Pigmented villonodular synovitis of the temporomandibular joint: A case study

Background: Pigmented villonodular synovitis (PVNS) is a benign but locally aggressive proliferative disorder, commonly arising from the synovium of long bone joints, tendon sheaths and bursae. PVNS is rarely found in the temporomandibular joint (TMJ), with around 52 reported cases in the current English literature. It is most commonly found in the knee joint, followed by the hip, ankle, small joints of the hands and feet, wrist, shoulder and elbow. Case study: This case report describes a 37 year old Cantonese lady who presented with a progressively enlarging mass at her right TMJ. Initial imaging and biopsies initially favoured a primary salivary gland neoplasm, with recommendations for surgical excision. Subsequent ultrasound core guided biopsy showed appearances consistent with a diffuse giant cell tumour (pigmented villonodular tenosynovitis). The patient underwent a superficial parotidectomy with clear surgical margins and no evidence of neoplasia in frozen sections. Conclusions: This case highlights the challenges involved in the diagnosis and management of this rare condition, showing how its clinical presentation can mimic a parotid mass. Radiological and histological investigations can often give conflicting results. Long term follow up is required given the high chance of local recurrence and potential for aggressive change. Correspondence to: Stephanie Tan, 237 Ipswich Road, Woolloongabba, Princess Alexandra Hospital, Queensland, 4006, Australia, Tel: +61438817733; E-mail: [email protected]