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Presented by Edward McCarthy, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 1: A 40-year old man had a soft tissue swelling behind his knee.
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1. Question
Week 257: Case 1
A 40-year old man had a soft tissue swelling behind his knee. A radiograph demonstrated the soft tissue swelling which contained stippled radiodensities.images/feb 2006 case 1 1.jpg
images/feb 2006 case 1 2.jpg
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images/feb 2006 case 1 4.jpgCorrect
Answer: Synovial chondromatosis
Histology: none provided
Discussion: Tenosynovial chondromas are examples of synovial chondrometaplasia identical to that seen inside joints where it is known as synovial chondromatosis. Tenosynovial chondromas develop in the synovial membrane that is part of the tendon sheaths. The histologic features are identical to that of synovial chondromatosis. Islands of hyaline cartilage with calcification and peripheral ossification are present. The hyaline cartilage may occasionally be cellular, and, rarely cellular atypia may be present.
The lesion is not chondrosarcoma. First, hyaline cartilage chondrosarcomas rarely develop in soft tissue. When they do, they are high-grade lesions with extensive spindle cell differentiation and numerous abnormal mitotic figures. It is safe to assume that mature nodules of hyaline cartilage in the soft tissues are almost always examples of synovial chondrometaplasia.
The lesion is not a periosteal chondroma. Periosteal chondromas are tightly adherent to the bone, often producing scalloped erosions. This current lesion is entirely in the soft tissue.
Incorrect
Answer: Synovial chondromatosis
Histology: none provided
Discussion: Tenosynovial chondromas are examples of synovial chondrometaplasia identical to that seen inside joints where it is known as synovial chondromatosis. Tenosynovial chondromas develop in the synovial membrane that is part of the tendon sheaths. The histologic features are identical to that of synovial chondromatosis. Islands of hyaline cartilage with calcification and peripheral ossification are present. The hyaline cartilage may occasionally be cellular, and, rarely cellular atypia may be present.
The lesion is not chondrosarcoma. First, hyaline cartilage chondrosarcomas rarely develop in soft tissue. When they do, they are high-grade lesions with extensive spindle cell differentiation and numerous abnormal mitotic figures. It is safe to assume that mature nodules of hyaline cartilage in the soft tissues are almost always examples of synovial chondrometaplasia.
The lesion is not a periosteal chondroma. Periosteal chondromas are tightly adherent to the bone, often producing scalloped erosions. This current lesion is entirely in the soft tissue.
