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Pigment villos nodular Synovitis PVNS

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Pigment villos nodular Synovitis PVNS

  1. 1. Pigmented Villous Nodular Synovitis
  2. 2. • 基本資料:32 歲 男性,勞力工作 • 兩個月前,左腳 腫痛,走路走不 遠,後來疼痛加 劇 • 一個月前,左後 膝窩處出現一個 軟軟的腫瘤
  3. 3. • 腫瘤變的更大 病患至醫院就診 • Doctor:為一個 貝克式囊腫 • 建議手術! • 病人接受手術 …………但是 B
  4. 4. • 切除術開了 七個小時 • 醫生後來說不是 囊腫… • 那切下來的東西 是什麼?? 病人:醫生說再看看 ?
  5. 5. 膝蓋週圍常見的囊腫
  6. 6. Synovial cysts • herniation of synovial tissue into the surrounding soft tissue • 有時連接的通道 消失了和其他的 Ganglion/Bursa 不易區分 S
  7. 7. Popliteal (Baker‘s) cyst • 膝蓋最常見的腫瘤 • Communication posterior joint capsule /gastrocnemius- semimembranosus recess. • "ball-valve”  • knee flexion/open extension/close S
  8. 8. • 大部分沒有症狀, 但是如果太大,會 造成神經,血管的 壓迫大部分發生於 屈曲時 • 有時囊腫會破裂, 會造成膝窩的腫脹, 靜脈栓塞和週圍組 織的血腫
  9. 9. 有時會有骨頭 漂至囊腫內
  10. 10. • 最近……膝後的腫 瘤更大,整個膝 蓋腫無法彎曲 • PE: ROM 0~30 Severe swelling and tenderness , soft tissue mass over operation scar . • PVNSMRI ??
  11. 11. T1 Saggital P F QF muscle Soft tissue tumor
  12. 12. Soft tissue tumor Soft tissue
  13. 13. MRI 報 告:PVNS Excision biopsy Posterior 順原傷口 Anterior ` Arthroscope ? Open arthrotomyOpen arthrotomy
  14. 14. Anterior Open Arthroto my
  15. 15. Anterior Open Arthroto myACL *
  16. 16. * Posterior Open Arthroto my
  17. 17. • 病理報告: • Anterior: PMN, lymphoid follicles, Hemosiderin PVNS • Posterior: Bursitis with inflammation
  18. 18. PVNS  Recurrent hemoarthrosis  Benign disease with malignant behavior  Easily local recurrence • High recurrence rate • Long recurrence period
  19. 19. • 正常關節/肌腱的滑 膜會不斷的增生 • 關節腔會發炎,增厚 • 組織內含Hemosiderin 外觀看起來暗紅色 • 形成絨毛(Villous) 或結節狀(Nodular) Pigmented Villous Nodular Synovitis
  20. 20. • Etiology --- unknown • Location – Monarticular: Knee (75%) > Hip > Wrist > Ankle > Shoulder – Polyarticular 少見 • 臨床症狀 :痛,活動受限,腫脹
  21. 21. • Diffuse type Large joint Localized type Small joint • 診斷 關節抽吸:Sero-sanguineou “Without” trauma history • MRI • T2 image: hemosiderin depositionLow signal
  22. 22. • 好發於20~50歲年輕人 • Non-surgical Treatment – Intra-articular injection • Steroid • Yttrium-90 silicate (RA, knee) – Radiation therapy • Post-op. (35 Gy / 15 fractions) • 術後行放療證實可以減少 復發

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