pigment villos nodular synovitis pvns
TRANSCRIPT
Pigmented
Villous
Nodular
Synovitis
• 基本資料 :32 歲男性,勞力工作• 兩個月前,左腳腫痛,走路走不遠,後來疼痛加劇• 一個月前,左後膝窩處出現一個軟軟的腫瘤
• 腫瘤變的更大病患至醫院就診• Doctor: 為一個貝克式囊腫• 建議手術 !• 病人接受手術………… 但是 B
• 切除術開了 七個小時 • 醫生後來說不是囊腫…• 那切下來的東西是什麼 ??病人 : 醫生說再看看 ?
膝蓋週圍常見的囊腫
Synovial cysts• herniation of
synovial tissue into the surrounding soft tissue
• 有時連接的通道消失了和其他的Ganglion/Bursa不易區分
S
Popliteal (Baker‘s) cyst• 膝蓋最常見的腫瘤• Communication
posterior joint capsule /gastrocnemius-semimembranosus recess. • "ball-valve” • knee flexion/open
extension/close
S
• 大部分沒有症狀,但是如果太大,會造成神經,血管的壓迫大部分發生於屈曲時• 有時囊腫會破裂,會造成膝窩的腫脹,靜脈栓塞和週圍組織的血腫
有時會有骨頭漂至囊腫內
• 最近……膝後的腫瘤更大,整個膝蓋腫無法彎曲• PE: ROM 0~30
Severe swelling and tenderness , soft tissue mass over operation scar .
• PVNSMRI ??
T1 Saggital
P F
QF muscle
Soft tissuetumor
Soft tissuetumor
Soft tissue cyst
MRI 報告 :PVNSExcision biopsy
Posterior
順原傷口Anterior
`
Arthroscope ?Open arthrotomyOpen arthrotomy
AnteriorOpen Arthrotomy
AnteriorOpen Arthrotomy
ACL*
*
PosteriorOpen Arthrotomy
• 病理報告 :• Anterior: PMN,
lymphoid follicles,
Hemosiderin PVNS• Posterior: Bursitis with inflammation
PVNSRecurrent
hemoarthrosisBenign disease with
malignant behaviorEasily local
recurrence• High recurrence
rate• Long recurrence
period
• 正常關節 / 肌腱的滑膜會不斷的增生• 關節腔會發炎,增厚• 組 織 內 含
Hemosiderin外觀看起來暗紅色• 形成絨毛 (Villous)或結節狀 (Nodular)
Pigmented
Villous
Nodular
Synovitis
• Etiology --- unknown• Location
– Monarticular: Knee (75%)> Hip > Wrist > Ankle > Shoulder
– Polyarticular 少見• 臨床症狀 : 痛,活動受限,腫脹
• Diffuse type Large joint
Localized type Small joint • 診斷 關節抽吸 :Sero-sanguineou
“Without” trauma history• MRI
• T2 image: hemosiderin depositionLow signal
• 好發於 20~50 歲年輕人• Non-surgical Treatment
– Intra-articular injection• Steroid • Yttrium-90 silicate (RA,
knee)– Radiation therapy
• Post-op. (35 Gy / 15 fractions)
• 術後行放療證實可以減少復發