|
Year |
2007 |
|---|---|
|
Question Number |
57 |
|
Category |
Orthopaedic Disease |
Question
A 58-year-old man has had increasing stiffness and swelling in his right knee for the past 9 months. Radiographs and a biopsy specimen are shown in Figures 19a through 19c. What is the most likely diagnosis?
1- Tumoral calcinosis
2- Synovial chondromatosis
3- Synovial hemangioma
4- Synovial sarcoma
5- Periosteal osteosarcoma
Figures
Answer (click for answer)
The answer is 2- Synovial chondromatosis
Synovial chondromatosis are benign periarticular cartilaginous lesions that arise from synovium; they may be calcified and/or ossified and often give rise to intra-articular loose bodies. The risk of malignant transformation is extremely low. These mainly occur in adults 20-40s, with 2:1 males to females. Presentation is commonly of joint pain, swelling, and stiffness; they may cause a locked joint or block full ROM with possibly an effusion. Xray shows multiple calcified bodies in the joint, regular in outline and uniform in size from a few mm to several cm.
These are classified as early: synovial chondrometaplasia but no loose bodies, transitional: synovial disease and loose bodies, and late: loose bodies predominate, generally with extensive effusion. Pathology shows nodules of chondroid tissue both free and within the synovium. If the cartilage is cellular, the cells are in clusters. There is variable mineralization and differentiation into trabecular bone may be present. These are treated by removal of loose bodies and total synovectomy in early or transitional stages.
Reference:
Attachments:
OITE 2007 figure 19a.jpg (image/jpeg)
OITE 2007 figure 19b.jpg (image/jpeg)
OITE 2007 figure 19c.jpg (image/jpeg)
