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[Pigmented villonodular synovitis of the shoulder joint]
1Klinik für Allgemeinchirurgie, Johannes-Gutenberg-Universität Mainz.
Zentralblatt Fur Chirurgie
|January 9, 1999
Summary
A rare case of pigmented villonodular synovitis presented as a malignant-appearing mass on the proximal humerus in a teen. This unusual presentation highlights the importance of considering joint capsule origins for shoulder masses.
Area of Science:
- Orthopedics
- Pathology
- Radiology
Background:
- Pigmented villonodular synovitis (PVNS) is a rare, benign neoplastic proliferation of the synovium.
- PVNS typically affects large joints like the knee, hip, and ankle, rarely presenting in the shoulder.
- The clinical presentation of PVNS can mimic malignant bone or soft tissue tumors, leading to diagnostic challenges.
Observation:
- A 16-year-old student presented with a painful, large (7.5 x 6 x 4 cm) soft tissue mass on the proximal humerus.
- Initial MRI suggested a malignant tumor invading the shoulder capsule.
- The patient later recalled a shoulder trauma from a mountain bike accident.
Findings:
- Intraoperative findings revealed two tumors infiltrating axillary vessels and nerves, originating from the shoulder joint capsule.
- Initial frozen section analysis did not show malignancy.
- Final histopathology confirmed localized pigmented villonodular synovitis (PVNS).
Implications:
- This case underscores the potential for PVNS to mimic aggressive bone tumors, particularly with unusual proximal humerus presentation.
- It highlights the diagnostic challenge when a patient has no prior shoulder complaints or deficits.
- Considering intra-articular origins is crucial for accurate preoperative diagnosis and management of shoulder masses.