The document describes several cases of rare soft tissue tumors, including: 1) Four cases of epithelioid sarcoma affecting the foot, forearm, and wrist in patients aged 22-36, which present as ulcerated lesions and are difficult to diagnose. 2) Three cases of myxoid chondrosarcoma in the thigh, shoulder, and leg in patients aged 41-65, which appear similar to hematomas and have a characteristic myxoid and chordoid pathology. 3) Several cases of synovial chondromatosis, juxta-articular chondroma, and secondary synovial chondromatosis affecting various large joints in patients aged 13

1. Volume 17
Chondroid tumors
Synovial chondromatosis---------Case 364-370 & 1243-5
Juxtaarticular chondroma---------Case 371-377 & 1246-7
2ndary synovial chondromatosis-Case 378-382 & 1248
Myxoid chondrosarcoma----------Case 383-385
Epithelioid sarcoma------------------Case 386-389
Soft tissue Ewing’s sarcoma--------Case 390-392
Clear cell sarcoma--------------------Case 393-394
Myositis ossificans-------------------Case 395-405
Pigmented villonodular synovitis---Case 406-416 & 1249
Intramuscular myxoma---------------Case 1258
Ganglion cyst--------------------------Case 1259-60
Soft tissue lympoma------------------Case 1261

2. Chondroid Tumors

3. Synovial
Chondromatosis

4. Synovial Chondromatosis
Synovial chondromatosis is a rare dysplasia seen in younger
patients. It is associated with metaplastic cartilage within the
synovial lining of major joints such as the hip, knee, shoulder and
elbow. It is twice as common in males as females and usually
occurs in patients in the 20-40 age group. It is a monarticular
disease that presents with symptoms of crepitation in the affected
joint with mild, intermittent effusion sometimes associated with
pain. Because of chronic irritation to the joint and damage to the
articular cartilage, osteoarthritis is an ultimate problem with this
disease and can lead to a total joint replacement at a later age. In
rare instances this condition can mutate into a secondary chondro-
sarcoma, usually around the hip or knee joint but seldom in the
shoulder area. This usually occurs in the later years of life.
In the early stages before the cartilage becomes calcified, the
synovial chondromatosis may be difficult to pick up on routine
radiographic examination. As time passes, the cartilage begins

5. to calcify in a typical chondroid pattern that suggests the diagnosis
of a chondroid tumor in or about a major joint. With excessive
proliferation, the cartilage can extrude out of the joint into adjacent
soft tissue, similar to what occurs with pigmented villonodular
synovitis. As the disease progresses, it is not unusual to see
enchondral ossification occurring within the cartilage when it is
still attached to the synovial lining and has access to a blood supply.
Multiple loose bodies are common with this disease and can run as
high as 200 pellets within a major joint that sometimes aggregrate
into a large mass that has the appearance of a chondrosarcoma.
Treatment consists of a surgical resection of the loose bodies as
well as a subtotal synovectomy of the tissue that produces the loose
bodies. Multiple surgical procedures may be required because of a
high recurrence rate. As in PVNS, it is not unusual to see a solitary
focus of synovial chondromatosis with the remaining synovial
lining being normal in appearance with only a solitary mass of
cartilage attached to the synovial lining. This localized nodular form

6. is more common about the hip, knee and ankle area. It is very
common to find loose bodies in a major arthritic joint in older
patients secondary to osteoarthritis where the joint cartilage is
broken away from the joint surface and than becomes reattached
to the synovial lining and gives the pseudo-appearance of primary
synovial chondromatosis when, in fact, the primary etiology in
this so-called secondary form is degenerative osteoarthritis. The
secondary form is seen in patients past the age of 50 years, where-
as the primary dysplastic form arising from the synovial lining
is seen during the first three to four decades of life.

