Disclosures: Alexander A. Turfe, II, DO: No financial relationships or conflicts of interest

Case Description: Physically active and normal BMI patient, presented with left knee pain reporting a history of osteoarthritis and PVNS. She was diagnosed with PVNS 1.5 years prior by biopsy during a left knee arthroscopy. During the surgery tumors were resected but part of the synovium was left intact. Upon evaluation 1.5 year later, MRI with contrast was ordered revealing regrowth of tumor throughout all aspects of knee joint upgrading diagnosis to diffuse PVNS. Patient was referred to orthopaedic surgery and underwent successful tumor resection with total synovectomy with arthroscopic anterior approach and open posterior approach. She was evaluated by musculoskeletal oncology and radiation treatment was not needed at that time. Postoperative course included a knee immobilizer, as well as therapy and physiatry follow up.

Setting: Outpatient Musculoskeletal Center

Patient: A 26 year old female with pigmented villonodular synovitis (PVNS). Assessment/

Results: Patient with confirmed diagnosis of PVNS via pathology showing diffuse-type giant cell tumor with a nodular appearance and infiltrative border into adipose tissues. Subtotal synovectomy and resection of tumors was done, only to have rapidly progressive knee pain 8 months later. MRI showed masses with diffuse heterogeneous enhancement, requiring surgery.

Discussion: PVNS, a rare benign proliferative growth of synovium, characterized by focal or diffuse villous proliferation of intra-articular synovium. It usually presents in the second and third decades of life, seen equally in both sexes. Most common location is the knee. Cause is unknown but repetitive trauma and inflammation play a role. End stage diffuse PVNS requires total joint replacement.

Conclusion: PVNS is a diagnosis that should be considered for knee pain in young adults. Once radiological evidence is displayed on MRI, prompt interdisciplinary care should be coordinated between physiatry, orthopedics, and oncology to ensure timely and effective treatment preventing progression and recurrence.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/recurrent-diffuse-pigmented-villonodular-synovitis-a-uncommon-etiology-of-the-common-knee-pain-a-case-report/