1. Volume 17Chondroid tumorsSynovial chondromatosis---------Case 364-370 & 1243-5Juxtaarticular chondroma---------Case 371-377 & 1246-72ndary synovial chondromatosis-Case 378-382 & 1248Myxoid chondrosarcoma----------Case 383-385Epithelioid sarcoma------------------Case 386-389Soft tissue Ewings sarcoma--------Case 390-392Clear cell sarcoma--------------------Case 393-394Myositis ossificans-------------------Case 395-405Pigmented villonodular synovitis---Case 406-416 & 1249Intramuscular myxoma---------------Case 1258Ganglion cyst--------------------------Case 1259-60Soft tissue lympoma------------------Case 1261

2. Chondroid Tumors 3. SynovialChondromatosis 4. Synovial ChondromatosisSynovial chondromatosis is a rare dysplasia seen in youngerpatients. It is associated with metaplastic cartilage within thesynovial lining of major joints such as the hip, knee, shoulder andelbow. It is twice as common in males as females and usuallyoccurs in patients in the 20-40 age group. It is a monarticulardisease that presents with symptoms of crepitation in the affectedjoint with mild, intermittent effusion sometimes associated withpain. Because of chronic irritation to the joint and damage to thearticular cartilage, osteoarthritis is an ultimate problem with thisdisease and can lead to a total joint replacement at a later age. Inrare instances this condition can mutate into a secondary chondro-sarcoma, usually around the hip or knee joint but seldom in theshoulder area. This usually occurs in the later years of life.In the early stages before the cartilage becomes calcified, thesynovial chondromatosis may be difficult to pick up on routineradiographic examination. As time passes, the cartilage begins 5. to calcify in a typical chondroid pattern that suggests the diagnosisof a chondroid tumor in or about a major joint. With excessiveproliferation, the cartilage can extrude out of the joint into adjacentsoft tissue, similar to what occurs with pigmented villonodularsynovitis. As the disease progresses, it is not unusual to seeenchondral ossification occurring within the cartilage when it isstill attached to the synovial lining and has access to a blood supply.Multiple loose bodies are common with this disease and can run ashigh as 200 pellets within a major joint that sometimes aggregrateinto a large mass that has the appearance of a chondrosarcoma.Treatment consists of a surgical resection of the loose bodies aswell as a subtotal synovectomy of the tissue that produces the loosebodies. Multiple surgical procedures may be required because of ahigh recurrence rate. As in PVNS, it is not unusual to see a solitaryfocus of synovial chondromatosis with the remaining synoviallining being normal in appearance with only a solitary mass ofcartilage attached to the synovial lining. This localized nodular form 6. is more common about the hip, knee and ankle area. It is verycommon to find loose bodies in a major arthritic joint in olderpatients secondary to osteoarthritis where the joint cartilage isbroken away from the joint surface and than becomes reattachedto the synovial lining and gives the pseudo-appearance of primarysynovial chondromatosis when, in fact, the primary etiology inthis so-called secondary form is degenerative osteoarthritis. Thesecondary form is seen in patients past the age of 50 years, where-as the primary dysplastic form arising from the synovial liningis seen during the first three to four decades of life. 7. CLASSIC Case #36433 year male with synovial chondromatoasis of shoulder 8. Sagittal T-2 MRI showing multiple calcified cartilage bodies 9. Coronal T-2 MRIshowing loose bodies 10. Surgical exposure showing loose bodies 11. Loose bodies and synovial lining following surgery 12. Cartilaginous bodies arising from synovial lining 13. Cartilaginous body formation in synovial villus 14. Case #36526 year male withsynovial chondromatosisknee joint 15. AP x-ray 