eMedicine Specialties > Orthopedic Surgery > Neoplasms
Synovial Chondromatosis: Workup
Updated: Nov 2, 2009
Workup
Laboratory Studies
- Erythrocyte sedimentation rate: Test the erythrocyte sedimentation rate if the physical findings suggest possible infection. Results are expected to be normal in persons with primary synovial chondromatosis, but they may be elevated in persons with secondary synovial chondromatosis due to systemic inflammation from a condition such as rheumatoid arthritis.
- C-reactive protein: Test the C-reactive protein level if the physical findings suggest possible infection. Levels are expected to be normal in persons with primary synovial chondromatosis, but they may be elevated in persons with secondary synovial chondromatosis due to systemic inflammation from a condition such as rheumatoid arthritis.
- CBC with differential: Order a CBC with differential if the physical findings suggest possible infection. The count is expected to be normal in persons with primary synovial chondromatosis, but it may be elevated in persons with secondary synovial chondromatosis due to systemic inflammation from a condition such as rheumatoid arthritis.
- Lyme titer (in endemic areas): Order a test of the Lyme titer if the physical findings suggest possible infection. Results are expected to be normal in persons with primary synovial chondromatosis, but they may be elevated in persons with secondary synovial chondromatosis due to systemic inflammation from a condition such as rheumatoid arthritis.
Imaging Studies
Arthroscopic appearance of synovial chondromatosis loose bodies in the shoulder.
Sagittal T2-weighted MRI through the knee in an adult with synovial chondromatosis demonstrates abnormal signal intensity in the suprapatellar pouch. Also note hypertrophic synovium in the intercondylar notch region and a normal posterior cruciate ligament.
Sagittal T2-weighted MRI of patient with synovial chondromatosis. Note the hypertrophic synovium and normal anterior cruciate ligament.
Sagittal T1-weighted MRI of the knee in a patient with synovial chondromatosis.
Coronal T2-weighted MRI of a patient with synovial chondromatosis demonstrates punctate areas of low intensity within the synovial fluid.
Coronal T2-weighted MRI of the knee in a patient with synovial chondromatosis.
Typical plain radiograph of the knee in a patient with synovial chondromatosis. No abnormalities are noted.
Arthroscopic image of pedunculated synovial chondromatosis in the knee.
Arthroscopic image of pedunculated synovial chondromatosis in the knee.
- Plain radiography with orthogonal views of the affected joint14
- Findings are frequently normal.
- If loose bodies undergo ossification, they may be visible in the joint space. The pattern of mineralization varies with size. Large nodules have large, stippled, or ringlike calcified areas. Small nodules have flecks of calcium.
- In 30% of cases, no matrix mineralization is present and loose bodies appear as foci with opacity similar to that of water.
- In secondary synovial chondromatosis, changes consistent with the underlying disease process are evident.
- Magnetic resonance imaging14
- Cartilaginous nodules have intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images, with decreasing intensity as the amount of calcium in the nodule decreases.
- The addition of intra-articular gadolinium-based contrast material increases the sensitivity for detecting lesions.
- CT: This is useful only for identifying calcified loose bodies. Unmineralized nodules typically cannot be visualized.
Diagnostic Procedures
- Arthrocentesis is used to obtain a sample of synovial fluid if the physical findings suggest infection. Send the sample for a cell count, crystal examination, Gram staining, and cultures. All findings should be within normal limits in persons with primary synovial chondromatosis.
Histologic Findings
Primary synovial chondromatosis
On hematoxylin and eosin staining, thick, villous formation to the synovial membrane with islands of clustered chondrocytes is seen. The chondrocytes in the nodules are usually arranged in loose clusters, though a nonclustered uniform distribution may occur.
In two thirds of cases, the chondrocytes show mild to moderate nuclear atypia with pleomorphism, enlarged and open-faced nuclei, and frequent binucleation. Mitotic figures are rarely found. Osteoclast-like giant cells and chondroblasts with a dense, eosinophilic cytoplasm may rim the nodules.
If calcification occurs, it is distributed in a patchy, irregular pattern. In late stages, the nodules may undergo true ossification via vascular invasion and endochondral bone formation.
Secondary synovial chondromatosis
Foci of implanted articular cartilage with and without subchondral necrotic bone are found. The chondrocytes of implanted cartilage usually lack significant atypia or binucleation, and any calcification occurs in a zonal, ringlike fashion.
More on Synovial Chondromatosis |
| Overview: Synovial Chondromatosis |
 Workup: Synovial Chondromatosis |
| Treatment: Synovial Chondromatosis |
| Follow-up: Synovial Chondromatosis |
| Multimedia: Synovial Chondromatosis |
| References |
| Further Reading |
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References
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Keywords
synovial chondrometaplasia, articular chondromatosis, osteochondromatosis, chondrocalcinosis articularis, tenosynovial chondrometaplasia, joint chondromata, diffuse endochondromatosis
