Pigmented Villonodular Synovitis and Giant Cell Tumor of the Tendon Sheath

Abstract

The purpose of this report was to determine the pattern of thallium (T1-201) uptake in pigmented villonodular synovitis (PVNS) and giant cell tumor of the tendon sheath (GCTTS) and to evaluate for features that might help to distinguish these lesions from malignant disease. Scintigraphic images from patients subsequently found to have pigmented villonodular synovitis confirmed by histopathologic analysis were assessed. The patients had been evaluated with T1-201 scintigraphy for a suspicious musculoskeletal lesion. All 6 patients with PVNS had significant T1-201 uptake on the early images with retention on the delayed images. The T1-201 activity was in a juxta-articular location and generally conformed to the synovial cavity with scattered irregular nodular components. Of 4 cases of giant cell tumor of the tendon sheath, all had T1-201 uptake on the early images, and 3 cases (75%) also had uptake on the delayed images. T1-201 uptake is observed almost invariably in pigmented villonodular synovitis on both early and delayed images and can simulate the findings of malignant disease. Features that should raise suspicion of PVNS include close proximity to a joint, especially with distribution corresponding to that of the synovial cavity. When T1-201 activity is detected in a lesion in the hand or foot, giant cell tumor of the tendon sheath should be considered. Magnetic resonance imaging will often aid in the differentiation by demonstrating features of hemosiderin degradation products.

Green Apple Heart Failure

“…In fat suppressed images, the mass is high signal and may enhance with thallium Tl-201 scintigraphy (7). However, the MRI can be negative as in the present case.…”

MRI and thallium features of pigmented villonodular synovitis and giant cell tumours of tendon sheaths: a retrospective single centre study of imaging and literature review

“…1 Increased isotope accumulation (Figures 1 and 2) has been demonstrated for both pigmented villonodular synovitis (PVNS) and giant cell tumours of tendon sheaths (GCTTS) in both early and delayed phase imaging, which may mimic malignant disease. [1][2][3] Recurrent PVNS and GCTTS demonstrate similar 201 TI uptake patterns on early and delayed phase sequences. 4 It has been reported that lesions with low isotope accumulation, suggesting low metabolic activity, are highly unlikely to be PVNS or GCTTS.…”

Pigmented villonodular synovitis of the knee in a 12-month-old girl

“…10e12 Structural imaging findings in PVNS are well documented. 13 The plain radiographs and ultrasound features are non-specific, 14 but magnetic resonance imaging (MRI), a non-invasive, highly accurate diagnostic modality, is useful in defining extension of disease to nearby tissues. 15 Although radiographic examinations are essential for diagnosis, histology is required to confirm the diagnosis.…”