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The Journal of Bone and Joint Surgery, Vol 66, Issue 1 76-94, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Pigmented villonodular synovitis (giant-cell tumor of the tendon sheath and synovial membrane). A review of eighty-one cases
AS Rao and VJ Vigorita
We reviewed the cases of eighty-one patients with pigmented villonodular
synovitis and giant-cell tumor of the tendon sheath. The average duration
of symptoms prior to consulting a physician was twenty-seven months. The
lesion was slow-growing, was located in one joint or tendon sheath, and
usually was asymptomatic in a finger or thumb but painful in a knee or toe.
Twenty-nine per cent of the finger or thumb lesions and 21 per cent of the
knee lesions that were followed recurred. Approximately 70 per cent of the
radiographs showed abnormalities that ranged from soft-tissue swelling to
bone erosion. Six lesions were incidental findings during arthrotomy for
some other lesion. The histological characteristics of the solitary
nodular, multiple nodular, and diffuse lesions suggested that they have a
common histogenesis that is characterized by proliferation of fibroblastic
or histiocytic mesenchymal cells, or both, beneath the synovial or
tenosynovial lining cells, and by collagen production. Foam cells and iron
deposits appear to be secondary changes and are usually seen in the
periphery of the expanding nodules. The centrifugal growth pattern and the
distinct differences between the lesional tissue and the adjacent
hyperplastic synovial tissue suggest that pigmented villonodular synovitis
is a true neoplastic process.
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