What is Pigmented Villousanodular Synovitis (Hemorrhagic Synovitis)?
Pigmented villesonodular synovitis (a synonym for hemorrhagic synovitis) is a rheumatic disease, which, like Pigmented villissonodular bursitis (PVNB), pigmented villissonodular tenosynovitis (PVNT), is a group of neoplasms of the synovial sacs, tendons, tendon ducts, or tendon.
Symptoms of Pigmented Villousanodular Synovitis (Hemorrhagic Synovitis)
The disease is characterized by the growth of villi or nodes of various sizes and shapes, which contain hemosiderin and cholesterol crystals, as well as multinucleated giant cells localized in the stroma of the connective tissue of the capsule-sumo-ligamentous apparatus. There is no doubt the granulomatous nature of the inflammatory reaction in PVNS, PVNB, PVNT, which sharply distinguishes them from true neoplasms. These lesions are characterized by a tendency to relapse, for example, after surgical excision of pathologically altered tissues, however, they never give metastases. Therefore, they are referred to as benign tumors of the connective tissue of the joints, tendons and synovial bags.
PVNS is most often detected in young women. The primary localization of the process is the knee joint. Clinically, mild or moderate pain, swelling due to exudatively proliferative reactions, and a slight violation of joint function are noted. These symptoms can be observed for a number of years, and patients seek medical help if exudation increases in the joint and movements in it are limited.
Diagnosis of Pigmented Villousanodular Synovitis (Hemorrhagic Synovitis)
With joint punctures, hemorrhagic synovial fluid is found, the color of which varies from slightly pink to saturated brownish tones. Radiologically in the early phase of PVNS, only the presence of effusion can be noted (in the knee joint an increase in the size of the patella). In a later stage, individual bone erosions, periarticular porosity are found.
Arthropneumography can provide more valuable information, allowing you to detect multiple rounded “filling defects” of the synovial membrane, which are nodes or giant villi. The final diagnosis is made on the basis of a morphological study of the synovial biopsy obtained by puncture biopsy and revealing the characteristic deposits of hemosiderin and cholesterol, as well as multinuclear giant cells.
Recently, arthroscopy has been used to diagnose PVNS, in which it is clearly possible to see nodes of different sizes painted in reddish and saturated brown tones. The articular cartilage loses its bluish tint and becomes yellowish and even brownish due to the impregnation of it with hemosiderin. As for PVNB, it is often localized in the ankle joints in the form of delimited swelling with pathological changes similar to PVNS.
PST is usually detected in young women in the area of the tendon sheaths of the flexor and less often the extensor fingers.
Treatment of Pigmented Villousanodular Synovitis (Hemorrhagic Synovitis)
The treatment of the disease is surgical. The success of treatment depends on the radical excision of the pathologically altered synovial membrane, bursa, or tendon sheath. For example, with PVNS of the knee joint, a complete synovapsullectomy is necessary, supplemented by subsequent x-ray therapy in a total dose of 1500-3000 R. In the latter case, combined surgical treatment with x-ray therapy provides a stable recovery.
It should be noted the possibility of combining PVNS or PVNT with other RBs. We have described the case of the combination of PVPT with RA: characteristic brownish nodules grew from tendons of the flexors of the wrist in the wrist joint in patients with seropositive RA. Histologically, PST was confirmed.