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Presented by Edward McCarthy, M.D. and prepared by Lynette S. Nichols, M.D.
Case 5: A 45 year old man had hip pain for 6 months.
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1. Question
Week 100: Case 5
A 45 year old man had hip pain for 6 months. A radiograph showed multiple radiodensities in the hip joint around the femoral neck and the femoral head. The radiodensities had a ring and stipple pattern of cartilage./images/Lyn’s/Mc-7-22-02.5.a.jpg
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/images/Lyn’s/Mc-7-22-02.5.d.jpgCorrect
Answer: Synovial chondromatosis
Histology: The lesion shows nodules of mature hyaline cartilage with varying degrees of cellularity. These nodules occur in the soft tissues of the synovial membrane. Endochondral ossification at the margins of these nodules as well as foci of calcification may occur accounting for the radiodensities on plain x-rays. Occasionally, mild cellular atypia is present in the chondrocytes of synovial chondromatosis.
Discussion: Synovial chondromatosis is a reactive disorder where there is chondroid metaplasia in the synovial membrane of joints or the synovial membrane of bursae or tendon sheaths. Therefore, synovial chondromatosis can occur anywhere in the soft tissues.
The lesion is not a chondrosarcoma because it is entirely in the soft tissues and consists of well defined nodules of cartilage confined within the joints. Chondrosarcomas of the soft tissue are extremely rare. Therefore, lesions in the soft tissue which consist of mature hyaline cartilage are almost never chondrosarcomas. Chondrosarcomas occasionally occur in the joint spaces. However, in these cases, the lesions show extensive cellurarity, abnormal mitotic figures, and myxoid differentiation.
The lesion is not an osteochondroma because it lacks a stalk, and the cartilage nodules are growing independently in the synovial membrane. Occasionally, synovial chondromatosis may develop in the bursa overlying a large osteochondroma, a phenomenon known as exostosis bursata.
Incorrect
Answer: Synovial chondromatosis
Histology: The lesion shows nodules of mature hyaline cartilage with varying degrees of cellularity. These nodules occur in the soft tissues of the synovial membrane. Endochondral ossification at the margins of these nodules as well as foci of calcification may occur accounting for the radiodensities on plain x-rays. Occasionally, mild cellular atypia is present in the chondrocytes of synovial chondromatosis.
Discussion: Synovial chondromatosis is a reactive disorder where there is chondroid metaplasia in the synovial membrane of joints or the synovial membrane of bursae or tendon sheaths. Therefore, synovial chondromatosis can occur anywhere in the soft tissues.
The lesion is not a chondrosarcoma because it is entirely in the soft tissues and consists of well defined nodules of cartilage confined within the joints. Chondrosarcomas of the soft tissue are extremely rare. Therefore, lesions in the soft tissue which consist of mature hyaline cartilage are almost never chondrosarcomas. Chondrosarcomas occasionally occur in the joint spaces. However, in these cases, the lesions show extensive cellurarity, abnormal mitotic figures, and myxoid differentiation.
The lesion is not an osteochondroma because it lacks a stalk, and the cartilage nodules are growing independently in the synovial membrane. Occasionally, synovial chondromatosis may develop in the bursa overlying a large osteochondroma, a phenomenon known as exostosis bursata.