Extraskeletal Intramuscular Chondroma of the Knee - Case Report and Review of the Literature / Condroma intramuscular extraesquelético do joelho - Relato de caso e revisão da literatura

Abstract Extraskeletal chondromas are small nodular cartilaginous lesions not attached to bone or the periosteum. They are rare tumors commonly occurring in the hands and feet. The objective of the present study is to describe a case of extraskeletal intramuscular chondroma (EIC) in the left knee and the diagnostic challenges faced by us. A 25-year-old female patient presented with slow-growing swelling in the left knee for 2 years. Clinically, the swelling was arising from the quadriceps muscle. We considered possibilities such as rhabdomyoma, neurofibroma, and intramuscular lipoma. Imaging studies suggested a benign fatty tumor. She was treated by excision. Microscopy was consistent with EIC without recurrence. A rare entity, clinically, EIC can mimic other benign soft-tissue tumors. Histopathology exams can provide a definitive diagnosis. The excision of the tumor is curative.

Resumo Os condromas extraesqueléticos são pequenas lesões cartilaginosas nodulares que não estão aderidas ao osso ou ao periósteo. São tumores raros que ocorrem comumente nas mãos e nos pés. Objetivo deste artigo é descrever um caso de condroma intramuscular extraesquelético (CIE) no joelho esquerdo e os desafios diagnósticos que enfrentamos. Uma paciente de 25 anos apresentou um edema de crescimento lento no joelho esquerdo havia 2 anos. Clinicamente, o edema era proveniente do músculo quadríceps. Foram consideradas possibilidades como rabdomioma, neurofibroma, e lipoma intramuscular. Os estudos de imagem sugeriram um tumor de gordura benigno. A paciente foi tratada com a excisão cirúrgica. A microscopia indicou CIE sem recorrência. O CIE é uma lesão rara. Clinicamente, pode ter aspecto semelhante ao de outros tumores benignos dos tecidos moles. A histopatologia pode fornecer um diagnóstico definitivo. A excisão cirúrgica do tumor é curativa.

Synovial chondromatosis of the hip was misdiagnosed as rice body bursitis: a case report / 中华骨科杂志

This study shows a case of a patient with synovial chondromatosis of the hip misdiagnosed as rice body bursitis. The patient complained of pain and limited activity in his left hip. He was diagnosed with synovial chondromatosis of the hip by medical history, physical examination, imaging examination and postoperative pathology. Based on literature review, the characteristics and differential diagnosis of the disease in epidemiology, imaging and pathology were discussed in detail, so as to improve the understanding of the disease and avoid misdiagnosis. He was treated with hip arthroscopy and obtained satisfactory therapeutic effect. The patient was followed up for 1 year without recurrence.

Surgical treatment of a rare bilateral synovial chondromatosis

Synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is an uncommon entity, mostly when the involvement is bilateral. The authors report a rare case of bilateral SC, with a follow-up of 13 months, and a literature review. A 60-year-old Caucasian woman, with the chief complaint of pain for 6 years in the bilateral pre-auricular region, had a progressive clacking and discomfort on the left side during mouth opening. The panoramic image was suggestive of SC. The bilateral lesion was surgically removed by direct access. Histopathological examination confirmed the clinical diagnosis of bilateral SC. This article shows the importance of a multidisciplinary approach for the early diagnosis and appropriate treatment. Also, it encourages the referral of such cases to professionals with a greater familiarity with this entity.

Bilateral symmetrical synovial chondromatosis of shoulder: a case report / Condromatose sinovial simétrica bilateral do ombro: relato de caso

ABSTRACT Synovial chondromatosis is a benign arthropathy rarely seen in diarthrodial joints. Extra-articular bilateral symmetrical synovial chondromatosis of shoulder is the rarest variety. The diagnosis is established with the help of imaging modalities and histopathological examinations. This report describes a case of a 39-year-old woman who presented with symmetrical, progressively increasing swelling over the bilateral shoulder region, of 12-18 months duration, with dull ache and restricted movements of the shoulder joints. Magnetic resonance imaging (MRI) and ultrasonography (USG) revealed large bilateral subacromial-subdeltoid bursal swelling with loose floating bodies. Surgical excision of extensive bilateral bursa was performed at four weeks of interval. Histopathological examination revealed synovial chondromatosis on either side. Postoperative recovery occurred without complications.

