Management of Recurrent Diffuse Pigmented Villonodular Synovitis: A Case Report

Author(s): Alphy Cherian Philips and Ponnanna Karineravanda Machaiah

Introduction: Pigmented villonodular synovitis is a rare disorder that is a benign, proliferative type of lesion of synovial tissue as well as bursal and tendon sheath tissue. There are two types: localised and diffuse, of which the diffuse variety has a higher recurrence rate. The sheer size and recurrent nature of the lesion in our case presented a challenge to effective treatment. Various treatment strategies have been tried to completely and effectively excise the mass and prevent recurrence.

Case: A 38-year-old male patient, who had previously undergone arthroscopic debridement of the left knee, presented with pain and swelling in the ipsilateral knee. Relevant investigations were done, and he was diagnosed with recurrent diffuse pigmented villonodular sinus.

Surgery was planned, anteriorly a medial parapatellar approach was employed and posteriorly an inverted L-shaped Burks and Schaffer approach was utilised and the mass of proliferated synovium excised. Histopathological examination revealed a diffuse proliferation of mononuclear cells with interspersed giant cells, confirming the diagnosis of a tenosynovial cell giant cell tumour. Once the surgical incisions had healed, the patient underwent radiotherapy using the 3DCRT technique. At a year and a half post-surgery, the patient is symptom-free.

Conclusion: Recurrent diffuse tenosynovial giant cell tumour is an uncommon entity and needs to be treated aggressively to prevent recurrence while maintaining the functionality of the knee joint. A dual open approach and postoperative adjuvant radiotherapy is a safe and effective way to execute this.