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Chap 33 - PATHOLOGY OF SYNOVIA AND TENDONS

Published online by Cambridge University Press:  01 March 2011

By
Markku Miettinen
Edited by
Markku Miettinen
Markku Miettinen
Affiliation:
Armed Forces Institute of Pathology, Washington DC
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Summary

This chapter includes infectious and inflammatory and diseases of the synovia, tenosynovia, and tendons, with an emphasis on morphology. Also included in the discussion are synovial foreign body reactions related to joint prostheses. The only neoplasm discussed here is the tenosynovial giant cell tumor. Synovial sarcoma is a neoplasm unrelated to synovial tissue, and it is discussed with soft tissue tumors with epithelial differentiation (see Chapter 27). Clear cell sarcoma of tendons and aponeuroses is included among the neuroectodermal neoplasms (see Chapter 25).

SYNOVIAL BIOPSY

Synovial tissue is normally lined by a mildly folded membrane lined by a one- to two-cell layer of specialized fibroblasts and histiocytes; there is no epithelial lining. The stroma contains fat cells and loose connective tissue. There are few if any lymphoid cells or neutrophils in the stroma, but scattered mast cells are sometimes present.

In the past, synovial specimens have mostly included synovectomy samples from patients with rheumatoid arthritis or other surgically treated disease. More recently, diagnostic synovial biopsies have been obtained arthroscopically or blindly, yielding diagnostic information on conditions such as rheumatoid arthritis, granulomatous inflammation, or foreign body arthritis. In one study of 59 patients, a blind synovial biopsy of 59 patients with arthritis of unknown cause revealed a specific cause in only 3 cases (5%). These diagnoses were tuberculotic synovitis, synovial chondromatosis, and villonodular synovitis.

ANALYSIS OF SYNOVIAL FLUID

In addition to biopsy (or sometimes instead of it), analysis of synovial fluid gives insight into the nature of joint effusion.

Type
Chapter
Information
Modern Soft Tissue Pathology
Tumors and Non-Neoplastic Conditions
 , pp. 939 - 964
Publisher: Cambridge University Press
Print publication year: 2010

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References

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Albrecht, M, Marinetti, GV, Jacox, F, Vaughan, JH. A biochemical and electron microscopy study of rice bodies from rheumatoid arthritis. Arthritis Rheum 1965;8:1053–1063.CrossRefGoogle Scholar
Berg, E, Wainwright, R, Barton, B, Puchtler, H, McDonald, T. On the nature of rheumatoid rice bodies: an immunologic, histochemical, and electron microscopic study. Arthritis Rheum 1977;20:1343–1349.CrossRefGoogle Scholar
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