RESUMO A condromatose sinovial é uma artropatia benigna raramente vista em articulações diartrodiais. A condromatose sinovial simétrica bilateral extra-articular do ombro é a variedade mais rara. O diagnóstico é estabelecido com a ajuda de exames de imagem e histopatológicos. Este relato descreve o caso de uma paciente de 39 anos, com aumento de volume progressivo simétrico sobre a região bilateral do ombro com 12-18 meses de duração com dor entorpecido e limitação dos movimentos das articulações do ombro. A ressonância magnética e a ultrassonografia revelaram um grande aumento de volume da bursa subacromial subdeltoidea bilateral com corpos livres flutuantes. A excisão cirúrgica extensa da bursa bilateral foi feita com quatro semanas de intervalo. O exame histopatológico revelou condromatose sinovial em ambos os lados. A recuperação pós-operatória transcorreu sem complicações.

Temporomandibular joint synovial chondromatosis accompanying temporal bone proliferation: A case report

Synovial chondromatosis is a rare metaplastic disease affecting the joints, including the temporomandibular joint (TMJ). Since its symptoms are similar to those of temporomandibular disorders, a careful differential diagnosis is essential. A 50-year-old male patient was referred with the chief complaint of pain and radiopaque masses around the left TMJ on panoramic radiography. Clinically, pre-auricular swelling and resting pain was found, without limitation of mouth opening. On cone-beam computed tomographic images, multiple calcified nodules adjacent to the TMJ and bone proliferation with sclerosis at the articular fossa and eminence were found. T2-weighted magnetic resonance images showed multiple signal-void nodules with high signal effusion in the superior joint space and thickened cortical bone at the articular fossa and eminence. The calcified nodules were removed by surgical excision, but the hypertrophic articular fossa and eminence remained. A histopathological examination confirmed the diagnosis. The patient was followed up few months later without recurrence.

Metotrexato en condromatosis sinovial: una serendipia / Methotrexate in sinovial chondromatosis: a case of serendipity

La condromatosis sinovial es una metaplasia idiopática benigna de la membrana sinovial que afecta a 1/100.000 habitantes, en una relación hombre/mujer de 3 a 1 entre los 30 y 50 años. Predomina en grandes articulaciones como rodilla (70%), cadera (20%) y hombro (19%), y en menor proporción en codo y tobillo. Puede ser primaria o secundaria. La etiología es desconocida. La resolución es quirúrgica ya sea por artroscopia o por cirugía a cielo abierto, no existiendo otra alternativa terapéutica. Se presenta el caso clínico de un paciente con condromatosis sinovial en hombro derecho, que se comporta como una artropatía erosiva, indicándose metotrexato y resolviendo casi totalmente los nódulos condromatosos.

The synovial chondromatosis is a benign idiopathic metaplasia ofthe synovial membrane which affects one in 100,000 inhabitants. Itis 3 times more common in males, aged between 30 and 50 yearsold. It is commonly found in large joints such as knee (70%), hip(20%) and shoulder (19%) and less frequently in elbow and heel. Itcan be primary or secondary. The etiology is still unknown.The resolution is surgical by means of arthroscopy or open surgery,existing no other therapeutic alternatives.We present a male patient with primary synovial chondromatosis inthe right shoulder, leading to an erosive arthropathy. Treatment withmethotrexate resolved almost entirely the cartilaginous nodules.

Plain X-ray radiography, CT and MRI diagnosis of synovial osteochondromatosis / 中国介入影像与治疗学

ObjectiveTo assess the value of plain X-ray radiography,CT and MRI in the diagnosis of synovial oateochondromatosis.MethodsTwenty patients with synovial osteochondromatosis confirmed with surgery and pathology were enrolled.The images of X-rays (n= 18),CT (n=20) and MRI (n= 10) were analyzed retrospectively.ResultsDefinite diagnosis was made in 15 patients according to plain X-ray radiography,in 18 patients according to CT findings,while in 8 patients according to MRI manifestations.Plain X-ray radiography,CT and MRI could show loose bodies around/within the involved joints in various shape,size and different amount.Plain X-ray radiography and CT could show calcification of loose bodies.MRI could show early cartilage loose bodies.CT and MRI could display effusion of the involved joints.ConclusionPlain X-ray radiography,CT and MRI are able to diagnose synovial osteochondromatosis.CT and MRI can depict lesions and characteristics that impossible for X-ray radiography.

