sinovial kondromatosis

8/3/2019 sinovial kondromatosis

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SynovialchondromatosisAlmu muhamadFacilitator: dr. Yogi Prabowo SpOT


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definitionTraditional view Synovial chondromatosis is abenign nodular cartilaginous proliferationarising in the synovium of joints, bursae or

tendon sheaths.

Recently a neoplastic condition withreproducible chromosomal abnormalities.

Synonims Synovial osteochondromatosis,primary, synovial chondromatosis, synovialchondrometaplasia.


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Epidemiology

Synovial chondromatosis is an uncommoncondition, usually occurring in adults (fifthdecade), twice as commonly in males

Sites of involvement

Usually only one joint is involved, mostoften the knee, less commonly the hip, elbow,

wrist, ankle, shoulder or temporomandibularjoint.


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EtiologyPrimary synovial chondromatosis This

form is described as the presence of ectopiccartilage in synovial tissue and as loose

bodies in the joint cavity with or withoutcalcification (osteochondromatosis) andwithout an identifiable joint pathology.

Secondary synovial chondromatosis The

secondary form is synovial chondromatosis inthe setting of preexistent osteoarthritis,rheumatoid arthritis, osteonecrosis,osteochondritis dissecans, neuropathicosteoarthropathy, tuberculosis, or


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Primary synovial chondromatosis(Milgram described in 1977)

Phase 1 - Active intrasynovial disease without

loose bodiesPhase 2 - Transitional lesions with

osteochondral nodules in the synovialmembrane and osteochondral bodies lying

free in the joint cavity

Phase 3 - Multiple free osteochondral bodieswith quiescent intrasynovial disease


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Clinical featuresSymptoms are non-specific

recurrent pain,

swelling,

stiffness or joint locking.

Rarely the lesion presents as a painless softtissue mass adjacent to a joint.


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X - rayRadiography may be negative except for

effusion

calcification or ossification of the nodules.


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MRIMagnetic resonance imaging demonstrates

the cartilaginous or ossific nodules withinthe joint.


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Atroscopicappearance loose


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MacroscopyLesional tissue consists of multiple glistening

blue/white ovoid bodies or nodules withinsynovial tissue, from less than a millimeter to

several centimeters.


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HistopathologyThe nodules are of variably cellular hyaline

cartilage covered by a fine fibrous layer, andsometimes by synovial lining cells.

The chondrocytes are clustered, may haveplump nuclei with moderate nuclearpleomorphism and binucleate cells are

common. Mitoses are uncommon. There may be

ossification, sometimes with fatty marrow inintertrabecular spaces.


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treatment

Treatment of synovial chondromatosis iscontroversial.

Conservative NSAID

Surgical:

Opent joint debridemant

SynovectomyArthroscopic synovectomy.


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Prognostic factors

Synovial chondromatosis is self-limiting butmay recur locally after excision or incompletesynovectomy, especially in the early phase of

the disease.

Damage to the joint surfaces may result insecondary degenerative joint disease.

Bone erosion with cranial extension from atemporomandibular joint lesion has beenreported .

Chondrosarcoma may uncommonly develop

from synovial chondromatosis


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Thank you

sinovial kondromatosis

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