J Korean Assoc Oral Maxillofac Surg.  2014 Jun;40(3):140-146.

Pigmented villonodular synovitis of the temporomandibular joint - computed tomography and magnetic resonance findings: a case report

• Kim IK
• Cho HY
• Cho HW
• Seo JH
• Lee DH
• Peng W

Abstract

Pigmented villonodular synovitis (PVNS) is a benign but locally aggressive and destructive disease originating in the synovial membranes. It is a proliferative disorder of unknown etiology. Involvement of the temporomandibular joint (TMJ) is very rare. Computed tomography clearly reveals areas of lytic bone erosion and sclerosis, and also clearly defines the extent of the tumor which is the focal areas of hyperdensity within the soft-tissue mass. Magnetic resonance images invariably show profound hypointensity on both T1- and T2-weighted sequences due to hemosiderin pigmentation. Additionally, high signal intensity on T2-weighted images may indicate cystic loculation of the joint fluid. This case study describes a rare case of PVNS of the TMJ with bone destruction of the mandibular condyle. Complete surgical excision of the lesion was performed through a preauricular approach with temporal extension. During the 10-year follow-up, two more operations were performed due to local recurrence and the fracture of the reconstruction plate. Total joint reconstruction with Biomet was finally performed, and the absence of disease was confirmed with a biopsy report showing fibrosis with hyalinization and mild inflammation of the excised soft tissue from the old lesion.

Keyword

Temporomandibular joint; Pigmented villonodular synovitis; Mandibular reconstruction

MeSH Terms

Biopsy
Cimetidine
Fibrosis
Follow-Up Studies
Hemosiderin
Hyalin
Inflammation
Joints
Mandibular Condyle
Mandibular Reconstruction
Pigmentation
Recurrence
Sclerosis
Synovial Membrane
Synovitis, Pigmented Villonodular*
Temporomandibular Joint*
Cimetidine
Hemosiderin

Figure

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  Fig. 1 The panoramic view shows the lobulated osteolytic lesion in the right condylar head.

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  Fig. 2 The axial (A) and coronal (B) views of computed tomography show a lobulated osteolytic lesion with the bony erosion (arrow) in the mandibular condyle.

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  Fig. 3 The axial (A) and coronal (B) T2-weighted images of magnetic resonance imaging show the multilobulated mass-like lesion with inner high signal intensity and outer low signal intensity.

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  Fig. 4 The axial T1-weighted image of magnetic resonance imaging shows the intermediate signal intensity with peripheral low signal intensity rim.

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  Fig. 5 The axial (A) and coronal (B) fat suppression T1-weighted images of magnetic resonance imaging show the multilobulated high signal intensity with the high soft tissue enhancement.

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  Fig. 6 Smear shows a few clustered and scattered plump spindle cells containing hemosiderin pigments (Papanicolaou staining, ×400).

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  Fig. 7 Grossly, the specimen is consisted of a few fragments of brownish gray soft tissue, cartilage and bone.

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  Fig. 8 The mass is composed of many mononuclear histiocytic cells and irregularly interspersed multinucleated giant cells. Hemosiderin deposits are found (H&E staining, A: ×100, B: ×400).

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  Fig. 9 The axial (A) and coronal (B) views of computed tomography show the round soft tissue opacity on the condylar fossa of temporal bone (arrow) and the skull base erosion with bony perforation (arrow head). Asterisk: metal condylar head.

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  Fig. 10 The axial (A) and coronal (B) fat suppression T1-weighted images of magnetic resonance imaging show the lobulated high signal intensity mixed up inner intermediate signal intensity with the moderate enhancement. The skull base perforation (arrow) is also seen.

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  Fig. 11 The axial T1-weighted image of magnetic resonance imaging shows the isosignal intensity mixed up inner low signal intensity with peripheral low signal intensity rim.

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  Fig. 12 The axial (A) and coronal (B) T2-weighted images of magnetic resonance imaging show the heterogenous high signal intensity mixed up inner low signal intensity with peripheral low signal intensity rim.

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  Fig. 13 The panoramic view after 18 months of final operation later.

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