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Joints

Reviewer: Vijay Shankar, M.D. (see Reviewers page)
Revised: 15 June 2013, last major update IN PROGRESS
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

Table of contents

General: primary references   anatomy   histology

Joint non-neoplastic disease: Baker’s cyst   bursitis   carpal tunnel syndrome   cystic meniscus   disc material   ganglion   implant related changes   meniscal tears   Morton neuroma   osteochondritis dissecans   sarcoidosis   spondylosis deformans   synovial cyst

Arthritis: general

Infective arthritis: general   Lyme disease   spondylodiskitis   suppurative   tuberculous   viral

Non-infective arthritis: ankylosing spondylitis   calcium pyrophosphate deposition   degenerative joint disease   enteropathic arthritis   gout   juvenile rheumatoid arthritis   psoriatic arthritis   Reiter’s syndrome   rheumatoid arthritis   scleroderma   systemic lupus erythematosus

Joint tumors: general   fibroma of tendon sheath   fibrous histiocytoma of tendon sheath   juxta-articular myxoma   pigmented villonodular synovitis   synovial chondromatosis   synovial chondrosarcoma   synovial giant cell tumor   synovial hemangioma   synovial lipomatosis   tenosynovial chondromatosis


Primary references
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AJCC Cancer Staging Manual (7th ed)
Websites with images: BoneTumor.org   PathoPic   UMDNJ   Univ Pittsburgh   USCAP (virtual slides)   WebPathology.com


Joint tumors

Fibrous histiocytoma of tendon sheath

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Also called tenosynovial giant cell tumor, giant cell tumor of tendon sheath, nodular tenosynovitis, xanthogranuloma, benign synovioma

Ages 20-40's, usually women

Solitary, slow-growing, painless nodule on tendon sheaths of flexor surfaces of wrists/fingers, ankle/toes

15% erode adjacent bone by pressure

May be related to tendon sheath fibromas

Unclear if reactive or neoplastic

Treatment: excision (benign), but may recur locally

Gross: discrete encapsulated nodule, 1-3 cm on tendon sheath, may be attached to synovium by a pedicle; red-brown to orange-yellow, localized, well circumscribed, resembles small walnut; diffuse form may be larger and infiltrative

Micro: polymorphic infiltrate of small histiocytes, multinucleated giant cells within dense fibrous tissue with hemosiderin and foamy macrophages; mitotic figures and focal hyalinized areas

Micro images: 2A: H&E with multinucleated giant cells and mononuclear cells; B: mononuclear cells are HAM56+; C: giant cells and some mononuclear cells are TRAP+; 3: differentiation sequence of giant cell tumor

EM: synovial cells, fibroblasts, histiocytes, lymphocytes

DD: epithelioid sarcoma (granuloma-like formations, necrosis, invasive, epithelioid features, keratin+)

 

Malignant variant of fibrous histiocytoma of tendon sheath

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High number of mitotic figures, marked nuclear hyperchromasia, few multinucleated giant cells


Synovial giant cell tumor

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Axial skeleton tumor; often cervical spine

<50 cases reported

Mean age 32 years, range 17-44 years

Xray: mass of posterior aspect of adjoining vertebrae, often involving facet joints, with bone abnormalities present

Treatment: resection; may persist if incompletely excised; no metastases reported

Case reports: malignant synovial giant cell tumor (Hum Path 1989;20:765)

Gross: 1-6 cm

Micro: epithelioid cells with mixed osteoclast-like giant cells, hemosiderin containing macrophages, xanthoma cells, fibroblasts, lymphocytes; often with infiltrative growth; variable mitotic activity

Positive stains: CD68, CD163, vimentin

DD: giant cell tumor of bone (10% involve spine, usually sacrum, giant cells have abnormally large number of nuclei), osteoblastoma (well circumscribed, surrounded by cortical bone or periosteum, osteoblastic rimming with scattered osteoclasts), aneurysmal bone cyst (younger patients, well demarcated, lytic lesion bordered by thin rim of new bone, cavernous blood filled spaces), schwannoma

References: Hum Path 2003;34:670


 

Tenosynovial chondromatosis

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Rare; may be extraarticular counterpart of synovial chondromatosis

Mean age 46 years, range 20-86 years

Painless mildly tender mass present for median 2 years

Usually recurs, perhaps due to subclinical micronodules

Sites: fingers (50%), feet (20%); also wrists, ankles, palm, knee, forearm

Treatment: complete excision in a conservative, function-preserving fashion

Micro: multinodular cartilaginous proliferation arising from tenosynovial membranes; often mild or moderate atypia similar to chondroma of soft parts or synovial chondromatosis; occasionally has prominent mineralization; often minute cartilaginous nodules; cartilaginous matrix more intensely basophilic than chondroma of soft parts

DD: chondroma of soft parts (not multinodular, younger patients overall although overlap exists)

References: AJSP 2003;27:1260


End of Joints chapter