Possibilities of ultrasonography in the diagnosis of pigmented villonodular synovitis. Clinical case





villonodular synovitis, ultrasound diagnostics, synovial membrane, elastometry


 Pigmented villonodular synovitis is a rare proliferative disease of the synovial membrane, which most often affects the knee joints. Being a benign disease, at the same time, this pathology is often aggressive, and in some cases spreads to the soft tissues outside the joint. There are two forms of monoarticular damage: localized and diffuse. The diffuse form gives frequent relapses. To date, there are no standards for the management of this disease, just as there are no early markers for the detection of pigmented villonodular synovitis. This joint lesion has a long asymptomatic course, or it has symptoms of non-specific recurrent arthritis, so the patients can later be referred for magnetic resonance imaging, which is the only non-invasive method of diagnosing this pathology. At the same time, in modern conditions, most patients with recurrent synovitis will undergo an ultrasound examination of the joint according to the diagnostic standards. Ultrasonography made for abovementioned synovitis is insufficiently described in the medical literature. The aim of our study was to highlight the current data on the diagnosis and management of patients with pigmented villonodular synovitis and to describe our own clinical case. A feature of our clinical case was the detection of characteristic symptoms using ultrasonography. Irregular thickening of the synovial membrane with nodular forma­tions and villous growths, with the length of villi up to 7 mm near the patella with single loci of blood flow, was revealed by ultrasound examination and power Doppler mapping. Shear wave elastometry of the synovial membrane was performed. It demonstrated a significant increase in the stiffness of the synovial membrane, which can be a patho­gnomonic symptom of this pathology. The diagnosis of villonodular synovitis was confirmed histologically after surgical treatment. Subsequently, the patient had a recurrence of the pigmented villonodular synovitis, which was also detected by ultrasound diagnostics. Thus, pigmented villonodular synovitis of the knee joint is a rather rare pathology that requires differential diagnosis with inflammatory joint diseases. The final diagnosis is based on histological exa­mination. MRI and ultrasound diagnostics are non-invasive methods that can detect this pathology with high accuracy. The advantage of ultrasonography is its availability and non-invasiveness. The increase in stiffness of the synovial membrane along with its proliferation, which we found, can serve as an additional criterion of villonodular synovitis, and, according to the data available to us, has not been described in the literature so far.


Asaad SK, Salih KM, Kakamad FH, Salih AM, Mohammed SH. Pigmented villonodular synovitis asso-ciated with developmental dysplasia of the hip: A case report. International journal of surgery case reports. 2020;74:260-2. doi: https://doi.org/10.1016/j.ijscr.2020.07.078

Zadeh C, Henrichsen J, Fatemi N, Westermann R. Intralabral pigmented villonodular synovitis: a rare case in two adult patients. Skeletal Radiol. 2023;52:1409-13. doi: https://doi.org/10.1007/s00256-022-04227-x

Spierenburg G, Suevos Ballesteros C, Stoel BC, Navas Cañete A, Gelderblom H, van de Sande MAJ, et al. MRI of diffuse-type tenosynovial giant cell tumour in the knee: a guide for diagnosis and treatment response assessment. Insights Imaging. 2023;14(1):22. doi: https://doi.org/10.1186/s13244-023-01367-z

Sugandhi A, Kondaveeti SK, Sunder A. A Case of Pigmented Villonodular Synovitis. Cureus. 2022;14(6):e25957. doi: https://doi.org/10.7759/cureus.25957

Nelakurti DD, Rossetti T, Husbands AY, Petreaca RC. Arginine Depletion in Human Cancers. Cancers (Basel). 2021;13(24):6274. doi: https://doi.org/10.3390/cancers13246274

Bernthal NM, Ishmael CR, Burke ZD. Manage-ment of Pigmented Villonodular Synovitis (PVNS): an Or-thopedic Surgeon’s Perspective. Curr Oncol Rep. 2020;22:63. doi: https://doi.org/10.1007/s11912-020-00926-7

Zhamardiy V, Shkola O, Tolchieva H, Saienko V. Fitness technologies in the system of physical qualities development by young students. Journal of Physical Education and Sport. 2020;20(1):142-9.

