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अमूर्त

Localized Pigmented Villonodular Synovitis of the Shoulder: A Difficult Diagnosis of a Rare Disorder

Douglas W Kelly, Stephen A Ovanessoff and J Paul Rubin

Introduction: Localized Pigmented Villonodular Synovitis (LPVNS) of the shoulder joint is an extremely rare disorder. It is most often associated with a nonspecific clinical presentation resulting in both delays in diagnosis and in treatment. The growth characteristics and natural history of LPVNS are poorly understood.

Case report: This article describes an unusual case of a 53 -year-old woman whose treatment delay allowed us to more closely study the natural history of LPVNS. Our patient first presented with poorly localized posterior shoulder pain. Her symptoms slowly progressed. An initial MRI study more than 2 years after the onset of symptoms demonstrated a soft tissue tumor in a subscapularis recess location. Treatment with corticosteroid injections and physical therapy failed. A second MRI study, nearly 2 years later, found no change in signal characteristics, location, and size measurements of the soft tissue tumor, all important distinctions. Arthroscopic resection produced a definitive diagnosis of an intra-articular localized pigmented villonodular synovitis of the shoulder. At her final 18 mos. follow-up the patient demonstrated pain relief and no clinical recurrence of disease.

Conclusion: To our knowledge, this is the first case report of a nodular appearing LPVNS arising from an intraarticular shoulder location in a patient with no prior shoulder surgery or trauma. It is also unique in that the tumor originated in a subscapularis recess location. This case documents for the first time a LPVNS with limited growth potential and emphasizes the importance of careful direct study and clinical correlation of MRI findings to avoid delays in treatment.