Imaging of Synovial Tumors and Tumor-like Conditions (Medical Radiology)

This vastly illustrated book offers a comprehensive survey of the role of imaging in the diagnosis of synovial tumors and tumor-like conditions. It gives an overview of the anatomy and histology of the synovium and discusses the classification, pathology, genetics and molecular biology of synovial tumors. The book presents the benefits of various imaging modalities in the diagnosis of these masses, which is important to provide appropriate treatment. Imaging of Synovial Tumors and Tumor-like Conditions will be a valuable resource not only for radiologists but also for orthopedic surgeons, oncologists, radiotherapists, and pathologists. Preface Contents Part I: Anatomy and Histology of the Synovium Normal Anatomy and Histology 1 Introduction 2 Gross Anatomy and Function 2.1 The Joints 2.2 The Synovial Joint 2.3 The Synovial Fluid 3 Histology of the Synovium 3.1 The Synovial Membrane 3.2 Synoviocytes 3.3 Subintima 4 Function of the Normal Synovium 4.1 Homeostasis of the Joint 4.2 Cytokine Production 5 Key Points References Part II: Classification, Pathology, Genetics and Molecular Biology Classification of Synovial Tumors According to WHO 2020 1 Introduction 2 World Health Organization Classification 3 Grading 4 Redefinition and Reclassification 5 Key Points References Pathology, Genetics, and Molecular Biology 1 Introduction 2 Fibroma of the Tendon Sheath 2.1 Genetics and Molecular Biology 3 Synovial (Intra-articular) Nodular Fasciitis 3.1 Genetics and Molecular Biology 4 Synovial Hemangioma 4.1 Genetics and Molecular Biology 5 Synovial Lipoma 5.1 Genetics and Molecular Biology 6 Synovial Chondromatosis 6.1 Genetics and Molecular Biology 7 Synovial Sarcoma 7.1 Genetics and Molecular Biology 8 Tenosynovial Giant Cell Tumor 8.1 Genetics and Molecular Biology 9 Synovial Chondrosarcoma 9.1 Genetics and Molecular Biology 10 Other Very Rare Mesenchymal Tumors Arising in Synovium 11 Lymphomas 12 Metastatic Disease in the Synovium 13 Key Points References Part III: Imaging Modalities Ultrasound of Synovial Tumors and Tumorlike Conditions 1 Generalities 2 Ultrasound-Guided Synovial Biopsy 3 Tenosynovial Giant Cell Tumor 4 Primary Synovial Chondromatosis 5 Lipoma Arborescens 6 Synovial Hemangioma 7 Synovial Chondrosarcoma 8 Intra- and Periarticular Cysts 8.1 Synovial Cysts 8.2 Mucoid or Ganglion Cysts 8.2.1 Intra-articular Ganglion Cysts 8.2.1.1 Meniscal Cysts 8.2.1.2 Cruciate Ligament Cysts 8.2.1.3 Hoffa’s Fat Pad Cysts 8.2.2 Extra-articular Ganglion Cyst 8.2.2.1 Spinoglenoid Notch Cyst 8.2.2.2 Intraneural Cyst 8.2.2.3 Cystic Adventitial Disease 8.2.2.4 Subperiosteal Cyst 9 Conclusion 10 Key Points References Radiography and CT in Synovial Tumors and Tumorlike Conditions 1 Introduction 2 Techniques 2.1 Radiography 2.2 Computed Tomography (CT) 2.3 Dual-Energy Computed Tomography (DECT) 3 Anatomical Considerations 3.1 Synovial Joints 3.2 Periarticular Fat Planes 3.3 Tendons 3.4 Bursae 4 Anatomical Considerations of Some Common Synovial Joints 4.1 Shoulder 4.2 Elbow 4.3 Hip 4.4 Knee 4.5 Ankle 5 Pathological Considerations 5.1 Synovial Hemangioma 5.2 Juxta-Articular Myxoma 5.3 Lipoma Arborescens 5.4 TSGCT 5.5 Primary Synovial Chondromatosis 5.6 Synovial Chondrosarcoma 5.7 Synovial Metastasis 5.8 BCP Crystal Deposition Disease 5.9 CPPD 5.10 Gout 5.11 Arthritides 5.12 Tuberculosis (TB) 6 Conclusion 7 Key Points References Magnetic Resonance Imaging of Synovial Tumor and Tumorlike Conditions 1 Field Strength, Coils, Matrix, and Imaging Planes 2 Basic Sequences 2.1 T1-Weighted Imaging (T1-WI) 2.1.1 T1-WI Without Fat Suppression (Non-FS T1-WI) 2.1.2 T1-WI with Fat Suppression (FS T1-WI) 2.2 