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SAT0215 Diagnostic value of synovial fluid analysis in pigmented villonodular synovitis (pvs)-a proposal of diagnostic criteria
  1. I Zimmermann-Górska,
  2. M Puszczewicz,
  3. G Bia³kowska-Puszczewicz
  1. Rheumatology and Rehabilitation, Karol Marcinkowski University of Medical Sciences, Poznañ, Poland

Abstract

Background PVS is an idiopathic lesion that affects the synovial lining joints, tendons, sheats, and bursea through the production of tumour-like growths. Diagnosis of PVS is difficult. Arthroscopy and biopsy together with microscopic examination is usually a base. According to our experience, cytologic features of synovial fluid is a very useful diagnostic tool in PVS.

Objectives Synovial fluid (SF) from the joints of 14 patients with biopsy-proven PVS were examined. Moreover in all the patients features of the disease were confirmed in surgical specimes.

Methods Synovial fluids were divided into three samples, for physicochemical analysis, bacteriological and cytologic findings and placed in sterile tubes. For cytological examination MMG staining was used.

Results SF analysis had revealed an inflammatory character of effusions. In all the cases synovial fluids were bloody and fragments of synovial villi in their sediments were observed as well as multinucleated giant cells, pseudomalignant cells, macrophages with phagocytized hemosiderin, foam cells an a few synoviocytes. Moreover the fat crystals were seen, under polarised light.

Conclusion Cytological features of synovial fluid in PVS are in parallel with results of microscopic examination of joint tissues. In our opinion SF analysis should be the first step in the diagnostic procedure in PVS. We propose the cytologic criteria:

Major

  1. the presence of bloody fluid with fragments of synovial villi in sediment

  2. macrophages containing hemosiderin

  3. pseudomalignant cells

Minor

  1. multinucleated giant cells

  2. foam cells

  3. fat crystals

The diagnosis of PVS can be establish if all major and at least one minor criteria are fulfilled.

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