16. Gross appearance of synovial chondromatosis 17. Microscopic evidence of cartilage elements in synovium 18. Case #366 28 year female with synovial chondromatosis knee 19. Another view 20. Photomic showing cartilage in synovial lining 21. Case #366.163 year female with long history of synovial chondromatosis 22. Sag T-2Sag Gad 23. Cor T-2 Axial Gad 24. Case #366.2Synovial chondromatosis42 year female with grinding sensations in knee for years 25. Case #36738 year male with synovial chondromatosis left hip 26. Frog leg lateral 27. Coronal T-2 MRI 28. Sagittal T-2 MRI cutshowing loose bodies 29. Surgical removal of cartilage bodies 30. Photo of largest cartilage body 31. Case #368 24 year female with large cartilaginous pelvic massarising from synovial chondromatosis of left hip 32. tumorClose up of deformed femoral neck 33. tumorNote deformity of medial femoral neck 34. femoral NExposure of large pelvic tumor by removal ant pubic ramus 35. pubic grooveResected cartilage masses and loose hip joint bodies 36. Cut specimen of one mass formed from compressed pellets 37. Loose bodies from hip joint 38. cartilagePhotomic of cartilage forming in synovial lining 39. Post op x-ray showing ramus surgical defect 40. 9 years later with DOA requiring THA 41. Case #36959 year male withsynovial chondromatosisright hip for 20 years 42. 5 years later with 2ndarychondrosarcoma infemoral neck 43. Frog leg lateral showing chondrosarcoma 44. Femoral head & neck specimen from THA showingchondrosarcoma in lower neck area 45. chondrosarcomaSynovectomy specimen obtained at time if THA 46. Photomic of chondrosarcoma 47. 1 yr later we see recurrent tumor requiring hemipelvectomy 48. Case #37050 year female with25 year history ofsynovial chondromatosis 49. Coronal T-2 MRI several years later with 2ndary chondrosarc 50. DedifferentiatedCase #370.1 Cor T-1T-2 chondrosarcoma60 yr male with swollen knee for years with recent increase in size 51. Cor T-2 Gad 52. Sag T-2 Gad T-2 53. Axial T-2Gad 54. Case #124320 year female withsynovial chondromatosiship 55. Frog leg lateral 56. CT scan showing loose bodies 57. Case #124426 year female withsynovial chondromatosiship 58. CT scan 59. CT scan at lower level 60. Photomic showing embryonic cartilage in synovial lining 61. Case #124549 year female with synovial chondromatosis wrist 62. AP view 63. Axial Gad contrast MRI 64. loose pellets fluidSagittal T-1 MRI showing wrist effusion and loose pellets 65. Juxta-articular Chondroma 66. CLASSIC Case #37125 year old with juxta-articular chondroma posterior knee 67. AP view 68. Surgical excision 69. Surgical specimen 70. X-ray of resectedspecimen 71. Photomic 72. Case #37241 year male with juxta-articular chondroma ant knee 73. Sagittal T-1 MRI 74. Sagittal T-2 MRI 75. Axial T-2 MRI 76. Photomic 77. Case #372.1Juxtr-articular chondroma60 yr female with lump in anterior knee area for years 78. Sag T-1 T-2Gad 79. Axial T-1 PDGad 80. Case #37358 year male with juxta-articular chondroma posterior knee 81. Sagittal T-2 MRI 82. Axial T-2 MRI 83. Case #374 Sagittal T-1 MRItumor 37 year male with juxta-articular chondroma post knee 84. Sagittal T-2 MRI 85. tumorSagittal gad contrast MRI with rim enhancement 86. tumorAxial T-2 MRI 87. tumorAxial gad contrast with rim enhancement 88. Case #1248 36 year male with soft tissue chondrosarc behind knee 89. Sagittal T-2 MRI 90. Axial T-1 MRI 91. Axial T-2 MRI 92. Case #37513 year male with juxta-articular chondroma posterior knee 93. Case #37618 year male with juxta-articular chondroma ankle 94. Case #376.1Juxta-articular chondroma 38 old male with long history of catching sensations in ankle 95. Axial T-1 PDGad 96. Sag T-1 PDGad 97. Case #377 19 year male with tenosynovial chondromatosis 98. Lateral view 99. Photomic 100. Case #124744 year male withsolitary synovialchondroma hip 101. Lateral view 102. Photomic from resected specimen 103. Secondary SynovialChondromatosis 