7. CLASSIC Case #364
33 year male with synovial chondromatoasis of shoulder

8. Sagittal T-2 MRI showing multiple calcified cartilage bodies

9. Coronal T-2 MRI
showing loose bodies

10. Surgical exposure showing loose bodies

11. Loose bodies and synovial lining following surgery

12. Cartilaginous bodies arising from synovial lining

13. Cartilaginous body formation in synovial villus

14. Case #365
26 year male with
synovial chondromatosis
knee joint

15. AP x-ray

16. Gross appearance of synovial chondromatosis

17. Microscopic evidence of cartilage elements in synovium

18. Case #366
28 year female with synovial chondromatosis knee

19. Another view

20. Photomic showing cartilage in synovial lining

21. Case #366.1
63 year female with long history of synovial chondromatosis

22. Sag T-2
Sag Gad

23. Cor T-2 Axial Gad

24. Case #366.2 Synovial chondromatosis
42 year female with grinding sensations in knee for years

25. Case #367
38 year male with synovial chondromatosis left hip

26. Frog leg lateral

27. Coronal T-2 MRI

28. Sagittal T-2 MRI cut
showing loose bodies

29. Surgical removal of cartilage bodies

30. Photo of largest cartilage body

31. Case #368
24 year female with large cartilaginous pelvic mass
arising from synovial chondromatosis of left hip

32. tumor
Close up of deformed femoral neck

33. tumor
Note deformity of medial femoral neck

34. femoral N
Exposure of large pelvic tumor by removal ant pubic ramus

35. pubic groove
Resected cartilage masses and loose hip joint bodies

36. Cut specimen of one mass formed from compressed pellets

37. Loose bodies from hip joint

38. cartilage
Photomic of cartilage forming in synovial lining

39. Post op x-ray showing ramus surgical defect

40. 9 years later with DOA requiring THA

41. Case #369
59 year male with
synovial chondromatosis
right hip for 20 years

42. 5 years later with 2ndary
chondrosarcoma in
femoral neck

43. Frog leg lateral showing chondrosarcoma

44. Femoral head & neck specimen from THA showing
chondrosarcoma in lower neck area

45. chondrosarcoma
Synovectomy specimen obtained at time if THA

46. Photomic of chondrosarcoma

47. 1 yr later we see recurrent tumor requiring hemipelvectomy

48. Case #370
50 year female with
25 year history of
synovial chondromatosis

49. Coronal T-2 MRI several years later with 2ndary chondrosarc

50. Dedifferentiated
Case #370.1
Cor T-1 T-2 chondrosarcoma
60 yr male with swollen knee for years with recent increase in size

51. Cor T-2 Gad

52. Sag T-2 Gad T-2

53. Axial T-2
Gad

54. Case #1243
20 year female with
synovial chondromatosis
hip

55. Frog leg lateral

56. CT scan showing loose bodies

57. Case #1244
26 year female with
synovial chondromatosis
hip

58. CT scan

59. CT scan at lower level

60. Photomic showing embryonic cartilage in synovial lining

61. Case #1245
49 year female with synovial chondromatosis wrist

62. AP view

63. Axial Gad contrast MRI

64. loose pellets
fluid
Sagittal T-1 MRI showing wrist effusion and loose pellets

