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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.