104. CLASSICCase #37849 year female with2ndary synovialchondromatosis fromosteoarthritis of kneeAP x-ray 105. Lateral view 106. Sagittal T-2 MRI 107. Axial protondensity MRI fluid 108. Axial T-2 MRI 109. Case 379Coronal T-1 MRI osteoarthritis 76 year male with 2ndary synovial chondromatosis knee 110. Sagittal T-2 MRIshowing loosebodies in poplitealsynovial cyst 111. Axial T-2 MRI with loose body in popliteal cyst 112. Axial T-2 MRI with many loose bodies in popliteal cyst 113. Case #379.1Secondary synovial chondromatosis57 year old soccer player with prior history of knee surgery 114. Sag T-1 T-2Gad 115. Axial T-2 Gad 116. Case #38070 year female2ndary synovialchondromatosis fromosteoarthritis knee 117. Lateral view 118. Case #38155 year female2ndary synovialchondromatosis fromosteoarthritis knee 119. Lateral view 120. Sagittal proton density MRI showing loose bodies in popliteal cyst 121. Case #381.1Secondary synovial osteochondromatosis62 year old male with DOA and largenecrotizing mass over tibia 122. Sag T-1 T-2 Gad 123. T-2Gad Axial T-2 Gad 124. Post op surgicaldebriedmentPost op flapcoverage overtibia 125. Case #38269 year male with 2ndarysynovial chondromatosisfrom traumatic arthritisof elbow 126. Surgical removal of loose bodies 127. Loose bodies and pieces of synovium 128. Case #124646 year female 2ndary synovial chondromatosis talonarvicular second to old trauma of subtalar joint 129. Sagittal T-1 MRI showing traumatic arthritic changes 130. Sagittal T-2 MRI showing excessive synovial fluid 131. Coronal T-2 MRI 132. MyxoidChondrosarcoma 133. Myxoid Chondrosarcoma (Chordoid Sarcoma)The extra-skeletal myxoid chondrosarcoma is a very rare softtissue tumor in the deep muscle belly, occurring most often in theextremities in patients over 40 years of age. Males are affectedtwice as often as females. The tumor is slow growing and maycause local pain and tenderness. Common locations are the thigh,popliteal fossa, and shoulder girdle. It presents with the clinicalappearance of a myxoid liposarcoma. Pathologically, the tumorsare greyish to tannish brown, depending on the amount ofhemorrhage into the tumor. Because hemorrhage often occurs, itcan be mistaken for a hematoma. Histologically, the tumor has amyxoid appearance with chords and nests of anastomosing cellsthat have a chondroblastic appearance. The histology is verysimilar to that of chordoma of the sacrum. The tumor is consideredlow grade in most instances; it is slow growing but has the potential 134. for local recurrence and pulmonary metastases in about one-thirdof cases. Treatment consists of aggressive wide local resection oramputation, if needed, followed by local radiation therapy. Chemo-therapy is usually not indicated. 135. CLASSIC Case #383Coronal T-1 MRI tumor 55 year male with myxoid chondrosarcoma distal thigh 136. Coronal T-2 MRItumor 137. tumorAxial T-2 MRI 138. Resected hemorrhagic surgical specimen 139. Photomic showing chordoid myxoid pattern like chordoma 140. Pathology similar to that of a chordoma 141. Case #384 Sagittal T-2 MRItumor 41 year female with myxoid chondrosarcoma shoulder 142. tumorAxial gad contrast MRI 143. Case #38565 year male withsoft tissue myxoidchondrosarcoma legeroding tibiaAP view 144. Lateral view 145. Sagittal T-2 MRI tumor 146. tumorAxial T-2 MRI 147. tumorAnother axial T-2 MRI 148. Epithelioid Sarcoma 149. Epithelioid SarcomaThe epithelioid sarcoma affects young adults and is mostcommonly seen in the fingers, hand and forearm where it isconsidered the most common soft tissue sarcoma next to thealveolar rhabdomysarcoma and synovial sarcoma. It can also occurin the popliteal area, the buttock, thigh, shoulder, foot and anklearea. It affects twice as many males as females. These tumors arefrequently misdiagnosed as a benign granulomatous process andare often attached to tendon sheaths and facial planes withassociated cutaneous ulcerations that