関: synovial chondromatosis

WordNet

relating to or secreting synovia
viscid lubricating fluid secreted by the membrane lining joints and tendon sheaths etc. (同)synovial_fluid

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/05/22 11:44:54」(JST)

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Synovial osteochondromatosis (SOC) is a rare disease that creates a benign change or proliferation in the synovium or joint-lining tissue, which changes to form bone-forming cartilage. In most occurrences, there is only one joint affected, either the knee, the hip, or the elbow.

The etiology or cause is unknown.

In this condition, cartilaginous metaplasia takes place within the synovial membrane of the joint. Metaplastic synovium organizes into nodules. With minor trauma, nodules are shed as small bodies into the joint space. In some patients, the disease process may involve tendon sheaths and bursal sacs.

Cartilaginous intra-articular bodies float freely within the synovial fluid, which they require for nutrition and growth. Progressive enlargement and ossification occur with time. If they remain free, they continue to grow larger and more calcified. In severe cases, they may occupy the entire joint space or penetrate to adjacent tissues. Also, they can deposit in the synovial lining, reestablish a blood supply, and become replaced by bone. On occasion, synovial reattachment can lead to complete reabsorption of the cartilage fragment.

Classification

Classification is divided into primary versus secondary SOC. Primary SOC occurs in an otherwise normal joint. It is suggested by monoarticular involvement in a patient in the third to fifth decades of life. Secondary SOC occurs in older patients in joints previously affected by joint disease such as osteoarthritis. This pattern is suggested by bilateral involvement with multiple joint intra-articular bodies.

Gross Pathology

Cartilaginous bodies or osteocartilaginous bodies with central ossification may be noted. They are typically spherical in shape. Sizes range from several millimeters to several centimeters in diameter. The synovium of the involved joint demonstrates villous hyperplasia, which imparts a wrinkled appearance on gross examination. There may be cartilaginous bodies attached to the synovium. Synovial involvement may be focal or diffuse in nature.

Signs and symptoms

Chronic, progressive pain and swelling of the affected joint are exacerbated by physical activity. Joint effusion and limited range of motion are common associated features. It affects primarily large joints, including knee (>50% of cases), elbow, hip, and shoulder. SOC is twice as common in men as women. Some patients have intra-articular bodies resting in stable positions within joint recesses or bursae. These patients may be asymptomatic, with SOC merely as an incidental finding at imaging.

Diagnosis

Radiography

Typical finding is of multiple, smooth, oval-shaped calcified masses within the joint space or bursa. They have a characteristic popcorn-ball appearance of calcified cartilage. With serial imaging, masses may be found to change in size, disappear, or migrate to recessed areas of the joint. They may pass from the main joint cavity into a neighboring synovial cyst. For this reason, a mass may not be appreciated within the actual joint space itself.

Additional radiographic findings include joint effusion and degenerative changes such as joint space narrowing, subchondral sclerosis, and osteophyte formation.

Computer tomography

CT is best utilized in earlier stages of the disease process, before cartilaginous bodies have calcified (become filled with calcium). CT can effectively detect non-calcified masses or those with only minimal calcification, which allows the radiologist to distinguish this condition from a simple joint effusion.

MR imaging

MR appearance depends on composition of the intra-articular body. Entirely cartilaginous bodies will appear isointense to muscle on T1 and hyperintense to muscle on T2 weighted images. Partly calcified intra-articular bodies demonstrate foci of absent signal on all pulse sequences. Like CT arthrography, MR with gadolinium may be used to detect intra-articular bodies that have not yet calcified.

Complications

Malignant transformation to synovial chondrosarcoma. This is a very rare complication occurring in chronic cases. Treatment entails synovial excision and total joint replacement.

Clicking, grating, or locking may result from acute mechanical problems due to intra-articular bodies within the affected joint. Locking may destroy articular cartilage, resulting in secondary osteoarthritis. Symptoms such as joint stiffness and aching are the result of osteoarthritis that sets in after years of persistent joint irritation.

Note: Possibility of paralyzation if left too long. [Citation appreciated]

Treatment

Asymptomatic patients do not require therapy. Symptomatic patients should undergo arthroscopic or surgical removal of intra-articular bodies. Patients who have recurrent intra-articular bodies or in whom the entire synovial lining is metaplastic require total synovectomy.

Differential Diagnosis

Trauma-related:
- Fracture with avulsed fragment
- Fragmentation of meniscus with calcification

Degenerative joint disease related:
- Degenerative joint disease with detached spur

Synovial proliferation:
- Pigmented villonodular synovitis

Neoplastic:
- Synovial chondrosarcoma

Other:
- Osteochondritis dissecans (Requires surgery to remove. 47% mortality rate, in 23% of the cases leg amputations may be required)
- Sequestrum from osteomyelitis
- Neuropathic (Charcot) joint

Intra-articular bodies in SOC typically have popcorn calcification, with a dense sclerotic border with radiolucent central region. This distinct radiographic appearance sets it apart from other cause of intra-articular bodies. Number and size of intra-articular bodies can prove helpful as well. SOC typically presents as multiple intra-articular bodies. Few or isolated intra-articular bodies are more consistent with trauma or osteoarthritis.

