Journal of Postgraduate Medicine
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ARTICLE
 
 
Year : 1979  |  Volume : 25  |  Issue : 3  |  Page : 189-191  

Synovial chondromatosis

Shaila A Nimbkar1, Sudha Y Sane1, Bhavana Patel1, RH Pathak2, AV Bavdekar2,  
1 Department of Pathology, Seth G. S. Medical College and K.E.M. Hospital, Parel. Bombay-100 012, India
2 Department of orthopaedic Surgery, Seth G. S. Medical College and K.E.M. Hospital, Parel. Bombay-100 012, India

Correspondence Address:
Shaila A Nimbkar
Department of Pathology, Seth G. S. Medical College and K.E.M. Hospital, Parel. Bombay-100 012
India

Abstract

Two cases of synovial ehondromatosis are presented of which one falls in a rare group o f extra-articular ehondromatosis develop­ing in a bursa. Awareness of this rare lesion is important to prevent radical treatment owing to overdiagnosis. The histologic changes may mimic chondrosarcoma causing diagnostic problem.



How to cite this article:
Nimbkar SA, Sane SY, Patel B, Pathak R H, Bavdekar A V. Synovial chondromatosis.J Postgrad Med 1979;25:189-191


How to cite this URL:
Nimbkar SA, Sane SY, Patel B, Pathak R H, Bavdekar A V. Synovial chondromatosis. J Postgrad Med [serial online] 1979 [cited 2020 Sep 28 ];25:189-191
Available from: http://www.jpgmonline.com/text.asp?1979/25/3/189/42147


Full Text

 Introduction



Synovial chondromatosis is a rare con­dition in which cartilage is formed in the synovial membranes of joints, tendon sheaths or bursae by metaplasia of the connective tissue under the surface of the synovial membrane. Secondary calcifica­tion or ossification may be seen in the cartilaginous nodules but it is not always present, hence the term synovial ehon­dromatosis is preferred to osteo-chondro­matosis.

 Case reports



Case 1

M.H., a twenty year old male was seen in May 108 at which time he complained of a lump in the right gluteal region of 4 months' duration. He gave history of dull aching pain which increased after walking for a long time. Physical examination showed an irregular, bony hard, swelling in the right gluteal region (see [Figure 1], on page 190A). There was no warm of tenderness and the right hip joint was normal.

There was no limitation of movements of the hip joint.

Roentgenograms showed multiple areas of speckled radio-opacity in the right gluteal re­gion appearing in connection to neck of the femur and greater trochanter (see [Figure 2], on page 190A). The hip joint was normal. Clini­cally, the case was diagnosed as chondrosarcoma arising from the neck of the femur.

On 26th May, wide excision of the tumor was done by postero-lateral incision of the right gluteal region. Multiple cartilaginous nodules and loose bodies were found in the bursa which was about 12 cms in diameter and was beneath the gluteus maximum muscle, reaching upto the greater trochanter. The right hip was free from the tumor. The bursa with its thickened carti­laginous wall and multiple loose bodies was excised.

Post-operatively, the patient developed haemorrhage and wound infection. Secondary suturing of the wound was done. Follow-up study has revealed that the patient's condition is good and all movements of the hip joint are normal.

Gross appearance

The bursa was about 12 cms x 10 cms, in size with a thickened wall showing multiple, polypoid, firm projections and small cartilaginous bodies, free in the cavity (see [Figure 3], on page 190A).

Histology

The bursa was lined by synovium which showed multiple islands of cartilage in the synovial connective tissue. Many of the chon­drocytes showed plump, irregular, hyperchro­matic nuclei, but there were no giant cells. Cal­cification and ossification was seen at places (see [Figure 4] and[Figure 5] on page 190B).

Case 2

S.N., a 16 year old male was first seen in April 1978, complaining of pain, swelling am restriction of movements of the right knee joint. There was no history of trauma or any history of similar complaints in other joints. There was history of fever off and on. Clinical diagnosis of tuberculosis of knee was made. Synovial biopsy was done which showed changes of mild chronic non-specific inflammation. Patient was put on antibiotics but there was no improvement. Roentgenograms of the right knee done repeat­edly showed normal knee joint. In May 1978, subtotal synovectomy was done by taking antero-medial incision over the right knee. The anterior synovium was thickened and showed polypoid hard masses while posteriorly it was normal. There were no loose bodies in the joint. Histology showed a picture of synovial chondromatosis with focal areas of calcification and ossification.

Post-operative course was uneventful.