65. Juxta-articular
Chondroma

66. CLASSIC Case #371
25 year old with juxta-articular chondroma posterior knee

67. AP view

68. Surgical excision

69. Surgical specimen

70. X-ray of resected
specimen

71. Photomic

72. Case #372
41 year male with juxta-articular chondroma ant knee

73. Sagittal T-1 MRI

74. Sagittal T-2 MRI

75. Axial T-2 MRI

76. Photomic

77. Case #372.1 Juxtr-articular chondroma
60 yr female with lump in anterior knee area for years

78. Sag T-1 T-2
Gad

79. Axial T-1 PD
Gad

80. Case #373
58 year male with juxta-articular chondroma posterior knee

81. Sagittal T-2 MRI

82. Axial T-2 MRI

83. Case #374 Sagittal T-1 MRI
tumor
37 year male with juxta-articular chondroma post knee

84. Sagittal T-2 MRI

85. tumor
Sagittal gad contrast MRI with rim enhancement

86. tumor
Axial T-2 MRI

87. tumor
Axial gad contrast with rim enhancement

88. Case #1248
36 year male with soft tissue chondrosarc behind knee

89. Sagittal T-2 MRI

90. Axial T-1 MRI

91. Axial T-2 MRI

92. Case #375
13 year male with juxta-articular chondroma posterior knee

93. Case #376
18 year male with juxta-articular chondroma ankle

94. Case #376.1 Juxta-articular chondroma
38 old male with long history of catching sensations in ankle

95. Axial T-1 PD
Gad

96. Sag T-1 PD
Gad

97. Case #377
19 year male with tenosynovial chondromatosis

98. Lateral view

99. Photomic

100. Case #1247
44 year male with
solitary synovial
chondroma hip

101. Lateral view

102. Photomic from resected specimen

103. Secondary
Synovial
Chondromatosis

104. CLASSIC
Case #378
49 year female with
2ndary synovial
chondromatosis from
osteoarthritis of knee
AP x-ray

105. Lateral view

106. Sagittal T-2 MRI

107. Axial proton
density MRI
fluid

108. Axial T-2 MRI

109. Case 379 Coronal T-1 MRI
osteoarthritis
76 year male with 2ndary synovial chondromatosis knee

110. Sagittal T-2 MRI
showing loose
bodies in popliteal
synovial cyst

111. Axial T-2 MRI with loose body in popliteal cyst

112. Axial T-2 MRI with many loose bodies in popliteal cyst

113. Case #379.1 Secondary synovial chondromatosis
57 year old soccer player with prior history of knee surgery

114. Sag T-1 T-2
Gad

115. Axial T-2 Gad

116. Case #380
70 year female
2ndary synovial
chondromatosis from
osteoarthritis knee

117. Lateral view

118. Case #381
55 year female
2ndary synovial
chondromatosis from
osteoarthritis knee

119. Lateral view

120. Sagittal proton density MRI showing loose bodies
in popliteal cyst

121. Case #381.1 Secondary synovial osteochondromatosis
62 year old male with DOA and large
necrotizing mass over tibia

122. Sag T-1 T-2 Gad

123. T-2 Gad
Axial
T-2 Gad

124. Post op surgical
debriedment
Post op flap
coverage over
tibia

125. Case #382
69 year male with 2ndary
synovial chondromatosis
from traumatic arthritis
of elbow

126. Surgical removal of loose bodies

127. Loose bodies and pieces of synovium

128. Case #1246
46 year female 2ndary synovial chondromatosis talonarvicular
second to old trauma of subtalar joint

129. Sagittal T-1 MRI showing traumatic arthritic changes

130. Sagittal T-2 MRI showing excessive synovial fluid

131. Coronal T-2 MRI

132. Myxoid
Chondrosarcoma

133. Myxoid Chondrosarcoma
(Chordoid Sarcoma)
The extra-skeletal myxoid chondrosarcoma is a very rare soft
tissue tumor in the deep muscle belly, occurring most often in the
extremities in patients over 40 years of age. Males are affected
twice as often as females. The tumor is slow growing and may
cause local pain and tenderness. Common locations are the thigh,
popliteal fossa, and shoulder girdle. It presents with the clinical
appearance of a myxoid liposarcoma. Pathologically, the tumors
are greyish to tannish brown, depending on the amount of
hemorrhage into the tumor. Because hemorrhage often occurs, it
can be mistaken for a hematoma. Histologically, the tumor has a
myxoid appearance with chords and nests of anastomosing cells
that have a chondroblastic appearance. The histology is very
similar to that of chordoma of the sacrum. The tumor is considered
low grade in most instances; it is slow growing but has the potential

134. for local recurrence and pulmonary metastases in about one-third
of cases. Treatment consists of aggressive wide local resection or
amputation, if needed, followed by local radiation therapy. Chemo-
therapy is usually not indicated.

