Postoperative radiotherapy for diffuse pigmented villonodular synovitis of the temporomandibular joint




Abstract


Background


Pigmented villonodular synovitis (PVNS) is a rare/benign condition of the synovial joint lining. It most commonly presents in the knee but has also been reported to occur in the temporomandibular joint (TMJ). Although there are several series reporting the use of postoperative radiotherapy (PORT) for extremity PVNS, there is scant literature on the use of PORT for PVNS of the TMJ.


Methods


We conducted a literature review for case reports related to PVNS of the TMJ and discuss two additional cases treated with surgery and PORT.


Results


71 cases were found in the literature. 89% were the diffuse subtype. 92% had primary surgery and 7% had PORT. 68% were locally controlled. Both patients treated at our institution are locally controlled.


Conclusions


PVNS of the TMJ is a rare entity. Surgery is the mainstay of treatment but PORT may be useful for local control of extensive tumors or positive margins.


1


Introduction


Pigmented villonodular synovitis (PVNS) is a benign, but locally aggressive, overgrowth and inflammation of the synovium that results in invasion and destruction of adjacent bone and functional impairment . The disease is rare with an annual incidence of 1.8 cases per million population . PVNS is almost always monoarticular, with 80% of cases occurring in the knee . Involvement by PVNS of the temporomandibular joint (TMJ) is uncommon, with the first case reported by Lapayowker et al. in 1973 . There are two forms of PVNS: localized (nodular) and diffuse. The diffuse subtype is more common and involves the entire synovium. Both forms of the disease are primarily treated with surgery – a marginal resection for the nodular subtype and a total or near total synovectomy for the diffuse subtype . The local recurrence rate is low for the nodular subtype but higher in the diffuse subtype (up to 45%). Because of the high risk of recurrence of the latter type, postoperative radiotherapy has been advocated and has been shown to improve local control in several small retrospective series of patients with diffuse PVNS of the extremities . In this report we conducted a literature review, present two additional cases, and discuss the role of radiation therapy in the management of diffuse PVNS of the TMJ.




2


Materials and methods


A PubMed query was performed using the keyword combinations of pigmented villonodular synovitis temporomandibular joint and the synonymous term of tenosynovial giant cell tumor temporomandibular joint . Articles in English and non-English (translated) reporting on at least one case of PVNS of the TMJ were included. The references and literature review tables of these articles were also reviewed to ensure all pertinent literature was included. A total of 71 cases were identified in the literature, not including the two cases presented in this report. The details are represented in Table 1 .



Table 1

Summary of the 72 reported cases of PVNS of the TMJ in English and foreign language literature and the two presented cases.










































































































































































































































































































































































































































































































































































































