T2-Weighted Imaging (T2-WI) 2.3 T2* Gradient Recalled Echo (T2* GRE) 2.4 Value of Fat Suppression (fs) Sequences 2.5 Fluid-Sensitive Sequences 2.6 Gadolinium Contrast-Enhanced MRI 3 Advanced MR Techniques 3.1 Dynamic Contrast-Enhanced MRI (DCE-MRI) 3.2 Diffusion MRI 3.3 MR Spectroscopy 4 Role of MRI in Characterization and Grading 5 Role of MRI in Evaluation of Lesion Extension 5.1 Size 5.2 Lesion Localization and Compartmental/Extracompartmental Extension 5.3 Local Staging 5.3.1 Bone (Marrow) Involvement 5.3.2 Lymph Node Involvement 6 Role of MRI in Follow-Up After Treatment 6.1 Follow-Up of Malignant Synovial Tumors 6.2 Follow-Up of Benign Lesions 7 Key Points References PET/CT in Synovial Tumors and Tumor-Like Conditions 1 Introduction 2 Differential Diagnosis of a Primary Mass 2.1 Rheumatoid Arthritis 2.2 Tumor-Like Conditions 2.2.1 Tenosynovial Giant Cell Tumor/Pigmented Villonodular Synovitis 2.2.2 Synovial Chondromatosis 2.2.3 Lipoma Arborescens 2.3 Tumors 2.3.1 Synovial Hemangioma 2.3.2 Synovial Sarcoma 2.3.2.1 Evaluation of Disease Extent 2.3.2.2 Evaluation of Response to Treatment 2.3.2.3 Detection of Recurrence 2.3.2.4 Prognostic Value 3 Conclusion 4 Key Points References Diagnostic Algorithm of Synovial Tumors and Tumor-Like Conditions 1 Proposed Imaging Algorithm 2 Key Points Reference Part IV: Imaging of Synovial Tumors and Tumor-Like Conditions of the Synovium Synovial Chondromatosis 1 Definition 1.1 Primary Synovial Chondromatosis 1.2 Secondary Synovial Chondromatosis 2 Clinical Aspects 2.1 Epidemiology 2.2 Location 2.3 Clinical Presentation 3 Pathogenesis 4 Histopathology 4.1 Macroscopy 4.2 Microscopy 5 Classification 6 Imaging of Primary Synovial Chondromatosis 6.1 Ultrasound 6.2 Radiography 6.3 Computed Tomography 6.4 Magnetic Resonance Imaging 6.5 Bone Scintigraphy 7 Differential Diagnosis 7.1 Secondary Synovial Chondromatosis 7.2 Diffuse-Type Giant Cell Tumor 7.3 Synovial Chondrosarcoma 8 Treatment and Prognosis 8.1 Treatment 8.2 Recurrence 8.3 Malignant Transformation 9 Key Points References Tenosynovial Giant Cell Tumor 1 Introduction 2 Epidemiology 3 Pathogenesis 4 Clinical Presentation 5 Pathologic Features 5.1 Diffuse Tenosynovial Giant Cell Tumor 5.2 Localized Tenosynovial Giant Cell Tumor 6 Imaging 6.1 Radiography 6.1.1 Diffuse Tenosynovial Giant Cell Tumor 6.1.2 Localized Tenosynovial Giant Cell Tumor 6.1.2.1 Extra-articular Form 6.1.2.2 Intra-articular Form 6.2 Ultrasound 6.2.1 Diffuse Tenosynovial Giant Cell Tumor 6.2.2 Localized Tenosynovial Giant Cell Tumor 6.2.2.1 Extra-articular Form 6.2.2.2 Intra-articular Form 6.3 CT Arthrography 6.4 CT 6.4.1 Diffuse Tenosynovial Giant Cell Tumor 6.4.2 Localized Tenosynovial Giant Cell Tumor 6.4.2.1 Extra-articular Form 6.4.2.2 Intra-articular Form 6.5 MRI 6.5.1 Diffuse Tenosynovial Giant Cell Tumor 6.5.2 Localized Tenosynovial Giant Cell Tumor 6.5.2.1 Extra-articular Form 6.5.2.2 Intra-articular Form 6.6 FDG PET/CT 7 Differential Diagnosis 7.1 Diffuse Tenosynovial Giant Cell Tumor 7.2 Localized Tenosynovial Giant Cell Tumor 8 Diagnosis 9 Treatment 10 Key Points References Lipoma Arborescens 1 Introduction 2 Epidemiology 3 Pathophysiology 4 Pathology 5 Clinical Findings 6 Imaging 7 Differential Diagnosis 8 Treatment 9 Synovial Lipoma 10 Key Points References Synovial Hemangioma 1 Introduction 2 Clinical Findings 3 Pathology 4 Imaging 4.1 Radiography 4.2 Ultrasound 4.3 Arthrography Computed Tomography and Angiography 4.4 Magnetic Resonance Imaging 5 Differential Diagnosis 6 Treatment 7 Key Points References Synovial Chondrosarcoma 1 Introduction 2 Epidemiology 2.1 Location 2.2 Age and Gender 2.3 Predisposing Factors 3 Clinical Presentation 4 Imaging 5 Histologic Diagnosis 6 