Title : Tenosynovial Giant Cell Tumor (TGCT) as the incidental finding in a patient undergoing total knee arthroplasty: A case report
Abstract:
Background: Tenosynovial Giant Cell Tumors (TGCT) also known as Pigmented Villonodular Synovitis (PVNS), are rare proliferative disorders of the synovium, often challenging to diagnose due to their nonspecific clinical presentation and radiographic findings.
Aims and Objectives: This case report highlights the incidental discovery of TGCT in a patient undergoing total knee arthroplasty for presumed osteoarthritis.
Materials / Patients & Methods: We present a 70 year old female with debilitating left knee pain, severely impacting her daily activities. Despite conservative treatments, including physiotherapy, oral medications, and injections, only temporary relief was achieved. Diagnostic imaging suggested degenerative changes, and laboratory tests showed no acute inflammation. With the patient's consent, total knee arthroplasty was planned.
Result: Intraoperatively, an unusual pigmented synovium raised suspicion and later confirmed by histopathology as TGCT. The patient underwent a total synovectomy followed by knee arthroplasty, resulting in significant postoperative improvement.
Conclusion: This case report illustrates the complexity of diagnosing and managing advanced Pigmented Villonodular Synovitis (PVNS) in the knee. Despite the limited diagnostic utility of conventional radiographs in early stages, the use of MRI was pivotal in assessing the extent of the disease. The treatment strategy, involving surgical total synovectomy followed by total knee arthroplasty, was selected based on the degenerative changes and the high recurrence rate associated with PVNS, particularly in its diffuse form.
