Bone Pathology Database

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2nd image
Third image
MRI - fats suppression study
The Sagittal MRI on the previous page shows the thickened synovium of the knee which has a villous appearance. There is extensive synovial hypertrophy especially about the lateral aspect of the patello-femoral joint.

At biopsy of the synovium which was brown with pigment, with a few giant cells present. This confirmed the diagnosis of Pigmented Villonodular Synovitis.

Differential diagnosis of hypertrophied pigmented synovium

  1. Haemophyllia
  2. Trauma
  3. Pigmented villonodular synovitis

Histologically the giant cell tumor of tendon sheath can be similar, but is usually only a small nodule. On Magnetic Resonance Lipoma arborens can give a similar hypertrophied synovium. On the fat suppression study of this case there was some fatty infiltration, which makes this a differential to think of if this MR alone was considered.

Record 116