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Presented by Edward McCarthy, M.D. and prepared by Orin Buetens, M.D.
Case 1: A 35 year-old man had twisted his knee and 6 months later noticed a swelling around the knee joint which was intermittently painful.
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1. Question
Week 33: Case 1
A 35 year-old man had twisted his knee and 6 months later noticed a swelling around the knee joint which was intermittently painful. The radiograph was normal. An arthroscopy showed a bloody effusion and darkly pigmented synovial membrane. A biopsy was done.images/Case1.1a.jpg
images/Case1.1b.jpg
images/Case1.1c.jpgCorrect
Answer: Hemosiderotic synovitis
Histology: The diagnosis is hemosiderotic synovitis. Hemosiderotic synovitis is due to the deposition of hemosiderin in synovial membrane secondary to hemarthrosis. This disorder is almost always present in patients with hemophilia who suffer repeated hemarthrosis. It also occurs in patients who have had multiple episodes of trauma. Occasionally, it is seen in patients with hemangioma of the synovial membrane. Hemosiderotic synovitis is characterized by the heavy deposition of hemosiderin in macrophages is the sub-synovial tissue. Occasionally, hemosiderin may be deposited in the synovial lining cells.
Discussion: Pigmented villonodular synovitis, while also characterized by hemosiderin deposition, always contains an abundant population of mononuclear macrophage-like cells. These cells are the diagnostic feature of pigmented villonodular synovitis which are not present in hemosiderotic synovitis. This population of mononuclear cells causes a nodular and villiform hyperplasia of the synovial membrane.
Inflammatory synovitis, as occurs in the immune complex arthritities, is characterized by a lymphoplasmacytic infiltrate in the synovial membrane. Although mononuclear cells and hemosiderin can be present, the cells that predominate are lymphocytes and plasma cells.
Incorrect
Answer: Hemosiderotic synovitis
Histology: The diagnosis is hemosiderotic synovitis. Hemosiderotic synovitis is due to the deposition of hemosiderin in synovial membrane secondary to hemarthrosis. This disorder is almost always present in patients with hemophilia who suffer repeated hemarthrosis. It also occurs in patients who have had multiple episodes of trauma. Occasionally, it is seen in patients with hemangioma of the synovial membrane. Hemosiderotic synovitis is characterized by the heavy deposition of hemosiderin in macrophages is the sub-synovial tissue. Occasionally, hemosiderin may be deposited in the synovial lining cells.
Discussion: Pigmented villonodular synovitis, while also characterized by hemosiderin deposition, always contains an abundant population of mononuclear macrophage-like cells. These cells are the diagnostic feature of pigmented villonodular synovitis which are not present in hemosiderotic synovitis. This population of mononuclear cells causes a nodular and villiform hyperplasia of the synovial membrane.
Inflammatory synovitis, as occurs in the immune complex arthritities, is characterized by a lymphoplasmacytic infiltrate in the synovial membrane. Although mononuclear cells and hemosiderin can be present, the cells that predominate are lymphocytes and plasma cells.