Differential Diagnosis 7 Treatment and Prognosis 8 Conclusion 9 Key Points References Synovial Metastasis and Lymphoma 1 Synovial Metastasis 1.1 Introduction 1.2 Epidemiology 1.2.1 Location 1.2.2 Age and Gender 1.2.3 Primary Cancer 1.3 Clinical Presentation 1.4 Imaging 1.5 Histologic Diagnosis 1.6 Differential Diagnosis 1.7 Treatment and Prognosis 1.8 Conclusion 2 Synovial Lymphoma 3 Key Points References Synovial Amyloidosis 1 Introduction 2 Pathogenesis 3 Epidemiology and Clinical Features 3.1 AL Amyloidosis 3.2 AA Amyloidosis 3.3 β2-Microglobulin Amyloidosis 3.4 ATTR Amyloidosis 4 Imaging 4.1 AL Amyloidosis 4.1.1 Appendicular Involvement 4.1.2 Spinal Involvement 4.2 AA Amyloidosis 4.3 Aβ2M Amyloidosis 4.3.1 Appendicular Involvement 4.3.2 Spinal Involvement 4.4 ATTR Amyloidosis 4.5 Scintigraphy/PET in Amyloidosis 5 Differential Diagnoses 6 Treatment 7 Key Points References Synovial Cysts, Ganglion Cysts, and Bursae 1 Introduction 2 Classification and Pathogenesis of Soft Tissue Cysts 2.1 (Arthro)synovial Cyst 2.2 Ganglion (Cyst) 2.3 Bursa De Novo (Adventitious Bursa) 2.4 Permanent Bursa 3 Clinical Manifestations 4 Imaging 4.1 Conventional Radiography 4.2 Ultrasound 4.3 CT (Arthrography) 4.4 Magnetic Resonance Imaging (MRI) 5 Key Points References Mimics of Synovial Tumors Due to Trauma and Inflammation 1 Introduction 2 Synovial Disease Due to Acute Trauma 2.1 Joint Hemorrhage 2.1.1 Imaging 2.2 Acute Traumatic Bursitis 2.2.1 Imaging 2.3 Fibrin Clot Formation 2.3.1 Imaging 3 Synovial Disease Due to Chronic Trauma 3.1 Osteoarthritis 3.1.1 Pathogenesis 3.1.2 Imaging 3.2 Frictional Bursitis 3.2.1 Pathogenesis 3.2.2 Imaging 3.3 Synovial Cyst and Ganglion Cyst 3.4 Lipoma Arborescens 3.5 Secondary Synovial Chondromatosis 3.6 Bleeding Disorders and Hemophilia 3.6.1 Imaging 3.7 Cyclops Lesion 4 Synovial Disease Due to Inflammation 4.1 Arthritis in Children 4.1.1 Pathogenesis 4.1.2 Imaging 4.2 Arthritis in Adults 4.2.1 Pathogenesis 4.2.2 Imaging 4.3 Gout 4.3.1 Pathogenesis 4.3.2 Imaging 4.4 CPPD 4.4.1 Pathogenesis 4.4.2 Imaging 4.5 Basic Calcium Phosphate Crystal Deposition Disease 4.5.1 Pathogenesis 4.5.2 Imaging 4.6 Rheumatologic Complications of Lyme Disease 4.6.1 Pathogenesis 4.6.2 Imaging 5 Key Differential Diagnoses 5.1 Septic Arthritis 5.2 Transient Synovitis in Children 5.2.1 Imaging 5.3 Tenosynovial Giant Cell Tumor 5.4 Primary Synovial Chondromatosis 6 Conclusion 7 Key Points References Mimics of Synovial Tumors Due to Chronic Infection 1 Introduction 2 Articular and Juxta-Articular Tuberculosis 2.1 Pathogenesis 2.2 Imaging 2.2.1 Arthritis 2.2.2 Tenosynovitis and Bursitis 3 Brucellar Arthritis 3.1 Pathogenesis 3.2 Imaging 4 Coccidioidal Arthritis 4.1 Pathogenesis 4.2 Imaging 5 Candida Arthritis 5.1 Pathogenesis 5.2 Imaging 6 Sporotrichal Arthritis 6.1 Pathogenesis 6.2 Imaging 7 Hydatid Arthritis 7.1 Pathogenesis 7.2 Imaging 8 Key Differential Diagnoses 9 Conclusion 10 Key Points References Part V: Treatment of Synovial Tumors and Tumor-Like Conditions of the Synovium Surgical Treatment 1 Benign Synovial Tumor and Tumor-Like Conditions of the Synovium 1.1 Synovial Cysts 1.2 Gout Tophi 1.3 Tenosynovial Giant Cell Tumor (TSGCT) 1.4 Synovial Chondromatosis 1.5 Lipoma Arborescens and Synovial Lipoma 1.6 Synovial Hemangioma 2 Synovial Sarcoma 2.1 General Considerations 2.2 Preoperative Planning for Resection Synovial Sarcoma 2.2.1 Upper Limb 2.2.2 Lower Limb 2.3 Surgical Technique 2.4 Postoperative Care 3 Key Points References Nonsurgical Treatment 1 Synovial Cell Sarcoma 1.1 Radiotherapy 1.1.1 Neoadjuvant Radiotherapy 1.1.2 Adjuvant Radiotherapy 1.2 Chemotherapy 2 Tenosynovial Giant Cell Tumor 2.1 Chemotherapy 2.2 Radiotherapy 3 Key Points References