 Discussion



While reviewing the literature on synovial chondromatosis, it is found that the condition lacks clear definition. Al­though many cases are reported to be synovial chondromatosis, true synovial chondromatosis is rare, when exacting diagnostic criteria including the finding of metaplastic foci of cartilage in the syno­vial membrane are employed. [6],[8],[9] Cer­tain authors suggested that at least some cases of multiple loose bodies not associ­ated with active intrasynovial disease are examples of this syndrome . [7],[10]

The etiology of synovial chondromato­sis remains an enigma. Many theories speculate about the role of trauma [10] or neoplasia. [6] Lexer postulated an overacti­vity of the embryonic rests at the junc­tion of the synovial membrane and arti­cular cartilage as the cause of chondro­matosis. [5]

The condition may affect any of the diarthrodial joints of the body. The knee is the site of involvement in about two thirds of patients with the hip or elbow about equally divided as the next most frequent site. A few cases are reported with extra-articular masses of carti­lage. [2],[4] The term "Bursal chondromato­sis" is applicable to those cases in which cartilaginous bodies develop in a bursal cavity originating from the lining of its wall. [13]

The males are affected twice as often as females and ages have ranged from 14 to 47 years with a peak in the 5th decade. The clinical findings are not distinctive and patients complain of various combin­ations of pain, swelling and limited motion. Radiological findings may be strongly suggestive of the disease in most of the cases but in about 10% of patients, no evidence may be present . [3]

The cytological atypia is many a times worrisome. [9] If the clinical and gross find­ings of chondromatosis show the disease confined to the synovium, the microscopic atypia can be discounted for all practical purposes. The presence of orderly ossific­ation further favours a benign course. [3] The malignant change occurring in syno­vial chondromatosis is rare. [1] There are a few reports with sarcomatous change in a nodule requiring radical surgery. [11],[12]

Even in the presence of roentgeno­graphic evidence or surgical demonstration of loose bodies, synovial chondroma­tosis should be distinguished from the more common causes which include osteoarthritis, osteochondritis dissecans, osteochondrol fractures, chronic infections etc., since the prognosis and treatment differ in case of synovial chondromatosis. The treatment consists, in principle, of clearing the joint of its free bodies and excising the affected synovium. Any re­maining synovium constitutes a possible source of new bodies, and the synovec­tomy should therefore be as nearly com­plete as possible.

 Acknowledgements



The authors thank Dr. S. G. Kinare, Professor of Pathology, and Dr. C. K. Deshpande, Dean, Seth G.S.M. College and K.E.M. Hospital for their kind per­mission to publish this paper.

References

1Ballard, R. and Weiland, L. H.: Syno­vial chondromatosis of the temporo-man­dibular joint. Cancer, 30: 791-795, 1972.
2Dunn, A. W. and Whisler J. H.: Synovial chondromatosis of the knee with associat­ed extracapsular chondroma. J. Bone and Joint Surg., 55A: 1747-1748, 1973.
3Fechner, R. E.: Neoplasms and neoplasm like lesions of the synovium: In "Bones and Joints"-International Academy of Pathology Monograph. The Williams and Wilkins Co. Baltimore, 1976, pp. 157-186.
4Jeffreys, T. E.: Synovial chondromatosis, J. Bone and Joint Surg. 49B: 530-534, 1967.
5Lexer, Erich: Galenhchondrome. Deutsche Zeitschr f. Chir. 88: 311-323, 1907-Cited by Mclvor, R. R. and King, D.: Osteo­chondromatosis of the hip joint. J. Bone and Joint Surg. 44A: 87-97, 1962.
6Mclvor, R. R. and King, D.: Osteochon­dromatosis of the hip joint. J. Bone and Joint Surg., 44A: 87-97, 1962.
7Milgram, J. W. and Addison, R. G.: Synovial osteochondromatosis of the knee. Chondromatous recurrence with possible chondrosarcomatous degeneration. J. Bone and Joint Surg., 58A: 264-266, 1976.
8Murphy, A. F. and Wilson, J. N.: Teno­synovial osteochondroma in the hand. J. Bone and Joint Surg., 40A: 1236-1246. 1958.
9Murphy, F. P., Dahlin, D. C. and Sullivan, C. R.: Articular synovial chondromatosis. J. Bone and Joint Surg., 44A: 77-86, 1962.
10Mussey, R. D. Jr. and Henderson, M. S.: Osteochondromatosis, J. Bone and Joint Surg., 31A: 619-627, 1949.
11Nixon, J. E., Frank, G. R. and Chamben, George: Synovial osteochondromatosis: with report of four cases one showing malignant change. U.S. Armed Forces Med., J., 11: 1434-1445, 1960.
12Reimann, H. and Kienbock, R.: Uber "Gelents" Osteochondromatose mit sar­kombildung. Rontgenpraxis. 3: 942-944, 1931. Cited by Murphy, F. P., Dahlin. D. C. and Sullivan, C. R.: Articular synovial chondromatosis. J. Bone and Joint Surg., 44A: 77-86, 1962.
13Symeonides, P.: Bursal chondromatosis, J. Bone and Joint Surg., 48B: 371-373, 1966.

 
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