may be multiple in nature.Calcification or even bone formation can occur in about 15% ofcases. The histological appearance of this lesion displays a distinctnodular growth pattern with epithelioid nests of cells at the centersurrounded by lymphocytic infiltration. The differential diagnosiswould include necrotizing infectious diseases such as tuberculosisor granuloma annulare or rheumatoid nodules. Regional lymph 150. node involvement occurs in about 35% of cases and metastases tothe lung in about 50% of cases. Because of the benign clinicalappearance of this lesion, it is common for surgeons to attemptlocal resection but there is a high recurrence rate that eventuallyleads to amputation. Local radiation therapy can help to decreasethe chance of local recurrence. 151. CLASSIC Case #38636 year male withepithelioid sarcomafootulceration 152. Side view with ulcerated cap 153. tumorCT scan 154. tumorAnother CT cut 155. necrotic centerScanning lens photomic 156. Close up outer edge 157. Higher power of epithelioid cells 158. Case #38734 year male withepithelioid sarcomaforearmSagittal T-2 MRI 159. Sagittal Gad contrast MRItumor 160. tumorAxial T-2 MRI 161. necrosistumorAxial gad contrast MRI 162. Photomic showing epithelioid cells 163. Case #387.1Epithelioid sarcoma 22 year old male with spontaneous fungating wound volar wrist 164. Cor T-1 T-2 FS Gad 165. Sag T-1 T-2 FS Gad 166. Axial T-1 T-2 FSGad 167. Case #388 27 year female with epithelioid sarcoma sole of foot 168. Case #388Sagittal T-1 MRI 169. Axial proton density MRI 170. Axial T-2 MRItumor 171. Case #38950 year male with epithelioid sarcoma middle finger 172. Soft TissueEwings Sarcoma 173. Extra-skeletal Ewings SarcomaEwings sarcoma is usually associated with primary tumor ofbone but in a small percentage of cases, Ewings sarcoma canoccur in soft tissue completely unattached to the skeletal system.However, the histological appearance and the clinical pictureassociated with soft tissue Ewings sarcoma is basically the sameas that of skeletal Ewings. This condition is seen in patientsbetween the age of 15 and 30 years. It occurs in males and femalesequally and is rare in black patients. The most common locationis the chest wall, followed by the lower extremities, paraspinousarea, pelvis, hip and retroperitoneum. The least common locationis the upper extremity. The reciprocal translocation of the longarm of chromosomes 11 and 22 is seen in soft tissue Ewings,just as it is in skeletal Ewings. The prognosis for five year survivalis approximately 65%, similar to that of skeletal Ewings. Treatmentconsists of wide local resection when possible, followed by 174. local radiation therapy if indicated. Adjuvant chemotherapy iscommonly used because of the excellent response, similar tothat of skeletal Ewings sarcoma. 175. CLASSIC Case #39028 year female withsoft tissue Ewingssarcoma anterior thighCoronal proton densityMRI 176. Coronal protondensity MRI 177. Coronal T-2 MRItumor 178. tumorAxial T-2 MRI 179. Surgical specimen inked and cut in path lab 180. Photomic 181. Case #390.1 Axial T-1 MRI 38 year female with painful thigh mass 2 months 182. Axial T-2Axial Gadnecrosis 183. necrosisCoronal T-2 Coronal Gad contrast 184. Case #39114 year male withsoft tissue Ewingssarcoma distal thigh 185. Axial protondensity MRI tumor 186. Axial T-2 MRItumor 187. Photomic 188. Case #391.1T-1 Sag MRIT-2 Sag18 yr female with Ewings sarcoma in sciatic nerve lookinglike a benign neurilemoma 189. Axial Gad MRI at two different levelsLower level Upper level 190. Coronal Gad MRI 191. Case #39216 year female withsoft tissue Ewingssarcoma thigh 192. Coronal T-1 MRI 193. tumorAxial T-2 MRI 194. Clear CellSarcoma 195. Clear Cell Sarcoma The clear cell sarcoma is thought to be a deep, non-cutaneousvariant of the pigmented melanoma. It is a very rare tumor affectingfemales more than males. It is typically seen between the ages of20 and 40 