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Pigmented Villonodular Synovitis: A Comprehensive Review and Proposed Treatment Algorithm.

Stephen R Stephan1, Brandon Shallop1, Richard Lackman2

  • 1Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.

JBJS Reviews
|August 11, 2016
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Summary

Pigmented villonodular synovitis may originate from neoplastic cells, with arthroscopic surgery being effective for localized cases. Diffuse cases may benefit from combined arthroscopic and open excision, while targeted therapies show promise.

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Area of Science:

  • Orthopedics
  • Oncology
  • Pathology

Background:

  • Pigmented villonodular synovitis (PVNS) is a rare joint disorder.
  • Evidence suggests a neoplastic origin for PVNS, involving specific translocations.
  • Understanding the etiology is crucial for effective treatment strategies.

Purpose of the Study:

  • To review the current evidence regarding the neoplastic origin of PVNS.
  • To compare surgical treatment options for localized and diffuse PVNS.
  • To explore emerging therapeutic modalities for PVNS.

Main Methods:

  • Literature review of studies on PVNS etiology and treatment.
  • Analysis of surgical outcomes for arthroscopic versus open excision.
  • Evaluation of radiation therapy and targeted therapies for PVNS.

Main Results:

  • Arthroscopic excision shows lower recurrence and morbidity for localized PVNS compared to open excision.
  • Open excision remains important for posterior nodules.
  • Combined arthroscopic and open excision is preferred for diffuse PVNS.
  • Radiation therapy poses toxicity risks.
  • Targeted therapies (small molecules, monoclonal antibodies) show promising results.

Conclusions:

  • PVNS likely has a neoplastic origin.
  • Surgical approach should be tailored to PVNS localization (localized vs. diffuse).
  • Novel targeted therapies offer a promising future treatment avenue for PVNS.