Histopathological Analysis of Synovial Lesions
Keywords:
synovitis, osteoarthritis, tuberculous, TB-PCR, calcium pyrophosphate, gout
Abstract
Introduction: Histopathological evaluation of synovial tissue is not routinely done for diagnosis in patients of arthritis, however it is of diagnostic value in patients, particularly if the joint involvement is monoarticular. A final diagnosis may be arrived at after considering the clinical and serological findings. Materials and Methods: We have analyzed a series of 46 cases which included 24 diagnostic biopsies and 22 cases of synovium sampled during joint replacement surgeries. Tissue was processed routinely, stained with Haematoxylin and Eosin and special stains when necessary.Histopathological findings were correlated with clinical, radiological, serological findings, TB culture and TB- PCR results wherever available.Results: We observed that knee joint was most commonly affected (73.91). Chronic non-specific inflammation was the most common histological finding seen in 15 cases (32.60%), 5 cases of which was further diagnosed as tuberculous synovitis based on, clinical and laboratory findings. This was followed by 11 cases (23.91%) of chronic degenerative osteoarthritis, nine (19.56%) cases of rheumatoid arthritis, and 5 cases (10.86%) of granulomatous inflammation. Other specific diagnosis included synovial lipomatosis, non-hemophilic hemosiderotic synovitis, synovial chondromatosis, gouty arthritis and pseudogout. In this study, we have discussed the importance of histopathological evaluation and clinical correlation in diagnosing synovial lesions.Conclusion: Histopathological findings in synovial lesions has its own limitations and may also be modified by treatment or chronicity of disease. However when correlated with clinical, serological and other investigations, it is of diagnostic importance in synovial lesions.DOI:10.21276/APALM.1651References
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25. Barry Bresnihan. Are synovial biopsies of diagnostic value? Review. Arthritis Res Ther 2003; 5:271-278.
26. Negi SS, Gupta S, Khare S, Lal S. Comparison of microbiological tests for osteoarticular tuberculosis. Ind J MM. 2005; 23(4):245-248.
27. Titov AG, Vyshnevskaya EB, Mazurenko SI, Santavirta S, Konttinen YT. Use of polymerase chain reaction to diagnose tuberculous arthritis from joint tissues and synovial fluid. Arch Path Lab Med. 2004; 128:205-9.
28. Sequeira W, Co H, Block JA. Osteoarticular tuberculosis: Current diagnosis and treatment. Am J Ther. 2000; 7:393-8.
29. Vanderspoel van dijk A, Mcleod A, Botha PL, Shipley JA, Kapnoudis MA, Beukes CA.The diagnosis of skeletal tuberculosis by polymerase chain reaction . Cent African J Med. 2000;46:144-9.
30. Tiwari V, Jain A, Verma RK. Application of enzyme amplified mycobacterial DNA detection in the diagnosis of pulmonary and extrapulmonary tuberculosis. Indian J Med Res. 2003;118: 224-8.
2. Vijay M, Doddikoppad M. Clincopathological study of Inflammatory Synovial Lesions. Int J Biol Med Res. 2011; 2(4):882-888.
3. Abhyankar SC, Vast RR, Shirdokar AB, Johari AN,Deodhar KP. A histopathological study of synovium in chronic joint diseases. Ind J Pathol Microbiol.1987; 30(1):1-5.
4. Sant MS. Role of synovial biopsy in diagnosis of synovitis of knee joint. Ind J Orth.1994; 28(1):3-6.
5. Inoque K, Shichikawa K, Nishioka J, Hirota S. Older age onset rheumatoid arthritis with or without osteoarthritis. Annals of the Rheumatic Diseases. 1987; 46:908-911.
6. Kakkar N, Vasishta RK, Anand H. Pathological case of the month- Synovial lipomatosis. Arch Pediatr Adolesc Med. 1999; 153:203-204.
7. Hallel T, Lew S, Bansal M. Villous lipomatous proliferation of the synovial membrane (lipoma arborescens). J Bone Joint Surg Am. 1988; 70:264-70.
8. Rao S, Rajkumar A, Elizabeth MJ, Ganesan V, Kuruvilla S. Pathology of synovial lipomatosis and its clinical significance. J Lab Physicians. 2011; 3:84-88.
