0:01

<v ->Let's begin with this 30 year old male

0:12

with pain and ankle pain, and increased density

0:19

and soft tissue mass near the ankle anteriorly.

0:25

So we can begin this with the x-ray

0:28

that is already showing a mass here, a soft tissue density.

0:37

And then we recommended MRI to better look to that.

0:46

So we can start looking at the T1, it's at the toe.

0:54

we have a mass here, intermediate signal.

1:02

We don't, let's take a look at the T2 fat sat, okay.

1:06

And it looks like it's interarticular, okay.

1:13

We did not think this would extend

1:16

to other parts of the joint.

1:20

We could see erosions here in some cyst talar dome

1:27

or also with bone marrow edema here.

1:31

We were in doubt if this cartilage and bone lesion

1:37

was related to the lesion or was another finding,

1:43

because it's common to see

1:45

asymptomatic talar dome cartilage lesion.

1:50

But here we can see beginning of an erosion.

1:58

Still, we can have the cortical bone integrity here.

2:02

It's not eroded, but it's remodeling.

2:06

We have remodelation, remodeling.

2:09

So this is telling that it is a chronic lesion soft tissue

2:13

and not very aggressive at this point

2:16

because it's remodeling the bone

2:18

and not causing erosion, okay.

2:21

So we were in doubt about synovial tumor,

2:28

for example, the differential diagnosis.

2:30

When we don't have the calcification,

2:33

we can have synovial chondromatosis

2:39

without the ossification or calcification.

2:42

And the PVNS, also the focal PVNS,

2:47

the relation with the bone, with this cyst and the edema,

2:54

and looks like beginning of an erosion,

2:58

favorite focal PVNS.

3:03

We did the contrast and show it

3:08

more like a tumor, like lesion

3:11

and patient did the surgery.

3:17

This is the post comparative

3:20

and showing some, showing the excision of the lesion.

3:26

Also, they did some surgeon at the talars,

3:36

and they found that this was extended also posteriorly

3:44

and the diagnosis was PVNS, and they call it diffuse PVNS.

3:50

Because it had 360 degree compromise of the synovial.

3:57

If we get back here, we could see some low signal density

4:07

on T1, some dots of, as you can see here,

4:11

of low signal showing the possible hemosiderin deposit.

4:16

But it's not very easy to make this differential

4:20

between both entities, the synovial chondromatosis for PVNS.

4:29

I'm gonna show you,

4:31

do you wanna comment on this case, Don?

4:33

<v ->Yeah, the one comment,

4:35

and I'm gonna ask you a question on this,

4:38

and it's something that I brought up,

4:40

is that, have you followed patients

4:44

with a single area of involvement, localized nodule

4:48

that later became pigmented diffuse involvement.

4:53

I mean, do you have follow up

4:54

on a lot of these cases?

4:57

Because we have a team of bone surgeons

5:01

and we have a center here and they have followed.

5:05

And if we don't operate or the patient disappear

5:11

and come back one or two years after, they grow, they grow.

5:16

And I can show you a case, it was not very localized

5:20

but can show how this can proliferate.

5:24

So this happens.