years. It usually occurs in tendon sheaths and fascialplanes, especially around the foot and ankle area, similar to theclinical appearance seen with synovial sarcoma with which it canbe confused. The tumor usually begins as a slow growing lump thathas a benign appearance but after a period of several years the tumorwill start growing more rapidly and become painful. It has a highpotential to metastasize to local lymph nodes and to the lung.Approximately 50% of patients with this tumor will be dead in fiveyears. The microscopic appearance is similar to that of the epithelioidsarcoma, especially if melanin is not found in the specimen.Treatment usually consists of wide local resection, if possible, but ahigh local recurrence rate is common because of its location in 196. extracompartmental structures such as tendon sheaths. If thatoccurs, amputation is carried out for local control of the disease.Local radiation therapy is utilized with attempts at wide resection.Adjuvant chemotherapy has been advised because of the poorprognosis but the response is usually not beneficial. 197. CLASSIC Case #39335 year female with clear cell sarcoma hand 198. Surgical exposure reveals extensive tendon sheath involvement 199. Photomic 200. Case#394Sagittal gad contrast MRI tumor 73 year female with clear cell sarcoma ankle 201. tibiaheel cordtumor Axial gad contrast MRI 202. MyositisOssificans 203. Myositis OssificansMyositis ossificans is a heterotopic ossification within musclefascial planes seen typically in young athletic individuals in theiradolescence and early adult life. It occurs primarily in males andusually results from a significant injury to a muscle, such as atearing of the quadriceps muscle which is the most commonlocation for this problem. It is also seen in the gluteus maximusand the brachialis muscle at the elbow. The calcification is typicallynoted on x-ray three to four weeks after the injury. It tends to occurat the periphery of the damaged muscle and hematoma is usuallyseen in the central area. As the lesion matures the calcific rimaround the damaged muscle will appear as fairly mature boneand the central area will remain radiolucent, giving the so-calledzonal pattern that is almost diagnostic of traumatic myositisossificans. This is the opposite of osteosarcoma of soft tissue thathas the most dense portion of the calcifying lesion occurring centrallyand the more lytic portion at the periphery of the lesion. Myositis 204. ossificans can also be seen in older patients with no history oftrauma in which case the clinician becomes concerned about thepossibility of a neoplasm such as a synovial sarcoma or soft tissueosteosarcoma. Histologically, the lesion will have the appearanceof a healing fracture, including immature cartilage and boneformation, along with hematoma in the early stages. In rare cases,after a period of 25 or 30 years, these dormant lesions can reactivateand develop into an osteosarcoma. Treatment usually consists ofrest until the lesion matures after six months, at which point thepatient is usually asymptomatic. There is no reason to remove thelesion unless there is significant clinical disability related tostiffness of the adjacent joint.There is a hereditary congenital form of myositis ossificansreferred to as myositis ossificans progressiva, or the newer term-inology is fibrodysplasia ossificans progressiva, that is typicallyseen in children under the age of ten years. It presents with aclinical picture of progressive fibroblastic proliferation and 205. subsequent calcification and ossification of subcutaneous fat,muscles, tendons, appeneuroses, and ligaments. This condition canbe associated with symmetrical malformations of the digits withmicrodactyly of the thumbs and great toes, sometimes associatedwith a failure of segmentation of the digital bony structures. Thecondition usually presents between birth and the first six years ofage. It