No. Author (date) Age (y)/ gender Type of PVNS Surgery Radiation (Gy) Local recurrence/follow-up period Other notes
1–2 Lapayowker et al. (1973) 22/M Diffuse Yes No No/8 y
58/F Diffuse Yes No NR
3 Barnard (1975) 37/M NR Conservative approach, biopsy only No No change in lesion/6 mo
4 Dinerman and Myers (1977) 58/F Diffuse Yes No No/4 y
5 Miyamoto et al. (1977) 34/M Diffuse Yes No No/2 y
6 Raibley (1977) 62/F Localized Yes No No/5 mo With synovial chondromatosis
7 Makek and Drommer (1978) 55/F Localized Yes No No/9 mo
8 Geiger and Pesch (1980) 50/F Diffuse Yes No No/4 y
9 Takagi and Ishikawa (1981) 36/M Diffuse Yes, X2 No Yes/5 y; No/11 y
10 Gallia et al. (1982) 47/F Diffuse Yes No No/2 y
11 Rickert and Shapiro (1982) 39/F Diffuse Yes No NR
12 Curtin et al. (1983) 47/F Diffuse Yes No NR
13 O’Sullivan et al. (1984) 61/F Diffuse Yes, X3 Yes, after the fourth recurrence (40) Yes/X3 in a 7 y period
14 Dawiskiba et al. (1988) 32/M Diffuse NR No NR
15 Eisig et al. (1992) 50/F Diffuse Yes No No/1 y
16 Syed et al. (1993) 10/F Diffuse Yes No NR
17 Franchi et al. (1994) 59/F Diffuse Yes No No/1 y
18 Shapiro et al. (1996) 36/M Diffuse Yes No No/18 mo
19 Youssef et al. (1996) 41/F Localized Yes No No/14 mo
20 Allias-Montmayeur et al. (1997) 39/F Localized Yes No No/7 mo
21 Bertoni et al. (1997) 71/F Diffuse, metastatic Yes, x5 Yes (45) Yes/X4 in 7 y period Malignant PVNS, local disease, intracranial extension, and lung metastasis
22 Renaga Rubin et al. (1997) 70/F Diffuse Yes No No/3 y
23 Tanaka et al. (1997) 47/M Diffuse Yes No No/2 y
24 Yu et al. (1997) 48/M Diffuse Yes No NR
25 Chow et al. (1998) 42/F Diffuse Yes No No/2 y
26 Omura et al. (1998) 18/M Diffuse Yes No No/2 y
27 Stojadinovic et al. (1999) 63/M Diffuse Yes No No/20 mo
28 Bemporad et al. (1999) 37/M Diffuse Yes No NR
29 Song et al. (1999) 57/F Diffuse Yes No NR
30 Lee et al. (2000) 59/F Diffuse Yes No No/2 y
31 Kişnişci et al. (2001) 45/F Diffuse Yes No No/1 y
32 Klenoff et al. (2001) 35/NR Diffuse Yes No No/3 y
33 Church et al. (2003) 42/M Diffuse Yes No No/3 y
33/M Diffuse Yes No No/2 y
34 Heo et al. (2003) 45/M NR NR NR NR
35 Kunz et al. (2003) 13/M Diffuse Yes No NR/2 y
36 Aoyama et al. (2004) 33/M Diffuse Yes No No/2 y
37–41 Kim et al. (2004) 28/F Diffuse NR NR NR
22/M Diffuse NR NR NR
47/M Diffuse NR NR NR
58/F Diffuse NR NR NR
42 Tosun et al. (2004) 60/M Diffuse Yes No No/7 y
43 Cascone et al. (2005) 38/F Localized Yes No No/1 y
44 Izzo et al. (2005) 67/NR Localized Yes No No/1 mo
45–46 Stryjakowska et al. (2005) 36/M Diffuse Yes No No/3 y
36/F Diffuse Yes, two times No Yes/2 y
47 Fang et al. (2007) 44/M Diffuse Yes No No/20 mo Radiation suggested, not done
48–49 Oda et al. (2007) 52/M Diffuse Yes No No/11 mo With chondroid metaplasia
67/M Diffuse Yes No No/7 y and 3 mo With chondroid metaplasia
50 Cascone et al. (2008) 78/M Localized Yes No No/2 y
51 Chen et al. (2008) 56/F Diffuse Yes Yes (NR) No/9 mo
52 Day et al. (2008) 38/M Diffuse Yes No No/3 mo
53 Cai, X-Y. et al. (2009) 21/F Localized Yes No No/13 mo With synovial chondromatosis
54 Herman et al. (2009) 36/M Diffuse Yes No No/11 y
55 Shkoukani et al. (2009) 74/F Diffuse Yes No No/NR
56 Gong et al. (2010) 34/M Diffuse Yes No No/2 y TGCT
57 Leiggener et al. (2010) 22/F Diffuse Yes No No/3 y
58 Cai, J. et al. 2011 59/F Diffuse Yes No No/NR
59 Lu et al. (2011) 42/M Diffuse Yes, two times No Yes/44 mo Recurrence at different location near TMJ
60–64 Hoch et al. 2001 36-70/3 M, 2 F Diffuse Yes No No/29 mo avg With chondroid metaplasia
65 Romanach et al. (2011) 26/M Diffuse Yes Yes (40) No/18 mo 20 fractions
66 Yoon et al. (2011) 29/M Diffuse Yes No No/30 mo Recurrence in lung at 30 mo, malignant with lung metastasis
67 Aimoni et al. (2012) 80/M Diffuse Yes No No/18 mo
68 He et al. (2012) 34/M Diffuse Yes No No/6 mo TGCT
69 Liu et al. (2012) 56/F Diffuse Yes Yes (35) No/2 y 4 mo 15 fractions
70 Tel et al. (2012) 29/M Diffuse Yes No No/5 y
71 Wong et al. (2012) 51/F Diffuse Yes No NR/1 yr
72–73 Present series (2014) 53/M Diffuse Yes Yes (45) No/4 y 25 fractions
30/M Diffuse Yes Yes (45) No/2 y 25 fractions

