Georgian Telemedicine Union (GTU)

Cases for review and consultation
Seventh case (August 17, 2004)

 Georgian Telemedicine Union (GTU)

 

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Patient: 43 years old male with a tumor in left knee.

The size of tumor formation was 1x1 cm. This formation was characterized by limited mobility and acute pain by touch. During the surgical procedure, it was revealed an encapsulated tissue formation which extended in the frontal aspect of the knee’s synovial pouch and invaded its wall. The formation was characterized by a cauliflower-like growth and moderate vascularization.  It was totally removed.  Liquid or other formations were not revealed in the pouch.

Several images from H&E sections of the tumor are presented below.  See post-surgery magnetic resonance images of left knee below the histological images.

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H&E, x10

 

 

Suggested histological diagnosis: “Mature” synovioma.

Immunohistochemically: Immunohistochemical investigation was performed. The following molecular markers were used: S-100, NSE, Vimentin, MNF-116 and Ki-67 (visualization system - LSAB, substrate – DAB). As a result of immunohistochemical investigation it was revealed, that: 1) S-100 is positive; 2) NSE – positive; 3) Vimentin – positive; 4) MNF-116 – negative; 5) Ki-67 - negative.

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IHC (anti-NSE), x20

 

 

Magnetic Resonance of Left Knee, post-surgery

Post operationally it was performed magnetic-resonance tomography of left knee in T1, T2 regimes in sagital and transversal plane.

The contours of medial meniscus are even and obvious, hind horn is revealing by irregular signals of increasing intensity, degenerative changes are manifested. The contours of lateral meniscus are even and obvious, structure – homogenous.

Fore and hind cross yogi is seen as regular signals at the whole length, contours are even and obvious, structure – homogenous.

Bone structures of knee (distal epiphysis of thigh, proximal epiphysis of shin, kneecap) are revealed by signals of uniform intensity; swelling and infiltration of bone marrow are not observed. Joint surfaces are manifested by signals of equal intensity, structure – homogenous.  Joint slot is uniform, quantity of synovia - normal.  In the front lateral area of knee at the level of distal epiphysis of thigh in hypodermic adipose tissue rough connective tissue is developed, structure – homogenous.

Paraoseal tissues without evident pathologic changes.

Postoperative scar changes and degenerative changes in medial meniscus are observed.  

Comments:  Please, write Your opinion and the suggestions about the further treatment strategy of this case to Eka Kldiashvili, Ph.D. kldiashvili@georgia.telepathology.org, Georgian Telemedicine Union (Association), Tbilisi, Georgia

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