JOINT TUMORS AND TUMOR-LIKE
CONDITIONS
Miriam Al Battal,MD
TUMOR-LIKE CONDITIONS
Reactive tumor-like lesions, such as ganglion cysts & synovial cysts commonly
involve joints and tendon sheaths.
They usually result from trauma or degenerative processes and are much
more common than neoplasms.
Ganglion cyst
Despite the name, the lesion is unrelated to ganglia of
the nervous system
Ganglion cysts are small, up to 1.5 cm, and nearly
always located near a joint capsule or tendon sheath.
A common location is around the joints of the wrist,
where the cysts appear as firm, fluctuant, pea-sized
translucent nodules.
Ganglion cysts develop due to cystic or myxoid
connective tissue degeneration, hence the cyst wall
lacks a cell lining.
The fluid that fills ganglion cysts is similar to synovial
fluid.
Synovial Cysts
Herniation of synovium through a joint capsule or massive enlargement of a
bursa may produce a synovial cyst.
A well recognized example is the popliteal synovial cyst, or Baker cyst
The cyst lining resembles the synovium, and both cyst and synovium may be
hyperplastic.
• The synovial cyst is usually removed by
surgery
• There is no chance for them to become a
neoplasia or to develop again if it is removed
The ganglion cyst has no lining
Tenosynovial Giant Cell Tumor
Tenosynovial giant cell tumor is a benign neoplasm that develops in the
synovial lining of joints, tendon sheaths, and bursae.
Tenosynovial giant cell tumor can be diffuse (previously known as pigmented
villonodular synovitis) or localized (also known as giant-cell tumor of tendon
sheath)
The diffuse type tends to involve large joints, while the localized type usually
occurs as a discrete nodule attached to a tendon sheath, commonly in the
hand.
Both variants are most often diagnosed in the 20s to 40s and affect the sexes
equally.
Localized
MORPHOLOGY
Tenosynovial giant cell tumors are red-brown to orange-yellow.
In diffuse tumors, the normally smooth joint synovium is converted into a
tangled mat by red-brown folds, fingerlike projections, and nodules.
In contrast, localized tumors are well circumscribed and resemble a small
walnut.
Diffused
MORPHOLOGY
The neoplastic cells, which account for only 2% to 16% of
the cells in the mass, are polyhedral, moderately sized,
and resemble synoviocytes.
In the diffuse variant they spread along the surface and
infiltrate the subsynovial tissue.
In localized tumors the cells grow in a solid aggregate
that may be attached to the synovium by a pedicle
Both variants are heavily infiltrated by macrophages,
which may contain hemosiderin and lipid-filled vacuoles,
or coalesce into multinucleated giant cells.
Clinical Features
Diffuse tenosynovial giant cell tumors present in the knee in 80% of cases.
Localized tenosynovial giant cell tumors predominantly occurs on the digits
(85%)
Affected individuals complain of pain, locking, and recurrent swelling, similar
to monoarticular arthritis.
Sometimes a palpable mass is appreciated.
Aggressive tumors erode into adjacent bones and soft tissues, causing
Diffused = aggressive
confusion with other types of neoplasms. Recurrence is common
Localized tenosynovial giant cell tumors present as a solitary, slow-growing
mass . Bone erosion and recurrence are less common than in the diffuse type.
Surgical excision is the mainstay of treatment.
Synovial sarcoma
Rare tumor of the synovial membrane, tendon sheaths and bursae.
Sites: The common sites are the knee and ankle joints.
Gross description: a firm grayish mass showing areas of hemorrhage,
necrosis and cyst formation.
On microscopy: Biphasic growth formed of sheets of sarcomatous spindle
shaped cells and gland like spaces lined by cubical cells.
The tumor grows slowly and spread locally.
Metastasis occurs lately to the lung.
Usually this is the first presentation
of the sarcoma
