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Intraarticular masses are infrequently encountered in clinical practice; however, the differential diagnosis can be broad. Neoplasia, both benign and malignant, and proliferative processes are the most common etiologies. We present a case of metastatic disease in the synovium in a patient with a history of lung cancer. Lung carcinoma is the most common primary malignancy to metastasize to synovial tissue, and the knee joint is the most common joint to be affected. I n this report, we discuss the diff erential considerations for intraarticular masses and the clinical presentation of metastatic synovial disease. We discuss some fi ndings that are classic for specifi c entities; however, many radiologic fi ndings concerning synovial pathology are nonspecifi c. As the diff erential considerations for intraarticular masses are vast, clinical history is often as necessary as radiologic fi ndings to elucidate the correct diagnosis. CASE PRESENTATIONA 61-year-old man who underwent a left pneumonectomy for cancer 4 months before presentation complained of knee pain with swelling since the operation. Th e knee joint was aspirated, and the fl uid demonstrated infl ammatory white blood cells but was negative for microorganisms. A diagnosis of rheumatoid arthritis had been made in the past, but the knee pain had never been of this character or intensity. Th e patient was unable to bear weight or straighten his leg in the emergency room. On examination, he was afebrile, normotensive, and tachycardic, with underlying atrial fi brillation and a ventricular rate of 90 to 127 beats per minute. Th e knee was edematous, erythematous, and warm with a range of motion of <90°. His leukocyte count was 23,600 cells/mL.Conventional gadolinium-enhanced magnetic resonance (MR) imaging of the left knee revealed diff use enlargement of the knee joint space secondary to multilobulated and heterogenous mass-like structures (Figures 1-4). Th ese structures demonstrated heterogeneously increased T2 hyperintense and intermediate T1 intensity characteristics. Most of the joint space was replaced by hyperenhancing synovium. Enlarged lymph nodes were seen in the popliteal fossa. At that time, diff erential considerations included severe infl ammatory arthritis and rather than unusual metastasis. Surgical pathology showed a diagnosis of synovial metastasis from primary large-cell lung carcinoma. DISCUSSIONApproximately 48 cases of synovial metastasis have been reported. Adenocarcinoma has been the most common type of synovial metastasis encountered. Despite the highly vascular nature of synovial tissue, neoplastic masses in articular spaces are much less frequently encountered than mass lesions secondary to infectious and infl ammatory arthritides. If intraarticular masses are discovered when they are still small, the tissue of origin such as synovium or cartilage may be delineated. However, commonly both cell types are involved, and the type can be impossible to decipher when the mass is as large, as in the case presented. Primary lung cancer is the ...

Considering that some university based principal preparation programs may not be properly training principals for leadership roles, "grow your own" leadership development programs have become more popular across the U.S. This study provides a contribution to previous research in terms of the specific components a district leadership development program may incorporate into its curriculum in order to positively influence school principals' effectiveness as school leaders. A purposeful sample of 2 nd , 3 rd , and 4 th year campus principals working in a large urban school district in the southwest region of the U.S. who had participated in their district's leadership development program were administered the Principal Effectiveness Survey and participated in semi-structured interviews to examine the influence of the program on the participants' effectiveness as leaders. Survey results indicated that principals consider training activities related to human capital, executive leadership, school culture, and strategic operations as having a "high" influence on their effectiveness as school leaders. In addition, interview data revealed the importance of supervisor support and building relationships with peers as critical to their continued success as leaders.