135. CLASSIC Case #383 Coronal T-1 MRI
tumor
55 year male with myxoid chondrosarcoma distal thigh

136. Coronal T-2 MRI
tumor

137. tumor
Axial T-2 MRI

138. Resected hemorrhagic surgical specimen

139. Photomic showing chordoid myxoid pattern like chordoma

140. Pathology similar to that of a chordoma

141. Case #384 Sagittal T-2 MRI
tumor
41 year female with myxoid chondrosarcoma shoulder

142. tumor
Axial gad contrast MRI

143. Case #385
65 year male with
soft tissue myxoid
chondrosarcoma leg
eroding tibia
AP view

144. Lateral view

145. Sagittal T-2 MRI
tumor

146. tumor
Axial T-2 MRI

147. tumor
Another axial T-2 MRI

148. Epithelioid
Sarcoma

149. Epithelioid Sarcoma
The epithelioid sarcoma affects young adults and is most
commonly seen in the fingers, hand and forearm where it is
considered the most common soft tissue sarcoma next to the
alveolar rhabdomysarcoma and synovial sarcoma. It can also occur
in the popliteal area, the buttock, thigh, shoulder, foot and ankle
area. It affects twice as many males as females. These tumors are
frequently misdiagnosed as a benign granulomatous process and
are often attached to tendon sheaths and facial planes with
associated cutaneous ulcerations that may be multiple in nature.
Calcification or even bone formation can occur in about 15% of
cases. The histological appearance of this lesion displays a distinct
nodular growth pattern with epithelioid nests of cells at the center
surrounded by lymphocytic infiltration. The differential diagnosis
would include necrotizing infectious diseases such as tuberculosis
or granuloma annulare or rheumatoid nodules. Regional lymph

150. node involvement occurs in about 35% of cases and metastases to
the lung in about 50% of cases. Because of the benign clinical
appearance of this lesion, it is common for surgeons to attempt
local resection but there is a high recurrence rate that eventually
leads to amputation. Local radiation therapy can help to decrease
the chance of local recurrence.

151. CLASSIC
Case #386
36 year male with
epithelioid sarcoma
foot
ulceration

152. Side view with ulcerated cap

153. tumor
CT scan

154. tumor
Another CT cut

155. necrotic center
Scanning lens photomic

156. Close up outer edge

157. Higher power of epithelioid cells

158. Case #387
34 year male with
epithelioid sarcoma
forearm
Sagittal T-2 MRI

159. Sagittal Gad contrast MRI
tumor

160. tumor
Axial T-2 MRI

161. necrosis
tumor
Axial gad contrast MRI

162. Photomic showing epithelioid cells

163. Case #387.1 Epithelioid sarcoma
22 year old male with spontaneous fungating wound volar wrist

164. Cor T-1 T-2 FS Gad

165. Sag T-1 T-2 FS Gad

166. Axial T-1 T-2 FS
Gad

167. Case #388
27 year female with epithelioid sarcoma sole of foot

168. Case #388
Sagittal T-1 MRI

169. Axial proton density MRI

170. Axial T-2 MRI
tumor

171. Case #389
50 year male with epithelioid sarcoma middle finger

172. Soft Tissue
Ewing’s Sarcoma

173. Extra-skeletal Ewing’s Sarcoma
Ewing’s sarcoma is usually associated with primary tumor of
bone but in a small percentage of cases, Ewing’s sarcoma can
occur in soft tissue completely unattached to the skeletal system.
However, the histological appearance and the clinical picture
associated with soft tissue Ewing’s sarcoma is basically the same
as that of skeletal Ewing’s. This condition is seen in patients
between the age of 15 and 30 years. It occurs in males and females
equally and is rare in black patients. The most common location
is the chest wall, followed by the lower extremities, paraspinous
area, pelvis, hip and retroperitoneum. The least common location
is the upper extremity. The reciprocal translocation of the long
arm of chromosomes 11 and 22 is seen in soft tissue Ewing’s,
just as it is in skeletal Ewing’s. The prognosis for five year survival
is approximately 65%, similar to that of skeletal Ewing’s. Treatment
consists of wide local resection when possible, followed by

174. local radiation therapy if indicated. Adjuvant chemotherapy is
commonly used because of the excellent response, similar to
that of skeletal Ewing’s sarcoma.

175. CLASSIC
Case #390
28 year female with
soft tissue Ewing’s
sarcoma anterior thigh
Coronal proton density
MRI

176. Coronal proton
density MRI

177. Coronal T-2 MRI
tumor

178. tumor
Axial T-2 MRI

179. Surgical specimen inked and cut in path lab

180. Photomic

181. Case #390.1 Axial T-1 MRI
38 year female with painful thigh mass 2 months

182. Axial T-2
Axial Gad
necrosis

183. necrosis
Coronal T-2 Coronal Gad contrast

184. Case #391
14 year male with
soft tissue Ewing’s
sarcoma distal thigh

185. Axial proton
density MRI
tumor

186. Axial T-2 MRI
tumor

187. Photomic

188. Case #391.1 T-1 Sag MRI T-2 Sag
18 yr female with Ewing’s sarcoma in sciatic nerve looking
like a benign neurilemoma