References

Webpage and Discussion Board for Sufferers of SOC
Intra-articular bodies by Mark Moore, M.D., University of Washington Department of Radiology
Bianchi S, Martinoli C (July 1999). "Detection of loose bodies in joints". Radiol. Clin. North Am. 37 (4): 679–90. doi:10.1016/S0033-8389(05)70123-8. PMID 10442075.
Coles MJ, Tara HH (January 1997). "Synovial chondromatosis: a case study and brief review". Am J. Orthop. 26 (1): 37–40. PMID 9021034.
Crotty JM, Monu JU, Pope TL (March 1996). "Synovial osteochondromatosis". Radiol. Clin. North Am. 34 (2): 327–42, xi. PMID 8633119.
Maurice H, Crone M, Watt I (1 November 1988). "Synovial chondromatosis". J Bone Joint Surg Br 70 (5): 807–11. PMID 3192585. http://www.jbjs.org.uk/cgi/pmidlookup?view=long&pmid=3192585.
Milgram JW, Gilden JJ, Gilula LA (January 1996). "Multiple loose bodies: formation, revascularization, and resorption. A 29-year followup study". Clin. Orthop. Relat. Res. (322): 152–7. PMID 8542691.
Images of Ostechondromatosis MedPix(R) Images

External links

Osteochondromatosis MedPix

UpToDate Contents

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1. 成人における膝関節腫瘍のX線評価 radiologic evaluation of knee tumors in adults
2. 成人における股関節痛の放射線評価 radiologic evaluation of the painful hip in adults
3. 膝関節の炎症性関節炎に対する滑膜切除 synovectomy for inflammatory arthritis of the knee
4. 肩痛の放射線評価 radiologic evaluation of the painful shoulder
5. 全人工股関節置換術 total hip arthroplasty

English Journal

Primary synovial chondromatosis of the ankle joint presenting as monoarthritis.

Santiago T, Mariano C.
BMJ case reports.BMJ Case Rep.2013 Dec 10;2013. pii: bcr2013202186. doi: 10.1136/bcr-2013-202186.
PMID 24326442

Surgical treatment of synovial chondromatosis of the temporomandibular joint with erosion of the skull base: a case report and review of the literature.

Pau M, Bicsák A, Reinbacher KE, Feichtinger M, Kärcher H.Author information Department of Oral and Maxillofacial Surgery, Medical University of Graz, Graz, Austria. Electronic address: pauromau@tiscali.it.AbstractSynovial chondromatosis (SC) is a rare metaplastic disease of the larger joints. It is rarely observed in smaller joints, especially in the temporomandibular joint (TMJ). This disease is considered to be metaplastic and shows no malignant tendencies, but can become locally aggressive, erode the cranial base, and even spread intracranially. To date, nine cases of spread into the intracranial space have been reported in the literature; however, the disease remained extradural in all cases. The authors present a review of the literature and report the case of a 70-year-old man with SC of the right TMJ that had eroded the cranial base, reaching the dura mater; a large intracranial mass was not present. The disease was considered to be stage 3 according to Milgram's classification. The patient was treated surgically, the tumour mass was removed, reconstruction of the cranial base was performed using titanium mesh, and the joint was reconstructed with a temporal muscle interposition flap. Diagnostic images and intraoperative photographs are also presented.
International journal of oral and maxillofacial surgery.Int J Oral Maxillofac Surg.2013 Dec 3. pii: S0901-5027(13)01158-2. doi: 10.1016/j.ijom.2013.10.019. [Epub ahead of print]
Synovial chondromatosis (SC) is a rare metaplastic disease of the larger joints. It is rarely observed in smaller joints, especially in the temporomandibular joint (TMJ). This disease is considered to be metaplastic and shows no malignant tendencies, but can become locally aggressive, erode the cran
PMID 24314559

Secondary synovial osteochondromatosis of the ankle in a child.

Song MH, Cheon JE, Moon KC, Lee DY, Choi IH.Author information Division of Pediatric Orthopedics, Seoul National University Children's Hospital, 101 Daehak-ro Jongno-gu, Seoul, 110-744, Korea.AbstractWe describe a case of a large intra-articular ossifying mass of the ankle joint in a 12-year-old boy who sustained a severe ankle twisting injury at 6 years of age. The mass is presumed to be the result of secondary synovial osteochondromatosis originated from a fractured osteochondral fragment of the medial tubercle of the posterior process of the talus. The mass could be differentiated from os trigonum syndrome, Trevor disease and primary synovial osteochondromatosis based on its location, size and radiologic and histological features.
Pediatric radiology.Pediatr Radiol.2013 Dec;43(12):1642-6. doi: 10.1007/s00247-013-2763-5. Epub 2013 Jul 17.
We describe a case of a large intra-articular ossifying mass of the ankle joint in a 12-year-old boy who sustained a severe ankle twisting injury at 6 years of age. The mass is presumed to be the result of secondary synovial osteochondromatosis originated from a fractured osteochondral fragment of
PMID 23860637

Japanese Journal

変形性足関節症を伴った足関節滑膜骨軟骨腫症の一例

野村裕
日本足の外科学会雑誌 = The journal of the Japanese Society for Surgery of the Foot 31(2), 67-70, 2010-05-31
NAID 10027254139

左中指MP関節に発生した滑膜性骨軟骨腫症の1例

向田雅司,大井宏之,神田俊浩 [他]
静岡整形外科医学雑誌 3(2), 105-108, 2010
NAID 40017367118

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リンク元	「滑膜骨軟骨腫症」「滑膜性骨軟骨腫」「滑膜性骨軟骨腫症」
関連記事	「synovial」「osteochondromatosis」

「滑膜骨軟骨腫症」

Synovial osteochondromatosis
	Classification and external resources
	; Synovial osteochondromatosis
ICD-10	M71.4
ICD-9	727.82
DiseasesDB	31508
eMedicine	article/396297