Surgical Assessment of Diffuse Pigmented Villonodular Synovitis

OBJECTIVE: One bilateral totally 16 diffuse pigmented villonodular synovitis of the knee cases was examined in terms of clinical presentations, histopathological findings and surgical outcome.
METHODS: 16 patients with the diagnosis of DPVNS were retrospectively analyzed with a period of 4 years. The mean age was 30 years (16-44). 10 patients were male and 6 patients were female. Nine patients left and 7 patients right knees were affected. Pain, swelling and pressure symptoms caused by mass effect were the most common clinical findings.
RESULTS: The most common physical examination finding was suprapatellar swelling (40%). Effusion in the knee joint was detected in 95% of the patients. There was mean of 1.5 cm thigh atrophy in 11 patients. Flexion contracture about 10 degrees in the affected knee was noted in 12 patients. Three of 8 patients that knee aspiration was performed have characteristic sero-hemorrhagic fluid.
CONCLUSION: We think that physical examination and history is very important in diagnosis of patients with PVNS. Aspiration of the joint should be avoided. Open or arthroscopic syneviectomy is the primary treatment of PVNS.

Diffüz Pigmente Villonodüler Sinovite Cerrahi Yaklaþým

AMAÇ: Diz ekleminde diffüz pigmente villonodüler sinovit tanýsý alan biri bilateral 16 olgu klinik, histopatolojik bulgular ve cerrahi tedavi sonuçlarý açýsýndan incelenmiþtir.
YÖNTEMLER: Diffüz pigmente villonodüler sinovit (DPVNS) tanýsý alan 16 olgunun 4 yýllýk takip sonuçlarý retrospektif olarak incelenmiþtir. Yaþ aralýðý 16 ile 44 (ortalama 30) olan hastalarýn 10’u erkek, 6’sý kadýndý. 9 hastada sol, 7 hastada sað diz eklem tutulumu mevcuttu. Aðrý, þiþlik ve kitle etkisi ile oluþan basý semptomlarý varlýðý en sýk görülen semptomlardý.
BULGULAR: Fizik muayenede en sýk bulgu (%40) özellikle suprapatellar bölgede görülen þiþlik idi. Hastalarýn %95’inde klinik olarak diz ekleminde efüzyon mevcuttu. Hastalarýn 11’inde ortalama 1.5 cm olarak ölçülen uyluk atrofisi vardý. Oniki hastada ise tutulan eklemde 10 dereceye varan fleksiyon kontraktürü mevcuttu. 8 hastaya baþvuru öncesi taný amaçlý diz eklem içi aspirasyon yapýlmýþtý ve sadece 3 hastada aspirasyonda karakteristik sero-hemorojik sývý içeriði gözlendi.
SONUÇ: Biz DPVNS’de hastalarýn tanýsýnda fizik muayene bulgularý ve anamnezlerinin çok önemli olduðunu düþünmekteyiz. Ayrýca bu hastalarda öncelikli olarak hastalýðýn akla getirilmesi ve ön planda artrosenteze baþvurulmamasý gerektiði kanýsýndayýz. PVNS’nin hala günümüzde primer tedavisi açýk veya artroskopik olarak yapýlan sinovyektomidir.