189. Axial Gad MRI at two different levels
Lower level Upper level

190. Coronal Gad MRI

191. Case #392
16 year female with
soft tissue Ewing’s
sarcoma thigh

192. Coronal T-1 MRI

193. tumor
Axial T-2 MRI

194. Clear Cell
Sarcoma

195. Clear Cell Sarcoma
The clear cell sarcoma is thought to be a deep, non-cutaneous
variant of the pigmented melanoma. It is a very rare tumor affecting
females more than males. It is typically seen between the ages of
20 and 40 years. It usually occurs in tendon sheaths and fascial
planes, especially around the foot and ankle area, similar to the
clinical appearance seen with synovial sarcoma with which it can
be confused. The tumor usually begins as a slow growing lump that
has a benign appearance but after a period of several years the tumor
will start growing more rapidly and become painful. It has a high
potential to metastasize to local lymph nodes and to the lung.
Approximately 50% of patients with this tumor will be dead in five
years. The microscopic appearance is similar to that of the epithelioid
sarcoma, especially if melanin is not found in the specimen.
Treatment usually consists of wide local resection, if possible, but a
high local recurrence rate is common because of its location in

196. extracompartmental structures such as tendon sheaths. If that
occurs, amputation is carried out for local control of the disease.
Local radiation therapy is utilized with attempts at wide resection.
Adjuvant chemotherapy has been advised because of the poor
prognosis but the response is usually not beneficial.

197. CLASSIC Case #393
35 year female with clear cell sarcoma hand

198. Surgical exposure reveals extensive tendon sheath involvement

199. Photomic

200. Case#394 Sagittal gad contrast MRI
tumor
73 year female with clear cell sarcoma ankle

201. tibia
heel cord
tumor
Axial gad contrast MRI

202. Myositis
Ossificans

203. Myositis Ossificans
Myositis ossificans is a heterotopic ossification within muscle
fascial planes seen typically in young athletic individuals in their
adolescence and early adult life. It occurs primarily in males and
usually results from a significant injury to a muscle, such as a
tearing of the quadriceps muscle which is the most common
location for this problem. It is also seen in the gluteus maximus
and the brachialis muscle at the elbow. The calcification is typically
noted on x-ray three to four weeks after the injury. It tends to occur
at the periphery of the damaged muscle and hematoma is usually
seen in the central area. As the lesion matures the calcific rim
around the damaged muscle will appear as fairly mature bone
and the central area will remain radiolucent, giving the so-called
zonal pattern that is almost diagnostic of traumatic myositis
ossificans. This is the opposite of osteosarcoma of soft tissue that
has the most dense portion of the calcifying lesion occurring centrally
and the more lytic portion at the periphery of the lesion. Myositis

204. ossificans can also be seen in older patients with no history of
trauma in which case the clinician becomes concerned about the
possibility of a neoplasm such as a synovial sarcoma or soft tissue
osteosarcoma. Histologically, the lesion will have the appearance
of a healing fracture, including immature cartilage and bone
formation, along with hematoma in the early stages. In rare cases,
after a period of 25 or 30 years, these dormant lesions can reactivate
and develop into an osteosarcoma. Treatment usually consists of
rest until the lesion matures after six months, at which point the
patient is usually asymptomatic. There is no reason to remove the
lesion unless there is significant clinical disability related to
stiffness of the adjacent joint.
There is a hereditary congenital form of myositis ossificans
referred to as myositis ossificans progressiva, or the newer term-
inology is fibrodysplasia ossificans progressiva, that is typically
seen in children under the age of ten years. It presents with a
clinical picture of progressive fibroblastic proliferation and

205. subsequent calcification and ossification of subcutaneous fat,
muscles, tendons, appeneuroses, and ligaments. This condition can
be associated with symmetrical malformations of the digits with
microdactyly of the thumbs and great toes, sometimes associated
with a failure of segmentation of the digital bony structures. The
condition usually presents between birth and the first six years of
age. It is inherited as an autosomal dominant trait. Males and
females are equally affected and the calcification in soft tissues is
usually precipitated by a local injury to the soft tissue. It occurs
typically in the musculature of the back, shoulder, paravertebral
region and upper arms. Fusion of the tempromandibular joint can
be seen. If the respiratory muscles are affected, death can result
because of respiratory failure or pneumonia in early adult life. The
prognosis for survival is very poor and most patients die within the
first ten to fifteen years of life. Biopsy or trauma of the affected
areas should be avoided because of new lesions that might
develop. There is no effective treatment or this condition.

