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Giant Cell Tumor of the Patella Tendon Sheath Presenting as a Painful Locked Knee.

Panagopoulos A, Tsoumpos P, Tatani I, Iliopoulos I, Papachristou D - Am J Case Rep (2015)

Bottom Line: Clinical examination revealed lack of extension by approximately 20°.Histological examination showed a tendosynovial giant cell tumor of the patella tendon sheath.At the latest follow-up, 2 years postoperatively, there was no local tumor recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Sports Medicine, Orthopaedic Clinic, Patras University Hospital, Patras, Greece.

ABSTRACT

Background: The giant cell tumor of the tendon sheath (GCT-TS) is a benign proliferative synovial tumor manifesting as an intra-articular solitary nodule. When it involves the infrapatellar fat pad it can present acutely as a painful locked knee.

Case report: A 26-year-old white male presented with a 2-week history of painful locking in his right knee. Clinical examination revealed lack of extension by approximately 20°. To help establish the diagnosis, an MRI scan of the right knee was performed, showing a large (5×4×2 cm), oval, well-circumscribed mass with a low-intensity homogenous signal. The size of the mass prohibited the removal by arthroscopy and we therefore proceeded with an open arthrotomy. Histological examination showed a tendosynovial giant cell tumor of the patella tendon sheath. At the latest follow-up, 2 years postoperatively, there was no local tumor recurrence.

Conclusions: These rare tumorous lesions should be included in the differential diagnosis of painful locking knee, especially in the absence of definite traumatic history.

No MeSH data available.


Related in: MedlinePlus

The mass is encapsulated by fibrous tissue and the diameter is about 5 cm. There are no villous fronds or evidence of cystic component. Signs of acute hemorrhage were also noted.
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f3-amjcaserep-16-568: The mass is encapsulated by fibrous tissue and the diameter is about 5 cm. There are no villous fronds or evidence of cystic component. Signs of acute hemorrhage were also noted.

Mentions: Once the diagnostic approach was terminated and the pre-operative examination found no contraindications, the patient was taken to the surgical theater. Examination under general anesthesia revealed full flexion of the knee and full extension except from terminal degrees where a soft block could be felt without accompanying effusion or palpable mass. Subsequent knee arthroscopy was performed by typical arthroscopic portals. A unique, large, intraarticular mass was identified, originating posteriorly to the patellar tendon (Figure 3). The size of the mass prohibited removal by arthroscopy and we therefore proceeded with an open arthrotomy. In this way, via medial parapatellar incision, a complete mass excision was achieved and the lesion was sent for histological interpretation. Gross macroscopic examination revealed a well-circumscribed, firm, homogenous, yellowish-to-brown mass measuring 5×4×1.8 cm. Microscopically, the lesion was moderately cellular, with the presence of ovoid-to-epithelioid mononuclear cells and scattered multinucleated giant cells with a varying number of nuclei, ranging from 3 to approximately 50 (Figure 4). The mononuclear cells displayed minimal atypia, moderate amount of cytoplasm, and large, round nucleus. The cells were embedded in dense collagenous stroma. Very low mitotic activity (1–2 mitotic figures/10 HPF) was observed.


Giant Cell Tumor of the Patella Tendon Sheath Presenting as a Painful Locked Knee.

Panagopoulos A, Tsoumpos P, Tatani I, Iliopoulos I, Papachristou D - Am J Case Rep (2015)

The mass is encapsulated by fibrous tissue and the diameter is about 5 cm. There are no villous fronds or evidence of cystic component. Signs of acute hemorrhage were also noted.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4554334&req=5

f3-amjcaserep-16-568: The mass is encapsulated by fibrous tissue and the diameter is about 5 cm. There are no villous fronds or evidence of cystic component. Signs of acute hemorrhage were also noted.
Mentions: Once the diagnostic approach was terminated and the pre-operative examination found no contraindications, the patient was taken to the surgical theater. Examination under general anesthesia revealed full flexion of the knee and full extension except from terminal degrees where a soft block could be felt without accompanying effusion or palpable mass. Subsequent knee arthroscopy was performed by typical arthroscopic portals. A unique, large, intraarticular mass was identified, originating posteriorly to the patellar tendon (Figure 3). The size of the mass prohibited removal by arthroscopy and we therefore proceeded with an open arthrotomy. In this way, via medial parapatellar incision, a complete mass excision was achieved and the lesion was sent for histological interpretation. Gross macroscopic examination revealed a well-circumscribed, firm, homogenous, yellowish-to-brown mass measuring 5×4×1.8 cm. Microscopically, the lesion was moderately cellular, with the presence of ovoid-to-epithelioid mononuclear cells and scattered multinucleated giant cells with a varying number of nuclei, ranging from 3 to approximately 50 (Figure 4). The mononuclear cells displayed minimal atypia, moderate amount of cytoplasm, and large, round nucleus. The cells were embedded in dense collagenous stroma. Very low mitotic activity (1–2 mitotic figures/10 HPF) was observed.

Bottom Line: Clinical examination revealed lack of extension by approximately 20°.Histological examination showed a tendosynovial giant cell tumor of the patella tendon sheath.At the latest follow-up, 2 years postoperatively, there was no local tumor recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Sports Medicine, Orthopaedic Clinic, Patras University Hospital, Patras, Greece.

ABSTRACT

Background: The giant cell tumor of the tendon sheath (GCT-TS) is a benign proliferative synovial tumor manifesting as an intra-articular solitary nodule. When it involves the infrapatellar fat pad it can present acutely as a painful locked knee.

Case report: A 26-year-old white male presented with a 2-week history of painful locking in his right knee. Clinical examination revealed lack of extension by approximately 20°. To help establish the diagnosis, an MRI scan of the right knee was performed, showing a large (5×4×2 cm), oval, well-circumscribed mass with a low-intensity homogenous signal. The size of the mass prohibited the removal by arthroscopy and we therefore proceeded with an open arthrotomy. Histological examination showed a tendosynovial giant cell tumor of the patella tendon sheath. At the latest follow-up, 2 years postoperatively, there was no local tumor recurrence.

Conclusions: These rare tumorous lesions should be included in the differential diagnosis of painful locking knee, especially in the absence of definite traumatic history.

No MeSH data available.


Related in: MedlinePlus