Pigmented Villonodular Synovitis in Temporomandibular Joint: Image Features and Differential Diagnosis

色素沉著絨毛結節性滑液膜炎於顳下頜關節：影像特徵及鑑別診斷

陳建宇(Chien-Yu Chen) ； 侯其禎(Chi-Chen Hou) ； 曾文盛(Wen-Sheng Tzeng) ； 李健逢(Chien-Feng Li)

《中華放射線醫學雜誌》 32卷4期 (2007/12) Pp. 211-216

摘要

色素沉著絨毛結節性滑液膜炎於顳下頜關節是個少見的疾病。在英文文獻中只有39個病例。我們再提出一個此種病例。這是一位52歲女性，她從兩年前開始出現右耳前疼痛及張開嘴巴受限制的情形。理學檢查在右耳前摸到一個結節。電腦斷層發現一個周邊顯影的結節在右下頜髁狀突頸部並有骨頭腐蝕。核磁共振下，這個結節在質子密度加權影像呈現輕微高訊號，在T2加權影像呈現混合高低訊號及部分暗訊號病灶。在加顯影劑的T1加權影像呈現周邊顯影。經外科切除後，病理確認了色素沉著絨毛結節性滑液膜炎的診斷。雖然色素沉著絨毛結節性滑液膜炎於顳下頜關節是個少見的情形，對於耳前疼痛性結節的病人仍應該將它列入鑑別診斷。

並列摘要

Pigmented villonodular synovitis in temporomandibular joint is an uncommon disorder. There are only 39 cases reported in the English literature. Here we report a case with this disease. The patient was a 52-year-old female suffering from progressive right pre-auricular pain and limitation in open mouth for 2 years. Physical examination revealed a palpable nodule in the right preauricular area. Computed tomography showed a peripherally enhancing nodular lesion adjacent to the neck of right mandibular condyle with bony erosion. Magnetic resonance imaging disclosed this nodular lesion slightly hyperintense on proton density-weighted images and hypointense mixed with some hyperintense regions and some foci of dark signal intensity on T2-weighted images. Peripheral enhancement on Gadolinium-enhanced T1-weighted images was also noted. Surgical excision was performed and pathology confirmed the diagnosis of pigmented villonodular synovitis. Even though pigmented villonodular synovitis in temporomandibular joint is a rare condition, it should be included in differential diagnoses for patients with pre-auricular painful nodule.