206. CLASSIC
Case #395
12 year female with
myositis ossificans
medial thigh

207. fibrous tissue
Cut surgical specimen showing mature bone at periphery

208. Photomic showing reactive bone at periphery of lesion

209. Less bone maturity toward center of lesion

210. Healing rhabdomyoblasts in center of lesion

211. Case #396
59 year male with
early myositis
ossificans ant thigh

212. Lateral view

213. Axial T-2 MRI

214. Axial T-2 MRI

215. Macro section of resected specimen

216. bone
Reactive bone at periphery

217. Case #397
biopsy
22 year male with early
myositis ossificans
anterior thigh

218. bone
fibrous
Biopsy specimen with typical benign zonal pattern

219. Mature myositis
ossificans 6 mos later

220. Case #398
2 mos later
early
17 year male with myositis ossificans of thigh 2 mos apart

221. Case #399
24 year female
myositis ossificans
2 months post injury

222. Axial T-1 MRI

223. Axial T-2 MRI

224. Coronal T-2 MRI

225. Biopsy specimen showing reactive bone

226. cartilage
bone
Close up of reactive bone and cartilage

227. Case #400
14 month male with
myositis ossificans
brachialis muscle from
fall 2 weeks ago

228. Case #401
14 year male with
myositis ossificans
triceps muscle
mature

229. Case #402
10 year old female with myositis ossificans of shoulder

230. Case #403
62 year female with old myositis ossificans teres major

231. Coronal T-1 MRI

232. Superficial biopsy specimen shows benign reactive bone

233. A deeper specimen reveals OGS arising from
previous myositis ossificans

234. Myositis
Ossificans
Progressiva

235. CLASSIC
Case #404
22 year male with
myositis ossificans
progressiva

236. Heavy ossification of
latissimus dorsi muscle

237. X-ray showing
ossification of
latissimus dorsi muscle

238. Spontaneous fusion
cervical spine

239. Ossification psoas m

240. Heterotopic ossification seen muscle biopsy

241. Microdactyly both great toes

242. X-ray of feet showing failure of segmentation great toes

243. Hands showing stiff thumbs and hypoplastic 5th digits

244. X-ray showing hypoplasia of 1st and 5th digits

245. Case #405
26 year male with
myositis ossificans
progressiva with
spontaneous fusion
scoliotic spine

246. Spontaneous extra-articular fusion left hip

247. Pigmented
Villonodular
Synovitis

248. Pigmented Villonodular Synovitis
The etiology of pigmented villonodular synovitis (PVNS)
remains controversial. It presents as an inflammatory synovial
disease, usually involving only one joint, but histologically the
disease presents with histiocytic proliferation in the subsynovial
tissue that takes on the characteristics of a neoplastic condition
similar to that of a giant cell tumor. PVNS occurs typically in the
subsynovial tissue about major joints of the lower extremity in
patients between the ages of 20 and 40 years. The knee joint is the
most common site, followed next by the hip, ankle and foot. It is
rare to see this disease in the upper extremity. The histiocytic
proliferation in subsynovial tissues is similar to that seen in giant
cell tumor of tendon sheathes in the hand and foot., The clinical
picture in the knee joint is that of spontaneous swelling associated
with pain and synovial hypertrophy. Hemarthrosis can result in
massive swelling about the knee joint and can occasionally result

