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Intra-articular lipoma arborescens of the knee joint.

Al-Shraim MM - Ann Saudi Med (2011 Mar-Apr)

Bottom Line: A biopsy reported intra-articular LA.This is the first case of LA reported in Saudi Arabia.LA should be included in the clinical and radiologic differential diagnosis of cases with persistent knee joint effusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, King Khalid University, College of Medicine, Abha, Saudi Arabia. malshraim@yahoo.com

ABSTRACT
Intra-articular lipoma arborescens (LA) is a rare entity that can present with monoarticular or polyarticular involvement of joints such as knees, ankles, hips, shoulders, and elbows. We describe a case in a 26-year-old man who presented with intermittent pain and swelling of the left knee joint for the previous 2 years. Physical examination showed only tenderness over the medial line of the left knee joint. MRI found only joint effusion; therefore, the patient was referred to the orthopedic clinic where he underwent arthroscopy, which revealed a diffuse yellow soft tissue synovial papillary growth involving both medial and lateral gutters of the suprapatellar pouch. A biopsy reported intra-articular LA. This is the first case of LA reported in Saudi Arabia. LA should be included in the clinical and radiologic differential diagnosis of cases with persistent knee joint effusion.

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Related in: MedlinePlus

MRI of the left knee. (A) Sagittal T1-weighted image showing small nodular soft tissue lesions of fatty signal intensity (back arrow) within the suprapatellar pouch. (B) Axial proton density fat suppressed weighted image showing suppression of the signal intensity of the lesions (white arrow), similar to subcutaneous fat.
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Figure 2: MRI of the left knee. (A) Sagittal T1-weighted image showing small nodular soft tissue lesions of fatty signal intensity (back arrow) within the suprapatellar pouch. (B) Axial proton density fat suppressed weighted image showing suppression of the signal intensity of the lesions (white arrow), similar to subcutaneous fat.

Mentions: A 26-year-old man presented with a history of intermittent pain and swelling of the left knee joint for the previous 2 years. He had a history of repeated soccer trauma to the same joint, without any other underlying joints disorders. The patient was treated initially by physiotherapy and nonsteroidal anti-inflammatory drugs such as piroxicam and diclofenac with limited response. Physical examination revealed an obese individual with tenderness over the medial line of the left knee joint. Pivot shift, McMurray, and Lachman test results were negative. Blood tests revealed a normal leukocyte and differential count. Other laboratory investigations were unremarkable. Initial MRI showed only mild effusion. The patient continued to have intermittent pain and tenderness over the medial side of the knee joint. He had another MRI, which found no significant abnormality except joint effusion. The patient subsequently was referred to the orthopedic clinic where he underwent diagnostic arthroscopy, which revealed diffuse yellow soft tissue synovial papillary growth involving both medial and lateral gutters of the suprapatellar pouch. In addition, there was a mild effusion, but no signs of injury to ligaments or menisci. A synovial biopsy was taken and histopathologic examination showed a synovial lined villous proliferation, in which the villi are diffusely infiltrated by mature adipose tissue (Figure 1). After the establishment of the histopathologic diagnosis of intra-articular lipoma arborescens, the second MRI was reexamined by the radiologist in the light of discussion with the orthopedic surgeon and the pathologist, allowing a precise radiologic localization of the lesion (Figure 2A, 2B). MRI post-arthroscopic intervention showed disappearance of the lesion (Figure 3A, 3B). The patient elected to continue on a conservative management without open synovectomy, unless the symptoms got worse. The clinical follow up showed mild improvement.


Intra-articular lipoma arborescens of the knee joint.

Al-Shraim MM - Ann Saudi Med (2011 Mar-Apr)

MRI of the left knee. (A) Sagittal T1-weighted image showing small nodular soft tissue lesions of fatty signal intensity (back arrow) within the suprapatellar pouch. (B) Axial proton density fat suppressed weighted image showing suppression of the signal intensity of the lesions (white arrow), similar to subcutaneous fat.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3102483&req=5

Figure 2: MRI of the left knee. (A) Sagittal T1-weighted image showing small nodular soft tissue lesions of fatty signal intensity (back arrow) within the suprapatellar pouch. (B) Axial proton density fat suppressed weighted image showing suppression of the signal intensity of the lesions (white arrow), similar to subcutaneous fat.
Mentions: A 26-year-old man presented with a history of intermittent pain and swelling of the left knee joint for the previous 2 years. He had a history of repeated soccer trauma to the same joint, without any other underlying joints disorders. The patient was treated initially by physiotherapy and nonsteroidal anti-inflammatory drugs such as piroxicam and diclofenac with limited response. Physical examination revealed an obese individual with tenderness over the medial line of the left knee joint. Pivot shift, McMurray, and Lachman test results were negative. Blood tests revealed a normal leukocyte and differential count. Other laboratory investigations were unremarkable. Initial MRI showed only mild effusion. The patient continued to have intermittent pain and tenderness over the medial side of the knee joint. He had another MRI, which found no significant abnormality except joint effusion. The patient subsequently was referred to the orthopedic clinic where he underwent diagnostic arthroscopy, which revealed diffuse yellow soft tissue synovial papillary growth involving both medial and lateral gutters of the suprapatellar pouch. In addition, there was a mild effusion, but no signs of injury to ligaments or menisci. A synovial biopsy was taken and histopathologic examination showed a synovial lined villous proliferation, in which the villi are diffusely infiltrated by mature adipose tissue (Figure 1). After the establishment of the histopathologic diagnosis of intra-articular lipoma arborescens, the second MRI was reexamined by the radiologist in the light of discussion with the orthopedic surgeon and the pathologist, allowing a precise radiologic localization of the lesion (Figure 2A, 2B). MRI post-arthroscopic intervention showed disappearance of the lesion (Figure 3A, 3B). The patient elected to continue on a conservative management without open synovectomy, unless the symptoms got worse. The clinical follow up showed mild improvement.

Bottom Line: A biopsy reported intra-articular LA.This is the first case of LA reported in Saudi Arabia.LA should be included in the clinical and radiologic differential diagnosis of cases with persistent knee joint effusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, King Khalid University, College of Medicine, Abha, Saudi Arabia. malshraim@yahoo.com

ABSTRACT
Intra-articular lipoma arborescens (LA) is a rare entity that can present with monoarticular or polyarticular involvement of joints such as knees, ankles, hips, shoulders, and elbows. We describe a case in a 26-year-old man who presented with intermittent pain and swelling of the left knee joint for the previous 2 years. Physical examination showed only tenderness over the medial line of the left knee joint. MRI found only joint effusion; therefore, the patient was referred to the orthopedic clinic where he underwent arthroscopy, which revealed a diffuse yellow soft tissue synovial papillary growth involving both medial and lateral gutters of the suprapatellar pouch. A biopsy reported intra-articular LA. This is the first case of LA reported in Saudi Arabia. LA should be included in the clinical and radiologic differential diagnosis of cases with persistent knee joint effusion.

Show MeSH
Related in: MedlinePlus