Diagnostic utility of fine needle aspiration cytology versus conventional histopathological study and immunohistochemistry of benign tumors and tumor like growths of the synovium

Benign Tumors and tumor like lesions of synovium are the tumors arising from the non specialized soft tissues of the subsynovium giving rise to tumors such as hemangiomas and lipomas with conventional histologic patterns and natural histories identical to those occurring in other soft tissue sites. On the other hand,the synovial cells themselves or primitive cells within the synovium giving rise to tumors which are peculiar to synovium e.g., Synovial chondromatosis and the various types of 1-4 nodular synovitis. ABSTRACT Aims: The aim of this retrospective study is to study the fine needle aspiration cytology of various clinically suspected benign tumors & tumor like growths of the synovium , its diagnostic utility & further confirmation of the lesions with biopsy study & immunohistochemical study. Methods: This study comprises analysis of 25 cases of clinically suspected benign tumors & tumor like growths of the synovium conducted at Department of Pathology, J.J.M Medical College, Davangere during period of 2 years from April 2002 to March 2004 contributing 23.8% of 105 total Fnacs & biopsies done for synovial lesions during the period respectively. Fine needle aspiration cytology (FNAC) was done for the clinically suspected cases and the smears were stained with haematoxylin and eosin, papinocolaus stain, geimsa & other romanowsky stains. The FNAC findings were further correlated with Histopathological study of Synovial biopsy Specimens which were processed routinely and stained with haematoxylin and eosin . Prussian blue stain for haemosiderrin were carried out in suspected cases of pigmented villonodular synovitis for the demonstration of haemosiderrin pigment. Wherever necessary the available clinical, radiological findings, immunohistochemical marker study were taken in to consideration to categorize the lesions. Results: In our study, the common age groups affected were between 30-50yrs. Females were commonly affected with M: F 1:1.8 Most common symptoms seen were pain, swelling, restricted movements. The commonest joints involved were knee, wrist, inerephalyngeal joints of hand. Most common FNAC diagnosis made among the clinically benign tumors & tumor like growths of the synovium were pigmented localized nodular tenosynovitis followed by diffuse tenosynovial giant cell tumor, ganglion cyst and synovial chondromatosis. Later these lesions were further correlated with histopathological study of synovial biopsies & wherever necessary some of these lesions were further confirmed by immunohistochemical study . Conclusion: Definitive diagnosis & prognosis of the benign tumors & tumor like growths of the synovium can be accessed only by combination of FNAC findings, histopathological examination & immunohistochemical study in correlation with the clinical & radiological findings.