From: It’s not what it looks like: challenges in diagnosis of synovial lesions of the knee joint
Case | Age & gender | Symptoms | Physical findings | MRI findings | Treatment and arthroscopy findings | Original diagnosis | Definitive histopathological findings | Final result & follow-up |
---|---|---|---|---|---|---|---|---|
1 | 28/Male | Swelling since 2 and a half years with dull aching pain | Knee effusion with boggy swelling. No joint line tenderness. No Instability, | MRI - Frond like synovial growth pattern characteristic of Lipoma Arborescens. Focal marrow edema in intercondylar notch and medial femoral condyle. Moderate synovial effusion | Synovial hypertrophy with branching frond-like pattern noted. Synovectomy done. | Lipoma Arborescens | Fibrocollagenous tissue with dense mixed inflammatory infiltrate comprised of lymphocytes, plasma cells, neutrophils and proliferative blood vessels. | Patient is being treated for Chronic Inflammatory Synovitis. Patient continues to have improvement in symptoms while being on anti-inflammatory medications. |
2 | 22/Male | Dull aching pain and swelling. | Effusion and boggy swelling. | Frond like branching synovial proliferation. Knee effusion. | Frond-like branching synovial growth. Synovectomy done. | Lipoma Arborescens | Inflammatory infiltrate in synovium, with absence of adipose tissue proliferation in subsynovial layer. | Patient is being treated for Chronic inflammatory synovitis. Patient is on rheumatologic medications and has improvement of symptoms. |
3 | 37/Male | Pain, Swelling, occasional locking of knee. | Minimal effusion. No tenderness. No instability. | Minimal joint effusion, with a rounded hypointese body in suprapatellar bursa (17 x 16 x 7 mm) suggestive of a focus of nodular synovitis. | White, glistening loose body appearing like a cartilaginous tissue. Loose body removal done. | Unclear Diagnosis. Differentials included Nodular Synovitis or Cartilage injury. | Hyalinised fibrous nodular mass, with underlying stroma showing an organized hematoma | Patient has no complaints at present after removal of the loose body. |