NR: not reported; TGCT: tenosynovial giant cell tumor.




2


Materials and methods


A PubMed query was performed using the keyword combinations of pigmented villonodular synovitis temporomandibular joint and the synonymous term of tenosynovial giant cell tumor temporomandibular joint . Articles in English and non-English (translated) reporting on at least one case of PVNS of the TMJ were included. The references and literature review tables of these articles were also reviewed to ensure all pertinent literature was included. A total of 71 cases were identified in the literature, not including the two cases presented in this report. The details are represented in Table 1 .



Table 1

Summary of the 72 reported cases of PVNS of the TMJ in English and foreign language literature and the two presented cases.










































































































































































































































































































































































































































































































































































































































No. Author (date) Age (y)/ gender Type of PVNS Surgery Radiation (Gy) Local recurrence/follow-up period Other notes
1–2 Lapayowker et al. (1973) 22/M Diffuse Yes No No/8 y
58/F Diffuse Yes No NR
3 Barnard (1975) 37/M NR Conservative approach, biopsy only No No change in lesion/6 mo
4 Dinerman and Myers (1977) 58/F Diffuse Yes No No/4 y
5 Miyamoto et al. (1977) 34/M Diffuse Yes No No/2 y
6 Raibley (1977) 62/F Localized Yes No No/5 mo With synovial chondromatosis
7 Makek and Drommer (1978) 55/F Localized Yes No No/9 mo
8 Geiger and Pesch (1980) 50/F Diffuse Yes No No/4 y
9 Takagi and Ishikawa (1981) 36/M Diffuse Yes, X2 No Yes/5 y; No/11 y
10 Gallia et al. (1982) 47/F Diffuse Yes No No/2 y
11 Rickert and Shapiro (1982) 39/F Diffuse Yes No NR
12 Curtin et al. (1983) 47/F Diffuse Yes No NR
13 O’Sullivan et al. (1984) 61/F Diffuse Yes, X3 Yes, after the fourth recurrence (40) Yes/X3 in a 7 y period
14 Dawiskiba et al. (1988) 32/M Diffuse NR No NR
15 Eisig et al. (1992) 50/F Diffuse Yes No No/1 y
16 Syed et al. (1993) 10/F Diffuse Yes No NR
17 Franchi et al. (1994) 59/F Diffuse Yes No No/1 y
18 Shapiro et al. (1996) 36/M Diffuse Yes No No/18 mo
19 Youssef et al. (1996) 41/F Localized Yes No No/14 mo
20 Allias-Montmayeur et al. (1997) 39/F Localized Yes No No/7 mo
21 Bertoni et al. (1997) 71/F Diffuse, metastatic Yes, x5 Yes (45) Yes/X4 in 7 y period Malignant PVNS, local disease, intracranial extension, and lung metastasis
