Synovial Membrane

滑膜
  • 文章类型: Case Reports
    背景:滑膜血管瘤是一种罕见的良性血管异常,由Bouchut于1856年首次描述。这些肿瘤可以在关节内区域发展,导致积液和膝盖疼痛。然而,他们的原因仍然未知。及时的诊断和干预对于防止软骨损伤至关重要。组织病理学检查用于实现诊断,通常由于缺乏特定的临床体征而延迟。该报告描述了一个独特的病例,其中痛苦的髌下肿块被诊断为滑膜血管瘤。缺乏典型的磁共振成像(MRI)发现突出了关节镜切除对诊断和症状缓解的重要性。
    方法:一名20岁女性出现持续的左膝前疼痛,当她爬楼梯时疼痛加剧。尽管以前的疼痛管理和物理治疗,她在髌骨下形成了一个疼痛的肿块,随着时间的推移而恶化。她还做过关节穿刺术,但这并不能减轻她的痛苦。体格检查显示,沿着髌腱固定5厘米的质量,膝关节屈伸有限,韧带稳定正常。左膝关节T1加权脂肪饱和MRI和基于钆的对比剂显示Hoffa的脂肪垫有一个分叶状的关节内肿块,类似于软组织软骨瘤。对肿块进行了活检以提供组织病理学证据,确认质量的良性性质。随后的关节镜切除,结合切口扩大进行肿块切除,证实滑膜血管瘤的组织病理学诊断是基于滑膜切片内存在大量扩张的血管和静脉增生。恢复完成,1年后随访MRI未见肿瘤残留。
    结论:本病例研究强调了关节镜切除对滑膜血管瘤患者的重要性。关节镜的微创性质与包囊良好的性质和肿块的位置相结合有助于完全切除。
    BACKGROUND: Synovial hemangiomas are rare benign vascular anomalies surrounded by a synovial lining and were first described by Bouchut in 1856. These neoplasms can develop in the intra-articular region, resulting in effusions and knee pain. However, their cause remains unknown. Prompt diagnosis and intervention are critical to prevent chondral damage. Histopathological examination is used to achieve the diagnosis, which is often delayed because of a lack of specific clinical signs. This report describes a unique case in which a painful infrapatellar mass was diagnosed as a synovial hemangioma. The absence of typical magnetic resonance imaging (MRI) findings highlights the importance of arthroscopic excision for diagnosis and symptom relief.
    METHODS: A 20-year-old woman presented with persistent anterior left knee pain that became exacerbated when she climbed stairs. Despite previous pain management and physical therapy, she developed a painful lump beneath her patella that worsened over time. She had also undergone arthrocentesis, but this did not relieve her pain. Physical examination revealed a palpable, immobile 5-cm mass along the patellar tendon with limited knee flexion and extension and normal ligament stability. T1-weighted fat-saturated MRI of the left knee with gadolinium-based contrast revealed a lobulated intra-articular mass in Hoffa\'s fat pad that resembled a soft tissue chondroma. A biopsy of the mass was performed to provide histopathological evidence, confirming the benign nature of the mass. The subsequent excisional arthroscopy, combined with incision enlargement for mass removal, confirmed the histopathologic diagnosis of synovial hemangioma based on the presence of numerous dilated blood vessels and venous proliferation within sections of the synovium. Recovery was complete, and no residual tumor was detected on follow-up MRI after 1 year.
    CONCLUSIONS: This case study emphasizes the importance of arthroscopic excision over open surgery for patients with synovial hemangioma. The minimally invasive nature of arthroscopy combined with the well-encapsulated nature and location of the mass facilitates complete resection.
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  • 文章类型: Review
    背景:滑膜软骨瘤病是一种非恶性滑膜疾病,其特征是滑膜内存在软骨形成,导致出现可能附着或未附着的多个软骨结节。这种解剖特征的存在经常在关节中观察到,例如膝盖,臀部,弯头,和脚踝。
    方法:在本研究中,我们介绍了一个60岁出头的健康男性膝关节滑膜软骨瘤病。值得注意的是,患者同时出现87个大的松散尸体。在关节内出现大量尺寸明显的未连接实体是非常罕见的。
    结论:患者有多个滑膜软骨瘤,一种罕见的疾病.滑膜软骨瘤病是一种良性疾病;然而,滑膜生长可引起化脓性软骨结节。关节中的大多数松散体可以磨损和退化关节软骨,造成长期不适。因此,早期手术切除松散的身体和仔细切除滑膜组织是必要的治疗这种情况。
    BACKGROUND: Synovial chondromatosis is a non-malignant synovial disorder characterized by the presence of cartilage formation within the synovial membrane, leading to the emergence of multiple cartilaginous nodules that may be either attached or unattached. The presence of this anatomical feature is frequently observed in articulations such as the knee, hip, elbow, and ankle.