is inherited as an autosomal dominant trait. Males andfemales are equally affected and the calcification in soft tissues isusually precipitated by a local injury to the soft tissue. It occurstypically in the musculature of the back, shoulder, paravertebralregion and upper arms. Fusion of the tempromandibular joint canbe seen. If the respiratory muscles are affected, death can resultbecause of respiratory failure or pneumonia in early adult life. Theprognosis for survival is very poor and most patients die within thefirst ten to fifteen years of life. Biopsy or trauma of the affectedareas should be avoided because of new lesions that mightdevelop. There is no effective treatment or this condition. 206. CLASSIC Case #39512 year female withmyositis ossificansmedial thigh 207. fibrous tissueCut surgical specimen showing mature bone at periphery 208. Photomic showing reactive bone at periphery of lesion 209. Less bone maturity toward center of lesion 210. Healing rhabdomyoblasts in center of lesion 211. Case #39659 year male withearly myositisossificans ant thigh 212. Lateral view 213. Axial T-2 MRI 214. Axial T-2 MRI 215. Macro section of resected specimen 216. boneReactive bone at periphery 217. Case #397biopsy22 year male with earlymyositis ossificansanterior thigh 218. bone fibrousBiopsy specimen with typical benign zonal pattern 219. Mature myositisossificans 6 mos later 220. Case #3982 mos later early17 year male with myositis ossificans of thigh 2 mos apart 221. Case #39924 year femalemyositis ossificans2 months post injury 222. Axial T-1 MRI 223. Axial T-2 MRI 224. Coronal T-2 MRI 225. Biopsy specimen showing reactive bone 226. cartilage boneClose up of reactive bone and cartilage 227. Case #40014 month male withmyositis ossificansbrachialis muscle fromfall 2 weeks ago 228. Case #40114 year male withmyositis ossificanstriceps musclemature 229. Case #40210 year old female with myositis ossificans of shoulder 230. Case #40362 year female with old myositis ossificans teres major 231. Coronal T-1 MRI 232. Superficial biopsy specimen shows benign reactive bone 233. A deeper specimen reveals OGS arising from previous myositis ossificans 234. MyositisOssificansProgressiva 235. CLASSIC Case #40422 year male withmyositis ossificansprogressiva 236. Heavy ossification oflatissimus dorsi muscle 237. X-ray showingossification oflatissimus dorsi muscle 238. Spontaneous fusioncervical spine 239. Ossification psoas m 240. Heterotopic ossification seen muscle biopsy 241. Microdactyly both great toes 242. X-ray of feet showing failure of segmentation great toes 243. Hands showing stiff thumbs and hypoplastic 5th digits 244. X-ray showing hypoplasia of 1st and 5th digits 245. Case #40526 year male withmyositis ossificansprogressiva withspontaneous fusionscoliotic spine 246. Spontaneous extra-articular fusion left hip 247. PigmentedVillonodular Synovitis 248. Pigmented Villonodular SynovitisThe etiology of pigmented villonodular synovitis (PVNS)remains controversial. It presents as an inflammatory synovialdisease, usually involving only one joint, but histologically thedisease presents with histiocytic proliferation in the subsynovialtissue that takes on the characteristics of a neoplastic conditionsimilar to that of a giant cell tumor. PVNS occurs typically in thesubsynovial tissue about major joints of the lower extremity inpatients between the ages of 20 and 40 years. The knee joint is themost common site, followed next by the hip, ankle and foot. It israre to see this disease in the upper extremity. The histiocyticproliferation in subsynovial tissues is similar to that seen in giantcell tumor of tendon sheathes in the hand and foot., The clinicalpicture in the knee joint is that of spontaneous swelling associatedwith pain and synovial hypertrophy. Hemarthrosis can result inmassive swelling about the knee joint and can occasionally result 249. in juxta-articular