Histomorphological study of synovial lesions

Abstract

Background:The synovium is a specialized mesenchymal tissue that is required for appropriate function of locomotor apparatus. Synovium is the site for a series of pathologic processes that are characteristic and in some cases are specific to distinctive disease. The histopathological examination of the synovial tissue plays a pivotal role in arriving at correct diagnosis in joint disease presenting as unclassified arthritis, suspicious of granulomatous disease, deposition disease or infectious disease with negative synovial fluid analysis. Objectives: To study the histomorphological features of various synovial lesions and to evaluate synovial scoring. Materials and Methods: In the present study 104 cases of synovial lesions were evaluated histopathologically. Results: Out of the 104 cases, chronic nonspecific synovitis (56.7%) was the commonest synovial lesions, followed by tubercular synovitis (12.5%) and Baker's cyst (10.5%). Synovial scoring was applicable in 85 cases and they were grouped into specific and non-specific synovitis. Interpretation & Conclusion:Majority of the synovial lesions could be classified into various subgroups by histopathological features. The high incidence of chronic nonspecific synovitis may represent a smoldering infection where the causative agent is not demonstrable. In cases of early rheumatoid arthritis, the histopathological features might be non-specific, however if there is strong clinical suspicion then it is worthwhile to do serological test for rheumatoid factor and synovial scoring. Synovial scoring was higher in cases of rheumatoid arthritis and was of less significance in conditions like granulomatous disease, metabolic disease, Lipoma arborescence and Hoffa's disease. Larger studies are needed to assess the reproducibility of synovial scoring system in the evaluation of synovial lesions.