    METHODS: In this study, we present a case of synovial chondromatosis in the knee joint of a healthy male in his early 60s. Notably, the patient exhibited the simultaneous presence of 87 large loose bodies. The occurrence of a substantial quantity of unattached entities of notable dimensions within the joint is highly uncommon.
    CONCLUSIONS: The patient had several synovial chondromas, a rare disease. Synovial chondromatosis is a benign disorder; however, growing synovium can cause pyogenic cartilage nodules. Most loose bodies in joints can abrade and degenerate articular cartilage, causing long-term discomfort. Thus, an early-stage procedure to remove loose bodies and carefully excise synovial tissue is necessary to treat this condition.
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  • 文章类型: Case Reports
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  • 文章类型: Case Reports
    颞下颌关节滑膜软骨瘤病(TMJ)是一种罕见的疾病,其特征是滑膜间充质残余物的软骨化生,形成松散的软骨结节。它普遍存在于中年女性,主要临床特征是肿胀,疼痛,和有限的下巴运动。诊断是困难的,尤其是在早期阶段,因为体征和症状就像其他TMJ疾病,如内部紊乱和肿瘤。影像学检查是鉴别诊断滑膜炎和游离软骨体的基础。为此目的,具有钆对比的磁共振成像将是特别感兴趣的。治疗包括去除软骨结节和滑膜切除术。根据病变的大小,可以通过关节镜或关节切开术进行。小体的数量,以及辅助外科手术的需要。最终诊断为解剖病理学。由于复发的风险,术后随访是必要的。
    Synovial chondromatosis of the temporomandibular joint (TMJ) is a rare disease characterized by cartilaginous metaplasia of the mesenchymal remnants of the synovial membrane with formation of loose cartilaginous nodules. It is prevalent in middle-aged women and the main clinical characteristics are swelling, pain, and limited jaw movements. Diagnosis is difficult, especially in the early stages, because the signs and symptoms are like other TMJ diseases such as internal derangements and tumors. Imaging exams are fundamental in differential diagnosis for detection of synovitis and free cartilaginous bodies. Magnetic resonance imaging with a gadolinium contrast would be of particular interest for this purpose. Treatment involves the removal of the cartilaginous nodules and synovectomy. It can be performed by arthroscopy or arthrotomy depending on the size of the lesion, the number of corpuscles, and the need for auxiliary surgical procedures. Final diagnosis is anatomopathologic. Postoperative follow-up is necessary due to the risk of recurrence.
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  • 文章类型: Case Reports
    本文讨论了两例罕见的髋部色素沉着绒毛结节性滑膜炎(PVNS)。髋关节是色素沉着绒毛结节性滑膜炎的第二常见部位,屈膝[1]。大多数髋关节PVNS病例要么弥漫性累及滑膜,要么是关节内的局灶性病变。病变和滑膜显示与含铁血黄素沉积相关的低信号强度病灶,这一发现将PVNS与滑膜增生的其他原因区分开来。我们的病例报告显示了两种罕见的位于髋唇内的PVNS病变表现。这种表现很容易被成像方式误认为是囊肿。尽管这种情况很少见,我们强调了质疑唇内PVNS可能性的重要性,当患者持续性髋部疼痛对治疗无反应和不典型的影像学表现时。强调这种罕见的表现对于建立正确的诊断至关重要,指导治疗,并获得最佳临床结果。
    This article discusses two rare cases of intra-labral pigmented villonodular synovitis (PVNS) of the hip. The hip joint represents the second most common location of pigmented villonodular synovitis, second to the knee [1]. The majority of hip PVNS cases either diffusely involve the synovium or are focal lesions within the joint. The lesions and synovium show foci of low signal intensity related to hemosiderin deposition, a finding that differentiates PVNS from other causes of synovial proliferation. Our case report presents two rare manifestations of PVNS lesions localized within the hip labrum. This presentation could easily be mistaken for a cyst by imaging modality. Despite the rarity of this condition, we highlight the importance of questioning the possibility of intra-labral PVNS, when patients have persistent hip pain not responding to therapy and atypical imaging findings. Highlighting this rare presentation is crucial for establishing the correct diagnosis, guiding treatment, and obtaining the best clinical outcome.
