Bone & joints

Other chondrogenic tumors

Synovial & tenosynovial chondromatosis



Topic Completed: 1 June 2013

Minor changes: 11 February 2021

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PubMed Search: Synovial chondromatosis [title] joints "loattrfree full text"[sb]"

Vijay Shankar, M.D.
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Cite this page: Shankar V. Synovial & tenosynovial chondromatosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/jointssynovialosteochondromatosis.html. Accessed October 25th, 2021.
Definition / general
    Synovial chondromatosis:
    • Also called synovial chondrometaplasia, synovial osteochondromatosis
    • Mean age 41 years, range 17 - 64 years, 2/3 male (Hum Pathol 1998;29:683)
    • Primary disease is uncommon, unknown etiology, aggressive (Hum Pathol 1979;10:439)
    • Usually monoarticular, can be bilateral rarely (JCDR 2012;6:475), affecting knee, hip, elbow and communicating bursae; may affect adjacent soft tissue
    • Aggravated by infection and trauma
    • May be extra-articular (tenosynovial chondromatosis)

    Tenosynovial chondromatosis:
  • Multinodular cartilaginous proliferation that arises from tenosynovial membranes due to synovial metaplasia
  • Also called tenosynovial or bursal chondromatosis
  • M > F; ages 20 - 86 years (mean and median age are 46 years)
  • Fingers (50%), feet (20%)
  • Also wrists, ankles, palm, knee, forearm
Secondary disease
  • Associated with degenerative joint disease - growth of fragments of articular cartilage
  • Initially intrasynovial disease without loose bodies; then intrasynovial proliferation and free loose bodies, then multiple free osteochondral bodies without intrasynovial disease
  • No atypia
Radiology description
  • Xray: usually calcific densities within joint; may be negative or show diffuse joint swelling
Case reports
Treatment
  • Excision but frequently recurs; 5% become malignant
Clinical images

Images hosted on other servers:
Smooth white nodule

Smooth white nodule

Showing extent of disease

Showing extent of disease

Dorsal first web space

Dorsal first web space

Multiple rice bodies within synovial sheath

Multiple rice bodies within synovial sheath

Gross description
  • Synovial: numerous round osteocartilaginous nodules cover a thickened synovial surface or float freely within joint space
  • Tenosynovial: bluish white subsynovial nodules, mm to cm in size, which conglomerate into lobulated mass attached to synovial membranes
Microscopic (histologic) description
  • Synovial: cartilage cells with variable atypia or binucleated forms within synovium; clusters of chondrocytes are often arranged in lobules; no underlying arthritis
  • Tenosynovial:
    • Multinodular cartilaginous proliferation involving tenosynovium or subsynovial connective tissue
    • Cartilaginous matrix more intensely basophilic than chondroma of soft parts
    • Often minute cartilaginous nodules
    • May have mild or moderate atypia
    • Occasionally prominent mineralization
    • Rarely crystalline deposits mimic tophi (APMIS 2004;112:624)
    • Rarely malignant transformation, which resembles synovial chondrosarcoma
Microscopic (histologic) images

Images hosted on other servers:
Nodule of cartilage

Nodule of cartilage

Loose bodies

Loose bodies

Subsynovial cartilaginous nodule

Subsynovial cartilaginous nodule

Moderate atypia of chondrocytes

Moderate atypia of chondrocytes


Osteochondral loose body Osteochondral loose body

Osteochondral loose body

Cartilaginous tissue enclosed by synovial tissue

Cartilaginous tissue enclosed by synovial tissue

Nodule surrounded by tenosynovial membrane

Nodule surrounded by tenosynovial membrane

Differential diagnosis
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