Pigmentierte villonoduläre Synovitis: Wieviel präoperative Diagnostik sollte erfolgen?

Objective: The aim of this article is to evaluate whether the radiological diagnostic criteria are sufficient to be able to make a certain diagnosis of pigmented villonodular synovitis (PVNS) based on magnetic resonance imaging (MRI) findings and from this to derive the indications for surgery. Therefore, it was examined to what extent the radiological diagnosis corresponded to the histopathological results. Method: In a retrospective data analysis, 52 patients with PVNS (22 male, 30 female, average age 38 years) who underwent a surgical intervention between 1991 and 2019 were analyzed. Inclusion criteria were positive MRI findings with indications for hemosiderin and subsequent synovectomy as well as an appropriately documented histopathological work-up. Results: In 71% of the cases the MRI findings corresponded to the histological results; however, this indicates that after the radical synovectomy a PVNS could not be histologically confirmed in approximately 29% of the cases. The knee joint was found to be the most frequently affect joint, followed by hip and ankle joints. Discussion: A PVNS mostly occurred in young adults. In this collective, women were slightly more affected than men. No established algorithm for the treatment of PVNS can be found in the current literature. When in doubt it is imperative that histological confirmation of the diagnosis by arthroscopic or open biopsy should be carried out before a radical synovectomy. Conclusion: Due to the invasive nature of a radical synovectomy, a preoperative biopsy is a further option to confirm the diagnosis and in case of doubt should categorically be implemented. In this context a close interdisciplinary cooperation between radiologists and tumor radiologists is essential.