Pigmented Villonodular Synovitis of the Spine: Report of a Lumbar Case

Marmara University, Faculty of Medicine, Department of Neurosurgery, Altunizade, Istanbul, Turkey.
Turkish neurosurgery (Impact Factor: 0.58). 04/2010; 20(2):251-6. DOI: 10.5137/1019-5149.JTN.1590-08.3
Source: PubMed


Pigmented villonodular synovitis is a benign proliferative disease of the synovial structures. This disease is most commonly seen in the extremities, and spinal involvement is extremely rare. In the relevant literature, 53 cases have been reported. We present a 66-year-old female patient with a long history of back pain, which progressed and radiated to the left leg over a period of 2 months. The patient also had a mass in the lumbar region on the grounds of spinal degenerative changes. Following gross total excision, the diagnosis was established by histopathology. In this report, we present our experience and discuss our neuroradiological and clinical findings.

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    • "Neurological signs differ according to the level of the tumoral mass. A patient admitted with chronic back pain and acute progression of neurological signs should alert the physician about tumoral and infectious lesions, among which PVNS involves a little proportion [5] [8] "
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    ABSTRACT: Pigmented villonodular synovitis (PVNS) is a proliferative benign lesion originating from the synovium and commonly affects large joints of the extremities. PVNS can arise from any synovium in the whole body and rarely affects the zygapophyseal joints of the spine. Spinal PVNS is diagnosed mostly after resection of the mass. In our case we present a 22-year-old male patient showing progressive spastic paraparesis with insidious onset of back pain and difficulty of walking in a relatively short period of 1 month. After gross excision of the mass, diagnosis was established through histopathology. Two years of follow-up period reveals complete resolution of the patient's complaints and no recurrence on radiologic images.
    Full-text · Article · Sep 2013
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    ABSTRACT: Introduction Pigmented Villonodular synovitis (PVNS) is a rare vertebral pathology––around 50 reports, only 3 concerning C1–C2 location. Case Report A 64-year-old man, submitted to a right nephrectomy for a clear cell carcinoma, presented with an asymptomatic osteolytic C1–C2 lesion. Even though the diagnosis of metastatic disease was the most probable, the presence of a solitary lesion without other osseous or systemic localization and the predicted low risk of recurrence imposed a surgical biopsy. A pigmented villonodular synovitis diagnosis was made, a rare vertebral pathology––around 50 reports, only 3 concerning C1–C2 location. No further treatment was assigned precluding the iatrogenic consequences of empirical treatments based on clinical diagnosis with no histopathological support. The patient remains stable at 18 months of follow-up. Conclusion A large differential diagnosis should be made when the typical findings for metastatic disease are absent precluding the iatrogenic consequences of empirical treatments based on clinical diagnosis with no histopathological support.
    No preview · Article · Jun 2014 · European Spine Journal
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    ABSTRACT: Three patients with spinal primary diffuse-type tenosynovial giant cell tumor (DTGCT) received surgical treatment in our department between 2002 and 2012. All 3 patients were female and aged 23, 33, and 44 years. The mean time from symptom onset to diagnosis was 17 months (range, 5-24 months). One case involved the C1 right lateral mass and C2 vertebral body, the second involved the C1-2 left lateral masses and C2 vertebral body, and the third involved the C5-7 left lateral mass and C6 vertebral body. All patients underwent computed tomographyguided biopsy to confirm the diagnosis of tenosynovial giant cell tumor. Gross total resection was achieved in all patients, including 2 piecemeal resections and 1 en-bloc resection. The mean follow-up time was 6 years (range, 1-11 years), and there was no sign of recurrence in the patients. Seventy cases have been identified so far in the English literature. The male to female ratio is 1:1.38. The mean patient age is 38.5 ± 17.9 years. The tumor distribution includes 32 cases in the cervical spine, 14 in the thoracic spine, 22 in the lumbar spine, and 1 in the sacrococcygeal region. The recurrence rate for patients who underwent gross total resection was 7.7%, and tumor progression was observed in 66.7% of patients who underwent subtotal resection. Above all, DTGCT is a rare primary spinal neoplasm. Preoperative image-guided biopsies play an important role in the diagnosis and treatment strategy. Gross total resection is the best treatment strategy and can reduce the recurrence rate.
    Preview · Article · Sep 2014 · Turkish neurosurgery
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