249. in juxta-articular erosion of bone, similar to what is seen in
rheumatoid synovitis. Other clinical conditions with a similar
presentation include hemophilia and coccydiomycosis. In fewer
than 10 % of cases this condition will present as a localized focal
mass in the suprapatellar pouch of the knee or high in the popliteal
space posteriorly that can masquerade as a neoplastic condition
such as a synovial sarcoma.
Treatment for the more generalized synovial involvement of
the knee joint or other lower extremity joints consists of a subtotal
synovectomy that in many cases can be performed through an
arthroscope. In more extensive cases an open procedure may be
necessary. The recurrence rate is fairly high, in the range of 30%.
In cases where multiple recurrences result, treatment with radiation
therapy in the neighborhood of 1500-3000 centigray by external
beam is used. Injectable isotopes have also been used for radiation
treatment of recurrent cases. Secondary arthritic changes, especially
in the knee joint, can occur as a late complication of this disease

250. and these changes could lead to a total joint replacement at the
age of 50 or 60 years. On very rare occasion, this disease can
convert to a neoplastic sarcoma with a high degree of giant cell
activity. This is similar to the conversion of a giant cell tumor to
a malignant sarcoma.

251. CLASSIC
Case #406
36 year male with
PVNS knee

252. Lateral x-ray of knee
showing soft tissue
swelling

253. AP x-ray showing
early osteoarthritis

254. Sagittal T-1 MRI
showing hypertrophic
synovitis
bone
erosion

255. hemosiderin cyst
laden
Sagittal T-2 MRI
erosion

256. Axial T-1 MRI showing hypertrophic synovitis

257. cyst
Coronal T-2 MRI

258. Brown discoloration of hypertrophic synovitis at surgery

259. Photomic showing giant cell activity

260. Photomic showing hemosiderin laden macrophages

261. Surgical appearance following subtotal synovectomy

262. Case #407 Sagittal proton density MRI
41 year female with PVNS knee

263. fluid
hemosiderin laden
synovitis
Axial GRE T-2 MRI

264. Surgical exposure of brown hypertrophic synovitis

265. Photomic showing giant cell activity

266. Case #407.1
38 year male with intermittent pain and swelling rt knee 2 years

267. Sag T-2 T-2 Gad

268. Axial T-2 Gad

269. Case #407.2 Recurrent PVNS
43 yr male with 5 scopes over 7 yrs for intermittent painful swelling
about the left knee