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  • 背景:滑膜软骨瘤病是一种罕见的良性疾病,其特征是滑膜增生和上皮化生。已经报道了类风湿关节炎患者的滑膜软骨瘤病病例。然而,肱骨关节受累是罕见的。
    方法:我们在此报告一例罕见的累及肩关节的滑膜软骨瘤病。使用抗肿瘤坏死因子药物可改善症状。因此,治疗滑膜软骨瘤病不需要侵入性治疗。
    结论:滑膜软骨瘤病具有侵袭性和破坏性。需要更多的试验来建立更好的临床诊断策略和药物管理。
    BACKGROUND: Synovial chondromatosis is an uncommon benign condition characterized by synovial membrane proliferation and metaplasia. Synovial chondromatosis cases in patients with rheumatoid arthritis have been reported. However, involvement of the glenohumeral joint is rare.
    METHODS: We herein report a case of a rare association of synovial chondromatosis involving the shoulder in a rheumatoid arthritis patient. The symptoms have improved with anti-tumor necrosis factor drugs. Consequently, there was no need for invasive therapy to treat synovial chondromatosis.
    CONCLUSIONS: Synovial chondromatosis can be aggressive and destructive. More trials are needed to establish a better clinical diagnostic strategy and pharmacological management.
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  • 文章类型: Case Reports
    肌腱滑膜巨细胞瘤(TSGCT)通常来自肌腱鞘的滑膜。Bursa,和关节。很少在脊柱中发现。上颈椎(C1/2)的病变极为罕见,文献中仅报道了13例以前的病例。其中,以前所有的上颈前路病例(C1/2)均被认为是不可切除的,并接受了免疫治疗或放射学监测.
    我们报告了两例颈椎TSGCST:一个在C1/2处病变,另一个在C6/7处病变。
    我们的C1/2病变的位置是独特的,允许一种新的内镜鼻内组织活检方法和一种新的经口手术方法,以成功进行全切除。我们的C6/7病变具有更典型的位置,并通过C6/7椎板切除术切除。
    Tenosynovial giant cell tumours (TSGCTs) usually arise from the synovial membranes of tendon sheaths, bursa, and joints. They are rarely found in the spine. Lesions of the upper cervical spine (C1/2) are extremely rare, with only 13 previous cases reported in the literature. Of these, all previous anterior upper cervical cases (C1/2) have been deemed unresectable and have been managed with immunotherapy or radiological surveillance.
    We report two cases of TSGCST in the cervical spine: one with a lesion at C1/2 and another at C6/7.
    The location of our C1/2 lesion was unique, allowing for a new endoscopic endonasal tissue biopsy method and a new transoral surgical approach for successful gross total resection. Our C6/7 lesion had a more typical location and was removed via a C6/7 laminectomy.
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  • 文章类型: Journal Article
    目的:这是一项前瞻性研究,旨在评估高频超声(HFUS)的临床价值,精湛的微血管成像(SMI),和超声造影(CEUS)在色素沉着绒毛结节性滑膜炎(PVNS)和高活性类风湿关节炎(RA)的鉴别中。
    方法:选择20例PVNS患者和24例活动性RA患者行HFUS,SMI,和CEUS考试。HFUS的特点,SMI,比较PVNS和RA中的CEUS,以及HFUS的鉴别诊断性能,SMI,通过受试者工作特性(ROC)分析评估PVNS和RA的CEUS。
    结果:关节积液有统计学意义,滑膜厚度,滑膜形态学,滑膜回声,滑膜血管形状,滑膜增强方向,PVNS和RA之间的模式增强(P<0.05)。然而,骨侵蚀无统计学意义,滑膜边界,滑膜血液信号分级,滑膜增强强度,和CEUS定量参数(包括PI,TTP,S,MTT,和AUC)(P>.05)。HFUS的AUC,SMI,鉴别诊断PVNS和RA的CEUS分别为0.832、0.675和0.817。HFUS+SMI的AUC,HFUS+CEUS,SMI+CEUS,HFUS+SMI+CEUS分别为0.923、0.940、0.817和0.940。HFUS+SMI和HFUS+CEUS的AUC均高于单独的AUC(P<0.05)。
    结论:HFUS,SMI,和CEUS可作为PVNS和活动性RA诊断和鉴别诊断的补充方法。更重要的是,建议采用HFUS+SMI和HFUS+CEUS。
    OBJECTIVE: This is a prospective study to evaluate the clinical value of high-frequency ultrasound (HFUS), superb microvascular imaging (SMI), and contrast-enhanced ultrasound (CEUS) in differentiation of pigmented villonodular synovitis (PVNS) and highly active rheumatoid arthritis (RA).
