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Table 1 Summary of all three cases

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.