22 Renaga Rubin et al. (1997) 70/F Diffuse Yes No No/3 y
23 Tanaka et al. (1997) 47/M Diffuse Yes No No/2 y
24 Yu et al. (1997) 48/M Diffuse Yes No NR
25 Chow et al. (1998) 42/F Diffuse Yes No No/2 y
26 Omura et al. (1998) 18/M Diffuse Yes No No/2 y
27 Stojadinovic et al. (1999) 63/M Diffuse Yes No No/20 mo
28 Bemporad et al. (1999) 37/M Diffuse Yes No NR
29 Song et al. (1999) 57/F Diffuse Yes No NR
30 Lee et al. (2000) 59/F Diffuse Yes No No/2 y
31 Kişnişci et al. (2001) 45/F Diffuse Yes No No/1 y
32 Klenoff et al. (2001) 35/NR Diffuse Yes No No/3 y
33 Church et al. (2003) 42/M Diffuse Yes No No/3 y
33/M Diffuse Yes No No/2 y
34 Heo et al. (2003) 45/M NR NR NR NR
35 Kunz et al. (2003) 13/M Diffuse Yes No NR/2 y
36 Aoyama et al. (2004) 33/M Diffuse Yes No No/2 y
37–41 Kim et al. (2004) 28/F Diffuse NR NR NR
22/M Diffuse NR NR NR
47/M Diffuse NR NR NR
58/F Diffuse NR NR NR
42 Tosun et al. (2004) 60/M Diffuse Yes No No/7 y
43 Cascone et al. (2005) 38/F Localized Yes No No/1 y
44 Izzo et al. (2005) 67/NR Localized Yes No No/1 mo
45–46 Stryjakowska et al. (2005) 36/M Diffuse Yes No No/3 y
36/F Diffuse Yes, two times No Yes/2 y
47 Fang et al. (2007) 44/M Diffuse Yes No No/20 mo Radiation suggested, not done
48–49 Oda et al. (2007) 52/M Diffuse Yes No No/11 mo With chondroid metaplasia
67/M Diffuse Yes No No/7 y and 3 mo With chondroid metaplasia
50 Cascone et al. (2008) 78/M Localized Yes No No/2 y
51 Chen et al. (2008) 56/F Diffuse Yes Yes (NR) No/9 mo
52 Day et al. (2008) 38/M Diffuse Yes No No/3 mo
53 Cai, X-Y. et al. (2009) 21/F Localized Yes No No/13 mo With synovial chondromatosis
54 Herman et al. (2009) 36/M Diffuse Yes No No/11 y
55 Shkoukani et al. (2009) 74/F Diffuse Yes No No/NR
56 Gong et al. (2010) 34/M Diffuse Yes No No/2 y TGCT
57 Leiggener et al. (2010) 22/F Diffuse Yes No No/3 y
58 Cai, J. et al. 2011 59/F Diffuse Yes No No/NR
59 Lu et al. (2011) 42/M Diffuse Yes, two times No Yes/44 mo Recurrence at different location near TMJ
60–64 Hoch et al. 2001 36-70/3 M, 2 F Diffuse Yes No No/29 mo avg With chondroid metaplasia
65 Romanach et al. (2011) 26/M Diffuse Yes Yes (40) No/18 mo 20 fractions
66 Yoon et al. (2011) 29/M Diffuse Yes No No/30 mo Recurrence in lung at 30 mo, malignant with lung metastasis
67 Aimoni et al. (2012) 80/M Diffuse Yes No No/18 mo
68 He et al. (2012) 34/M Diffuse Yes No No/6 mo TGCT
69 Liu et al. (2012) 56/F Diffuse Yes Yes (35) No/2 y 4 mo 15 fractions
70 Tel et al. (2012) 29/M Diffuse Yes No No/5 y
71 Wong et al. (2012) 51/F Diffuse Yes No NR/1 yr
72–73 Present series (2014) 53/M Diffuse Yes Yes (45) No/4 y 25 fractions
30/M Diffuse Yes Yes (45) No/2 y 25 fractions

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Aug 23, 2017 | Posted by in OTOLARYNGOLOGY | Comments Off on Postoperative radiotherapy for diffuse pigmented villonodular synovitis of the temporomandibular joint

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