9. Humphrey PA .Joints and synovium. In: Humphrey PA, Dehner LP, Pfeifer JD, editors. The Washington Manual of Surgical pathology .2nd ed. PA: LWW: 2012; p822-5.
10. Devaney K, Vinh TN, Sweet DE. Synovial hemangioma: A report of 20 cases with differential diagnostic considerations. Hum Pathol. 1993; 24:737-745.
11. Yalin N, Bektaser B, Cicekil O, Ugras S , Dogan M. An unusual cause of recurrent joint effusions: Nonhemophilic hemosiderotic synovitis of the knee. Acta Orthop Traumatol Turc. 2010; 44:162-165.
12. Wong M, Salama S, Thoma A. Synovial chondromatosis of the hand: Three case reports and literature review. Can J Plast Surg. 2003; 11(1):47-52.
13. Milgram JW. Synovial Osteochondromatosis: A Histopathological Study of Thirty Cases. J Bone Joint Surg Am. 1977; 59:792-801.
14. Kumar A, Thomas AP. Swelliing of a metacarpophalangeal joint. Postgrad Med J. 2000; 76:430-31.
15. Maurice H, Crone M, Watt I. Synovial chondromatosis. J Bone Joint Surg AM. 1988; 70:807-11.
16. Song JS, Lee YH, Kim SS. Acute Polyarthritis Caused by CPPD Crystals. J Korean Med Sci. 2002; 17:423-425.
17. Srinivasan. V ,Wensel A ,Dutcher P ,Newlands S, Johnson M, Vates G. Calcium Pyrophosphate Deposition Disease of the Temporomandibular Joint. V J Neurol Surg Rep. 2012; 73:6–8.
18. Dijkgraaf LC, Liem RSB,DeBont LGM,Boering G. Calcium pyrophosphate dehydrate crystal deposition disease: a review of the literature and a light and electron microscopic study of a case of the temporomandibular joint with numerous intracellular crystals in the chondrocytes.Osteoarthritis and Cartilage. 1995; 3:35-45
19. Gupta SJ. Crystal induced arthritis: An Overview. J Ind Rheumatol Assoc. 2002; 10:5-15.
20. Garg ML, Kumar R, Chugh TD, Maini PS. Histological and histochemical studies of rheumatoid synovitis. Ind J Surg. 1973; 35:500-505.
21. Hough, Aubrey J. Joints Chapter-75, in Anderson's pathology, Vol.2, 10th Edition. Edt. Ivan, Damjanov & James Lindu, St.Louis; Mosby, 1996:2615.
22. Jaffe B. Henry. Degenerative joint disease. Chapter-25, Metabolic, degenerative and inflammatory diseases of bones and joints. 1st Edn. Philadelphia; Lea & Febiger, 1972: 725-761.
23. Sherma Mary S. The non-specificity of synoival reaction. JBJS. 1951; 149:110.
24. Khosla P, Shankar S, Duggal L. Anti CCP Antibodies in Rheumatoid Arthritis. Review article. J Indian Rheumatol Assoc. 2004; 12:143-46.
25. Barry Bresnihan. Are synovial biopsies of diagnostic value? Review. Arthritis Res Ther 2003; 5:271-278.
26. Negi SS, Gupta S, Khare S, Lal S. Comparison of microbiological tests for osteoarticular tuberculosis. Ind J MM. 2005; 23(4):245-248.
27. Titov AG, Vyshnevskaya EB, Mazurenko SI, Santavirta S, Konttinen YT. Use of polymerase chain reaction to diagnose tuberculous arthritis from joint tissues and synovial fluid. Arch Path Lab Med. 2004; 128:205-9.
28. Sequeira W, Co H, Block JA. Osteoarticular tuberculosis: Current diagnosis and treatment. Am J Ther. 2000; 7:393-8.
29. Vanderspoel van dijk A, Mcleod A, Botha PL, Shipley JA, Kapnoudis MA, Beukes CA.The diagnosis of skeletal tuberculosis by polymerase chain reaction . Cent African J Med. 2000;46:144-9.
30. Tiwari V, Jain A, Verma RK. Application of enzyme amplified mycobacterial DNA detection in the diagnosis of pulmonary and extrapulmonary tuberculosis. Indian J Med Res. 2003;118: 224-8.
Published
2018-04-21
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