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2014 ; 4
(4
): 9-11
Nephropedia Template TP
J Orthop Case Rep
2014[Oct]; 4
(4
): 9-11
PMID27298991
show ga
INTRODUCTION: Malignant pigmented villonodular synovitis (PVNS) or Malignant
giant cell tumour tendon sheath (MGCTTS) is a controversial and debatable lesion.
Few case reports have indicated the potential for metastasis.1These aggressive
cases are designated malignant giant cell tumour tendon sheath or malignant PVNS.
Less than 20 cases are described in literature. We report a case of 65 year old
lady who was diagnosed eight years back as pigmented villonodular synovitis. She
had multiple local recurrences and now presented with lymphnodal metastases,
which is extremely rare. CASE REPORT: Sixty five year old lady presented with
swelling in left inguinal region of six months duration. She gave a past history
of swelling around medial condyle of left femur eight years back. Swelling was
excised three times. At the time of third recurrence, swelling was extensive,
infiltrating surrounding tissues and underlying bone, encasing femoral and
popliteal vessels for which she underwent an above knee amputation. She now
presented with inguinal swelling measuring 5.7×3.0 cms. Positron Emission
Tomography Scan (PET-CT) revealed multiple enlarged left common iliac, internal
and external iliac nodes, largest measuring 7.0 cms. Both the inguinal and pelvic
nodes were excised. Lesion was diagnosed as metastatic deposits of Malignant
pigmented villonodular synovitis based on morphological and Immunohistochemical
findings. CONCLUSION: It is important to have a high index of clinical suspicion
because these lesions can have an aggressive behaviour even with bland
cytological features. Our experience suggests that in a recurrent lesion for
GCTTS. A wide surgical excision with safe surgical margins and close follow up
with radiological evaluation might help to diagnose these lesions early and be
amenable to limb salvage surgeries.