Imaging Features of Pigmented Villonodular Synovitis with Emphasis on Sonographic Findings

J. Lin MD, W.J. Weadock, MD, T.J. Quinn MD, J.A. Jacobson MD, D.A. Jamadar MBBS, J.H. Ellis MD

University of Michigan, Ann Arbor Michigan

 

Case I: 31 year old female with giant cell tumor of the tendon sheath

Image A: AP radiograph of the left foot shows irregular osseous radiolucencies with sclerotic margins (arrows) affecting several consecutive articulations at the tarsal-metatarsal junction. Note that intervening joint spaces are preserved.

Image B: Sagittal STIR MR image shows a lobulated, high signal lesion (arrows) involving the bases of the third and fourth metatarsals, the cuboid, and the lateral cuneiform bone. Abnormal signal extends along the flexor tendons and into the plantar soft tissues of the foot.

Image C: Coronal PD-weighted image shows a lobulated mass (arrows) occupying the space between the flexor digitorum tendons and the metatarsals. The mass extends between the third and fourth metatarsals into the soft tissues of the dorsum of the foot.

 

  • Giant cell tumor of the tendon sheath and pigmented villonodular bursitis are lesions related to PVNS that occur in extraarticular locations.

  • The joint space in PVNS is typically preserved, as in this case. Cartilage destruction does not occur until late in the disease process. In case II where joint space narrowing is present, the lack of productive bone formation suggests that the cause is PVNS rather than osteoarthritis.