Fang Yushun, Zhang Qingsong. Recurrence of pigmented villonodular synovitis of the knee: A case report with review of literature on the risk factors causing recurrence. Medicine. 2020;99(16):e19856. doi: https://doi.org/10.1097/MD.0000000000019856

Koutalos AA, Ragias D, Rizniotopoulos E, Tsanadis K, Xydias E, Tsoukalas N, et al. Diffuse pigmented villonodular synovitis of the knee joint: 3-year follow-up of a case report. Radiat Oncol J. 2022;40(4):270-5. doi: https://doi.org/10.3857/roj.2022.00122

Zhdan VM, Lebid VG, Ivanytskyi IV, Tkachenko MV, Isheykana YuO. [Effectiveness of treatment accor¬ding to elastometry of the synovial membrane in patients with rheumatoid arthritis.] Aktualni problemy suchasnoy mediciny: Visnyk ukrainskoi medichnoi stomatologichnoi akademii. 2020;4(72):34-9. Ukrainian. doi: https://doi.org/10.31718/2077-1096.20.4.40

Коstogryz YО. [Pigmented villonodular synovitis of the knee joint: current state of the problem]. Visnyk ortopedii, travmatologii ta protezuvannya. 2018;1:57-63. Ukrainian.

Margad O, Boukhris J, Azriouil O, Daoudi M, Mortaji A, Koulali K. Villonodular synovitis of the knee: about 20 cases. Pan Afr Med J. 2017;28:86. doi: https://doi.org/10.11604/pamj.2017.28.86.9507

Sahin MS. Localized Pigmented Villonodular Synovitis of the Knee Joint: A Case Report. J Orthop Case Rep. 2022;12(4):44-8. doi: https://doi.org/10.13107/jocr.2022.v12.i04.2760

Luo D, Yu L, Yang L, Zhu Q, Ren H, Liu H. Atypical and bilateral pigmented villonodular synovitis of wrist in an adolescent patient: case report and literature review. Int J Clin Exp Pathol. 2021;14(3):383-8. PMID: 33786156; PMCID: PMC7994141

Ota T, Nishida Y, Ikuta K, Tsukushi S, Yamada K, Kozawa E, et al. Tumor location and type affect local re¬currence and joint damage in tenosynovial giant cell tumor: a multi-center study. Scientific reports. 2021;11(1):17384. doi: https://doi.org/10.1038/s41598-021-96795-6

Okamura H, Ishikawa H, Ohno T, Fujita S, Inagaki K. Localized Pigmented Villonodular Synovitis of the Bilateral Knee: A Case Report. Journal of orthopaedic case reports. 2022;12(7):18-21. doi: https://doi.org/10.13107/jocr.2022.v12.i07.2898

Kissel JA, Leonardelli C. Pigmented villonodular synovitis of the hip in a recreational runner: a case report. The Journal of the Canadian Chiropractic Association. 2021;65(3):344-9.

Ivanoski S, Nikodinovska VV. Sonographic assessment of the anatomy and common pathologies of clinically important bursae. J Ultrason. 2019;19(78):212-21. doi: https://doi.org/10.15557/JoU.2019.0032

Heo S, Park SY, Seo J, et al. Diffuse-Type Tenosynovial Giant Cell Tumor of the Tendon Sheath in Both Wrists. Taehan Yongsang Uihakhoe Chi. 2021;82(1):250-4. doi: https://doi.org/10.3348/jksr.2020.0055

Fernandes TL, Videira LD, Sasaki SU, Natalino RJ, Almeida AM, Pedrinelli A, et al. Bilateral localized pigmented villonodular synovitis of the knee: case report and review. Acta ortopedica brasileira. 2018;26(3):183-6. doi: https://doi.org/10.1590/1413-785220182603179623

Zhang YN, Fowler KJ, Ozturk A, Potu CK, Louie AL, Montes V, et al. Liver fibrosis imaging: A cli-nical review of ultrasound and magnetic resonance elastography. J Magn Reson Imaging. 2020;51(1):25-42. doi: https://doi.org/10.1002/jmri.26716

Kapustianskyi D, Ivanytskyi I, Ivanytska T, Zhamardiy V, Donchenko V. Differential diagnosis of soft tissue tumors. Wiadomosci Lekarskie. 2022;LXXV(6):1596-9. doi: https://doi.org/10.36740/WLek202206131

Herasymenko SI, Kostohryz OA, Kostohryz YuO, Babko AM, Maiko VM. [Results of the surgical treatment of diffuse pigmented villonodular synovitis (diffuse-type tenosynovial giant-cell tumor) of the knee]. Zaporizkyi medychnyi zhurnal. 2021;5(128):656-63. Ukrainian. doi: https://doi.org/10.14739/2310-1210.2021.5.230164




How to Cite

Zhdan V, Ivanytskyi I, Babanina M, Ivanytska T, Kitura Y, Volchenko H, Tkachenko M, Kyrian O, Lebid V. Possibilities of ultrasonography in the diagnosis of pigmented villonodular synovitis. Clinical case. Med. perspekt. [Internet]. 2023Sep.29 [cited 2024Mar.3];28(3):218-26. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/289260