    METHODS: Twenty PVNS patients and 24 active RA patients were selected to undergo HFUS, SMI, and CEUS examinations. The characteristics of HFUS, SMI, and CEUS in PVNS and RA were compared, and the differential diagnosis performances of HFUS, SMI, and CEUS in PVNS and RA were evaluated by receiver operating characteristic (ROC) analysis.
    RESULTS: There were statistically significant in joint effusion, synovial thickness, synovial morphology, synovial echo, synovial vessel shape, synovial enhanced direction, and enhanced pattern between PVNS and RA (P < .05). However, no statistically significant were found in bone erosion, synovial boundary, blood signal grading of synovium, synovial enhanced strength, and CEUS quantitative parameters (including PI, TTP, S, MTT, and AUC) (P > .05). The AUC of HFUS, SMI, and CEUS for differential diagnosis PVNS and RA were 0.832, 0.675, and 0.817, respectively. The AUC of HFUS + SMI, HFUS + CEUS, SMI + CEUS, HFUS + SMI + CEUS were 0.923, 0.940, 0.817, and 0.940, respectively. The AUC of HFUS + SMI and HFUS + CEUS was higher than that of each alone (P < .05).
    CONCLUSIONS: HFUS, SMI, and CEUS can be used as supplementary methods for diagnosis and differential diagnosis in PVNS and active RA. What is more, the combination of HFUS + SMI and HFUS + CEUS was suggested.
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  • 文章类型: Case Reports
    滑膜软骨瘤病(SC)是一种罕见的疾病,涉及滑膜下结缔组织化生继发的滑膜内软骨的增殖。向软骨肉瘤的恶性转化很少见。我们举一例关节镜清创术难治的髋关节SC,在流产的全髋关节置换术中发现继发性软骨肉瘤,其中治愈性治疗最终通过外部半盆切除术获得。
    SC有可能发生恶性转化为软骨肉瘤。不认识到这种转变的后果可能会显著影响患者的预后,并限制局部控制手术和肢体抢救的选择。
    Synovial chondromatosis (SC) is a rare condition involving the proliferation of cartilage within the synovial membrane secondary to subsynovial connective tissue metaplasia. Malignant transformation to chondrosarcoma is rare. We cite a case of SC of the hip refractory to arthroscopic debridement, found to have secondary chondrosarcoma on aborted total hip arthroplasty, in which curative treatment was ultimately obtained with external hemipelvectomy.
    SC has the potential to undergo malignant transformation to chondrosarcoma. The consequences of not recognizing such transformation can significantly impact patient outcomes and limit options for local control surgery and limb salvage.
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  • 文章类型: Case Reports
    滑膜软骨瘤病(SC)是一种良性疾病,其特征是在关节滑膜中形成化生软骨,导致许多附着和未附着的骨软骨体。SC主要影响大型滑膜关节,尤其是膝盖,臀部,弯头,还有脚踝,而颞下颌关节(TMJ)的受累很少。迄今为止,英语文献中已报道了大约240例TMJSC。松散身体的数量因患者而异,但通常范围从几十个到大约100个。我们在此报告了一名健康的53岁女性的TMJSC伴有约400个松散身体的病例。在狭小空间内如此大量的松散物体是极为罕见的。我们还对TMJSC的鉴别诊断和当前诊断方法进行了简要讨论。值得注意的是,延迟诊断或误诊是常见的,因为提出的投诉的非特异性。
    Synovial chondromatosis (SC) is a benign condition characterized by the formation of metaplastic cartilage in the synovial membrane of the joint, resulting in numerous attached and unattached osteocartilaginous bodies. SC mostly affects the large synovial joints, especially the knee, hip, elbow, and ankle, whereas involvement of the temporomandibular joint (TMJ) is rare. Approximately 240 cases of SC of the TMJ have been reported in the English-language literature to date. The number of loose bodies varies among patients but usually ranges from the dozens to around 100. We herein report a case of SC of the TMJ accompanied by approximately 400 loose bodies in a healthy 53-year-old woman. Such a high number of loose bodies within a small space is extremely rare. We also include a brief discussion about the differential diagnoses and current diagnostic approaches to SC of the TMJ. Notably, delayed diagnosis or misdiagnosis is common because of the nonspecific nature of the presenting complaints.
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