Ganglia (see hand tumours)
- Synovial proliferative disorders.
Pigmented villonodular synovitis
- This is a true neoplasm.
- Exuberant proliferation of synovial villi and nodules.
- Most common in the knee, followed by hip and shoulder.
- Symptoms include painful swollen joint.
- Aspiration reveals a bloody effusion.
- X-ray may show cystic.
- Histologically, highly vascular villi lined with plump hyperplastic synovial cells, haemosiderin stained multinucleated giant cells and chronic inflammatory cells.
- Often requires MDT discussion as appearances can be mimicked by haemarthrosis of the joint unless radiologists and pathologists discuss the case.
- Associated with high rates of recurrence, likely to reflect non-specialised tumour surgeons underestimating the magnitude of surgery required (20–40%).
- Often require complete synovectomy to eliminate disease.
Giant cell tumour of the tendon sheath (see hand tumours)
- Second most common hand mass (ganglia more common) and is the most common neoplasm in the hand.
- Benign but recurrent lesion originating in the tendon sheaths or joint synovium.
- Usually seen on the palmar surface of the digits especially the PIP joint of the index and middle fingers.
- Recurrence rate of 30% in the literature but with meticulous surgery recurrence rates very low.
- Typically affects adults aged 30–50 years.
- Present with pain, stiffness and swelling.
- X-rays show fine stippled calcification.
- Histologically varies between metaplasia of synovial tissue to firm nodules of hyaline cartilage.
- Treat with synovectomy and removal of loose bodies.