Ultrasound diagnosis of primary synovial osteochondromtosis of the knee / 中华超声影像学杂志

Objective To explore the ultrasound appearance of primary synovial osteochondromatosis (PSO) of the knee. Methods Thirty-eight cases with PSO were confirmed by pathology, their ultrasound features were analyzed retrospective. Results Two hundred and sixty calcify nodules showed medium echo and several motting or bolus strong echo. Two hundred and eighty-nine ossify nodules showed slightly strong echo or strong echo,or only showed arc strong echo with rear sound shadow near nodules. Twenty-six mixed type nodules showed promiscuity moderately strong echo or with rear sound shadow. Forty introsynovium cartilage lesser nodules showed synovium thickening and similar round low echo nodules,30 sursynovium lesser nodules showed high echo, with a pedicel connected to synovium, can shift deform or sway because of the pressure from transducer, often concomitance other type nodules. Ten cartilage greater nodules showed similar round or lobulated low or medium echo tuberculum. Conclusions Ultrasound can show multiple nodules of PSO of the knee, especially noncalcific nonage smaller cartilage nodules. It is helpful for clinicians to decide more reasonable operation strategy.

Comparison study of four imaging modalities in diagnosis of primary synovial osteochondromatosis / 中华放射学杂志

ObjectiveTo compare the diagnostic value of X-ray, CT, MRI, and ultrasound in primary synovial osteochondromatosis ( PSO ).Methods The imaging data of X-ray, CT, MRI, and ultrasound of 42 patients with 44 knees with PSO proved by surgery and pathology were retrospectively collected and analyzed. ResultsThe Plain X-ray demonstrated 197 calcific nodules in 28 joints, 96 ossific nodules in 24 joints, and 5 mixed type nodules in 3 joints. Compared with the data of surgery and pathology,36 joints (81.8 ％, 36/44) were diagnosed correctly by X-ray. The CT showed 8 big cartilaginous nodules in 5 joints, 255 calcific nodules in 30 joints, 146 ossific nodules in 28 joints, and 16 mixed type nodules in 7 joints.Twenty-four knees underwent volume rendering technique reconstruction which displayed the quantity, size, shape, and position of non-cartilaginous nodules clearly. Compared with the data of surgery and pathology, 40 joints (90. 9％ , 40/44)were diagnosed correctly by CT. The MRI demonstrated 8 big cartilaginous nodules in 5 joints, 70 small cartilaginous nodules in 4 joints, 248 calcific nodules in 29 joints,146 ossific nodules in 28 joints, and 16 mixed type nodules in 7 joints. All nodules displayed low signal in DWI and there was no enhancement. Compared with the data of surgery and pathology, 43 joints (97.7％,43/44) were diagnosed correctly by MRI. The ultrasound showed 8 big cartilaginous nodules in 5 joints,70 small cartilaginous nodules in 4 joints, 232 calcific nodules in 30 joints, 142 ossific nodules in 28 joints,and 16 mixed type nodules in 7 joints. Compared with the data of surgery and pathology, 43 joints (97. 7％,43/44) were diagnosed correctly by ultrasound. ConclusionsThe less common manifestations of the PSO require multimodality imaging to make the diagnosis. Multimodalities (X-ray,CT, MRI and ultrasound) are particularly useful in fully characterising PSO and to allow for appropriate clinical planning.

Clinical analysis of 12 cases of primary synovial chondromatosis of hip joint / 解放军医学杂志

Objective To study the clinical, imageological and pathologic characters of primary synovial chondromatosis of hip joint, and effect of open surgery. Method 12 cases of primary synovial chondromatosis of the hip joints admitted from May 1973 to May 2004 were retrospectively studied in respect to clinical manifestations, X-ray picture, and pathological findings. The effects of operation were followed up. Results Intermittent pain, swelling, limitation of hip joints were the main complaints. Mass and myatrophy near involved hip joint were discernible in a few patients. Although there was no obvious image of calcification, swelling of articular capsule was seen in X-ray film in 4 patients. CT scan showed arthroedema, loose bodies and bone erosion of the femoral head in the hip joint. The X-ray films of the other 8 patients showed obvious calcified loose bodies. All cases were diagnosed by pathology after operations. 8 cases were categorized Milgram Ⅱstage, and 4 cases Milgram Ⅲ stage. Eight patients were followed-up for a period of 1 to 7 years (mean 5 years). Recurrence occurred in 2 cases. Conclusion The diagnosis should be based on clinical characters, X-ray films and pathologic findings, and the pathology is most reliable. In order to decrease recurrence, CT or MRI examinations should be taken before the operation. X-ray monitoring should be carried out during the operation of the patient in whom loose bodies were found in X-ray film before the operation.