptom is a slowly enlarging soft tissue mass, which may be painful or cause limitation of joint motion. Plain radiograph may appear normal during early phases of the disease, but subsequent imaging may be necessary to exclude other pathologies. Nonoperative treatment may be elected for some patients, but a synovectomy and the removal of loose bodies are indicated for persistent symptoms. This report describe a case with a multinodular cartilaginous proliferation and rice body in the first web space of the hand, similar to synovial chondromatosis, but arising in the tenosynovial membranes.
| S-EPMC3464747 | biostudies-other
Project description:Synovial chondromatosis is a benign metaplastic disease of the synovial joints, characterized by the development of cartilaginous nodules in the synovium. Treatment generally includes open or arthroscopic loose body removal combined with a synovectomy. An all-arthroscopic approach has been described to minimize complications and reduce morbidity while providing adequate control of local disease. The purpose of this Technical Note is to describe our techniques and technical pearls that allow for adequate excision of disease while minimizing complications and disease recurrence. The combination of patient positioning, the establishment of multiple arthroscopic portals to ensure optimal visualization and freedom of instruments, the use of a leg holder, and the use of a variety of surgical instruments to facilitate loose body removal and synovectomy is critical to optimize clinical outcomes and minimize complications. Although technically demanding, our described technique can help facilitate extensive loose body removal and complete synovectomy.
| S-EPMC8556586 | biostudies-literature
Project description:Tenosynovial chondromatosis is an uncommon type of chondro-dysplasia of synovial and connective tissue. We report a case of a patient with a primary right wrist extra-articular chondromatosis extending to the flexor and the extensor compartments.Until now, there has been no study describing double surgical access for such a case.Due to the extension, two surgical accesses are required to completely remove the neoformation.At 2 years of follow-up, the good functional-clinical results and absence of recurrence confirm the validity of our surgical strategy.
| S-EPMC5546645 | biostudies-other
Project description:Bursal chondromatosis is synovial chondromatosis of the bursae. It is a rare disease entity that can involve the adventitial bursa of the lateral ankle. Complete synovectomy, removal of loose bodies, and bursectomy comprise the treatment of choice. Detailed preoperative radiologic assessment and surgical planning are the keys to success. Any accompanying synovial chondromatosis of the ankle or subtalar joint or tenosynovial chondromatosis of the peroneal tendon sheath should be treated together with the bursectomy. Endoscopic bursectomy can be performed through the bursal portal. The proximal and distal peroneal tendoscopy portals serve as viewing portals. The resection of the diseased tissues should be performed in a step-by-step zonal manner. Complete synovectomy and removal of loose bodies should be performed before bursectomy. Internal drainage of the bursal sac into the peroneal tendon sheath may be indicated if the sac is adherent to the skin. It should only be performed after complete synovectomy and removal of loose bodies.
| S-EPMC5020423 | biostudies-literature
Project description:Synovial chondromatosis (SCh) can undergo malignant transformation. Pathologic diagnosis of secondary synovial chondrosarcoma (SChS) is challenging and misdiagnosis may result in over- or undertreatment.A systematic review revealed 48 cases of SChS published in 27 reports since 1957. Data was collected to identify findings indicative of SChS and outcomes of treatment.At median follow-up of 18 months, patients were reported as alive (10%), alive without disease (22%), alive with disease (15%), dead of disease (19%), dead of pulmonary embolism (4%), and unknown (29%). Initial diagnosis of SChS (grade: low/unknown 48%, intermediate/high 52%) was after biopsy in 58%, local resection in 29%, and amputation in 13%. Seventy-four percent of patients underwent 1.8 (mean) resections. Patients treated prior to 1992 were managed with amputation in 79% of cases compared to 48% after 1992. Symptoms were present for 72 mos prior to diagnosis of SChS. Synovial chondrosarcoma demonstrated symptom progression over several months (82%), rapid recurrence after complete resection (30%), and medullary canal invasion (43%). The SChS tumor dimensions were seldom quantified.Malignant degeneration of synovial chondromatosis is rare but can necessitate morbid surgery or result in death. Pathognomonic signs for SChS including intramedullary infiltration are present in the minority of cases. Progression of symptoms, quick local recurrence, and muscle infiltration are more suggestive of SChS. Periarticular cortical erosion, extra-capsular extension, and metaplastic chondroid features are non-specific. Although poorly documented for SChS, tumor size is a strong indicator of malignancy. Biopsy and partial resection are prone to diagnostic error. Surgical decisions are frequently based on size and clinical appearance and may be in conflict with pathologic diagnosis.
| S-EPMC5481616 | biostudies-other
Project description:Primary synovial chondromatosis (PSC) of the shoulder is a rare condition and usually necessitates operative therapy. Arthroscopic partial synovectomy with removal of loose osteochondromas may be regarded as the current surgical treatment of choice. However, involvement of the biceps tendon sheath (BTS) occurs in almost half of the patients and required additional open surgery in all previously reported cases. We successfully performed tenoscopy of the BTS and long head of the biceps tendon during arthroscopic treatment of PSC in a 26-year-old male competitive wrestler. Biceps tenoscopy enabled minimally invasive partial (teno)synovectomy and removal of all osteochondromas within the BTS. The symptoms of PSC fully subsided within 2 postoperative weeks. There were no functional restrictions at the 3-month follow-up examination. These preliminary results support the feasibility, safety, and efficacy of biceps tenoscopy as a complement in arthroscopic treatment of PSC of the shoulder, dispensing with the need for additional open surgery. The spectrum of indications for biceps tenoscopy has still to be defined. Conceivable indications are proposed. This first report of a diagnostic and interventional biceps tenoscopy entails a detailed step-by-step description of the surgical technique.
| S-EPMC4175161 | biostudies-literature
Project description:The purpose of this study was to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for synovial chondromatosis (SC) of the temporomandibular joint (TMJ). In this study, 1415 patients (2109 joints) with temporomandibular joint disorders were collected between January 2012 and January 2017. All patients had a preoperative MRI examination and were treated by either arthroscopy or open surgery. On reviewing all MRI images, the number of "positive", "suspicious", and "negative" cases was collected afterwards, then the number of reported SC cases in operative data was recorded. The SPSS software was used to process all collected data. The kappa coefficient and ROC curve (AUC-index) with sensitivity and specificity were calculated to evaluate the consistency between MRI and arthroscopy/open surgery. Compared to 156 joints with SC detected by arthroscopy and open surgery, the results of MRI examination showed "positive" in 117 joints, and "negative" in 1938 joints. The number of "true positive", and "true negative" cases was 95, and 1897 respectively. The AUC-index was 0.86 (0.82-0.90) with a kappa coefficient of 0.74 (P < 0.05). In conclusion, the incidence of synovial chondromatosis diagnosed on MRI was in accordance with the arthroscopic and open surgery. Therefore, being a relatively non-invasive tool, MRI could be recommended as an effective diagnostic modality for SC.
| S-EPMC6317805 | biostudies-literature