Localized Pigmented Villonodular Synovitis of Joints

關節腔局限型色素絨毛結節滑膜炎

王德源(Der-Yean Wang)

《Mid-Taiwan Journal of Medicine》 6卷4期 (2001/12) Pp. 203-209

https://doi.org/10.6558/MTJM.2001.6(4).2

摘要

背景：色素絨毛結節滑膜炎有三種型態：一為腱鞘型，二為關節腔瀰漫型，三為關節腔局限型。後兩者為較少見，其發生率約為百萬分之一點八，又關節腔局限型更為少見，故我將本院11年間經開刀及病理證實為關節腔局限型之六個病例提出報告。
方法：從1988至1999本院曾開刀及病理證實為關節腔局限型之六個病人，將其病歷、開刀紀錄、病理報告、術前及術後的影像，及病理標本加以回顧及探討。所有病人皆回院，再接受理學檢查及影像攝影，主要目的為針對是否有術後復發，另從病歷記載中特別針對發病時間、腫瘤位置、大小、顏色、先前是否受傷、開刀方法及磁核共振檢查等，加以詳加回顧。
結果：此六個病人中有四女兩男，平均年齡為37歲，此腫瘤皆發生在膝關節，均以關節切開術或關節鏡手術開刀取出，追蹤期平均為56.3個月，皆無再發，症狀以關節不舒服感最多(100%) ，其次為有腫瘤異物感(50%) ，再次為關節腫脹或彎曲受限(33.3%)。有二個病例有外傷病史，有一例有關節血腫，有三例在術前曾施行磁核共振檢查，其中二例磁核共振診斷為此病。
結論：此病在以前之報告其術前診斷不易，但磁核共振發明及使用後已增加術前診斷正確率，大部分此種腫瘤皆小於2.5公分，而且好發在半月板前角處附近。另與瀰漫型比較，此種局限型之病人，其症狀較急性，年紀也較輕。此病治療以腫瘤過磁切除術可獲得良好結果。

關鍵字

色素絨毛結節滑膜炎

並列摘要

Background: Pigmented villonodular synovitis (PVNS) occurs in three forms: giant cell tumors of tendon sheaths or bursae, diffuse PVNS of joints, and localized PVNS of joints. Both the diffuse form and the localized form of PVNS of joints are rare disease entities that most often affect the knee joint. The over-all annual incidence rate is 1.8 patients per million in the general population. Six cases of intra-articular localized PVNS were reviewed in this study.
Methods: The records of all six patients who had received surgical treatment and pathology-proven localized PVNS of joints between June 1988 and February 1999 were reviewed. The material review included clinical notes, operative records, pathological reports, preoperative and postoperative imaging studies, and histological reports. All patients were called for a follow-up evaluation, and all of them were seen and examined.
Results: There were two men and four women. The average age was 37 years (range, 19 to69 years). PVNS was located in the knee joints and managed with marginal excision by either open arthrotomy or arthroscopic operation in all cases. There was no evidence of recurrence at the follow-up evaluation (range, 12 to 126 months: average, 56.3 months). The average duration from onset of symptoms to presentation was 10.7 months-(range, 3 to 36 months). Discomfort was the most common complaint in the clinic (6/6).
Conclusions: Preoperative diagnosis is difficult without the use of MR imaging. Painless hemarthrosis is not as common as that reported in the literature, and the ages of these cases are younger than those of patients with diffuse PVNS. The symptoms are more acute in cases of localized PVNS of joints. Marginal excision is the appropriate treatment for patients with localized PVNS.

並列關鍵字

pigmented villonodular synovitis