270. Sag PD T-2 FS T-2 FS

271. Axial T-2

272. Cor T-1 T-2

273. Case #408
55 year female
PVNS knee with
large subchondral
lytic granuloma

274. Coronal T-1 MRI

275. Case #409
38 year male with
PVNS hip joint with
large supra-acetabular
granuloma

276. Diffuse synovial
hypertrophic nodularity
seen with arthrogram

277. Treatment in the 60’s
with a cup arthoplasty
and bone graft to the
acetabular granuloma

278. Case #410 Sagittal proton density MRI
17 male with localized nodular form of PVNS

279. Sagittal T-2 MRI

280. Axial T-2 MRI

281. Surgical specimen

282. Photomic showing hemosiderin laden macrophages

283. Case #410.1 Sag T-1 PD Nodular PVNS
45 year female with knee pain for 5 months

284. Cor T-1 PD FS

285. Surgical excision

286. Case #410.2 Localized nodular form of PVNS
32 yr male with dull pain R knee for 5 months

287. Sag T-1 T-2
Gad

288. Axial T-1 T-2
Gad

289. Cor T-1 T-2 FS
Gad

290. Case #411 Sagittal proton density MRI
erosion
50 year male with PVNS knee with large popliteal mass

291. Sagittal T-2 MRI

292. Case #412 Sagittal T-1 MRI
17 year female with PVNS ankle

293. Sagittal T-2 MRI

294. Another sagittal T-2 cut

295. Synovectomy specimen

296. Photomic

297. Case #413 Sagittal T-1 MRI
39 year female with diffuse form of GCT tendon sheath

298. Axial T-1 MRI

299. tumor
Axial T-2 MRI

300. Photomic

301. Case #414
67 year female with
giant cell tumor of
tendon sheath

302. X-ray showing bony
erosion

303. Case #415
14 year female with GCT tendon sheath

304. X-ray showing bony erosion

305. digital nerve
Surgical resection

306. Case #416
14 year female with xanthomatous variant of giant cell
tumor of tendon sheath on index finger

307. Surgical resection

308. Photomic showing cholesterol laden foam cells

309. Case # 1249
20 year female with PVNS knee

310. Lateral view

311. R L
Bone scan

312. Sagittal T-1 MRI

313. Coronal T-1 MRI

314. Coronal gad contrast MRI

315. Case #1250
PVNS
DOA
68 year male with PVNS and DOA left knee

316. Lateral view showing subchondral erosions

317. Axial T-1 MRI with subpatellar synovial hypertrophy

318. Sagittal T-1 MRI showing extensive
suprapatellar pouch involvement

319. Sagittal T-2 MRI showing fluid in suprapatellar pouch

320. Coronal T-2 MRI with
dark signal hemosiderin
laden synovitis and
bright signal synovial
fluid

321. Another coronal
T-2 MRI
Subchondral erosions

322. Case #1251
34 year male with
PVNS knee
Sagittal T-1 MRI

323. Sagittal GRE T-2*
MRI

324. Another sagittal
GRE T-2* MRI

325. Coronal GRE T-2* MRI

326. Case #1252
23 year male with PVNS
suprapatellar pouch area
Coronal T-1 MRI

327. Coronal T-2 MRI

328. Axial T-2 MRI

329. Case #1253 Sagittal T-1 MRI
19 year male with localized nodular form of PVNS knee

330. Coronal T-1 MRI

331. Coronal T-2 MRI

332. Case #1254
40 year female with PVNS hip joint

333. CT scan

334. Axial T-1 MRI

335. Axial T-2 MRI

336. Case #1255
32 year male with
PVNS hip joint

337. Case #1256
40 year female with
pigmented villonodular
tenosynovitis flexor
hallicus longus tendon
sheath
Sagittal T-1 MRI

338. Coronal T-1 MRI

339. Axial T-1 MRI

340. Axial T-2 MRI

341. hemosiderin
histiocytes
Photomic showing giant cell activity

342. Case #1256.1
12 year old male with tender lump under heel cord 4 months

343. Sag T-1 PD Gad

344. Axial T-1 T-2
Gad

345. Case #1257
8 year female with
GCT tendon sheath
2nd toe

346. Sagittal T-1 MRI

347. Coronal T-1 MRI

348. Case #1257.1 GCT tendon sheath
53 yr female with tender and swollen 2nd toe for 1 yr

349. Cor T-1 T-2 FS
Gad

350. Axial T-1 T-2 FS
Gad

351. Sag T-1 T-2
Gad

352. Intramuscular
Myxoma

353. Case #1258
Axial T-2 Axial Gad
46 yr female with painless lump in post axilla for 8 years

354. Sagittal T-2 Sagittal Gad

355. Coronal Gad
Surgical specimen

356. Case #1258.1
68 year old male with painless lump right shoulder for 1 yr

357. Cor T-1 T-2

358. Sag T-1 T-2

359. Case #1258.2 Axial T-1 T-2
59 year male with painless soft
tissue mass medial calf for 6 mos.
Gad
Intramuscular myxoma

360. Sagittal
T-1 T-2 Gad

361. Ganglion Cyst

362. Case #1259
Axial T-1
48 yr male with
painless lump in
anterior thigh 1 yr
T-2

363. Axial Gad
Shows rim enhancement
Sagittal Gad

364. Case #1260 Ganglion cyst
49 year female with tender lump medial knee for 6 mos

365. Cor T-1 Cor T-2

366. Case #1160.1 Ganglion cyst
65 year female with non tender mass over patellar ligament

367. Sag T-1 PD FS

368. Cystic lateral meniscus
Case #1261
Axial T-1 T-2
49 year male with prior history of subcutaneous ganglion cyst
removed from knee area 6 years ago

369. Cor T-1 T-2

370. Case #1261.1
Axial T-1 T-2
Gad
72 year male with painless lump
lateral ankle for 1 year

371. Cor STIR Surgical excision

372. Ganglion cyst
Case #1261.2
Axial T-2
45 year male runner
With tender nodule in
Medial gastroc head
Gad

373. Cor T-2 Gad

374. Case #1261.3 Ganglion cyst
60 year male with mild R hip pain for 1 year

375. Cor T-1 PD Gad

376. Axial T-2

377. Soft Tissue Lymphoma

378. Case #1262 Axial T-1 T-2 Lymphoma
100 year old male with chronic edema
in legs but recent tender lump in calf
for 3 months
Gad

379. Sag T-1 STIR Gad