erosion of bone, similar to what is seen inrheumatoid synovitis. Other clinical conditions with a similarpresentation include hemophilia and coccydiomycosis. In fewerthan 10 % of cases this condition will present as a localized focalmass in the suprapatellar pouch of the knee or high in the poplitealspace posteriorly that can masquerade as a neoplastic conditionsuch as a synovial sarcoma.Treatment for the more generalized synovial involvement ofthe knee joint or other lower extremity joints consists of a subtotalsynovectomy that in many cases can be performed through anarthroscope. In more extensive cases an open procedure may benecessary. The recurrence rate is fairly high, in the range of 30%.In cases where multiple recurrences result, treatment with radiationtherapy in the neighborhood of 1500-3000 centigray by externalbeam is used. Injectable isotopes have also been used for radiationtreatment of recurrent cases. Secondary arthritic changes, especiallyin the knee joint, can occur as a late complication of this disease 250. and these changes could lead to a total joint replacement at theage of 50 or 60 years. On very rare occasion, this disease canconvert to a neoplastic sarcoma with a high degree of giant cellactivity. This is similar to the conversion of a giant cell tumor toa malignant sarcoma. 251. CLASSICCase #40636 year male withPVNS knee 252. Lateral x-ray of kneeshowing soft tissueswelling 253. AP x-ray showingearly osteoarthritis 254. Sagittal T-1 MRIshowing hypertrophicsynovitis bone erosion 255. hemosiderin cystladenSagittal T-2 MRI erosion 256. Axial T-1 MRI showing hypertrophic synovitis 257. cystCoronal T-2 MRI 258. Brown discoloration of hypertrophic synovitis at surgery 259. Photomic showing giant cell activity 260. Photomic showing hemosiderin laden macrophages 261. Surgical appearance following subtotal synovectomy 262. Case #407 Sagittal proton density MRI41 year female with PVNS knee 263. fluidhemosiderin laden synovitis Axial GRE T-2 MRI 264. Surgical exposure of brown hypertrophic synovitis 265. Photomic showing giant cell activity 266. Case #407.138 year male with intermittent pain and swelling rt knee 2 years 267. Sag T-2 T-2 Gad 268. Axial T-2 Gad 269. Case #407.2Recurrent PVNS43 yr male with 5 scopes over 7 yrs for intermittent painful swellingabout the left knee 270. Sag PD T-2 FS T-2 FS 271. Axial T-2 272. Cor T-1 T-2 273. Case #40855 year femalePVNS knee withlarge subchondrallytic granuloma 274. Coronal T-1 MRI 275. Case #40938 year male withPVNS hip joint withlarge supra-acetabulargranuloma 276. Diffuse synovialhypertrophic nodularityseen with arthrogram 277. Treatment in the 60swith a cup arthoplastyand bone graft to theacetabular granuloma 278. Case #410Sagittal proton density MRI17 male with localized nodular form of PVNS 279. Sagittal T-2 MRI 280. Axial T-2 MRI 281. Surgical specimen 282. Photomic showing hemosiderin laden macrophages 283. Case #410.1 Sag T-1PDNodular PVNS45 year female with knee pain for 5 months 284. Cor T-1 PD FS 285. Surgical excision 286. Case #410.2Localized nodular form of PVNS32 yr male with dull pain R knee for 5 months 287. Sag T-1 T-2Gad 288. Axial T-1 T-2Gad 289. Cor T-1T-2 FS Gad 290. Case #411Sagittal proton density MRI erosion50 year male with PVNS knee with large popliteal mass 291. Sagittal T-2 MRI 292. Case #412Sagittal T-1 MRI17 year female with PVNS ankle 293. Sagittal T-2 MRI 294. Another sagittal T-2 cut 295. Synovectomy specimen 296. Photomic 297. Case #413 Sagittal T-1 MRI 39 year female with diffuse form of GCT tendon sheath 298. Axial T-1 MRI 299. tumorAxial T-2 MRI 300. Photomic 301. Case #41467 year female withgiant cell tumor oftendon sheath 302. X-ray showing bonyerosion 303. Case #41514 year female with GCT tendon sheath 304. X-ray showing bony erosion 305. digital nerveSurgical resection 306. Case #416 14 year female with xanthomatous variant of giant celltumor of tendon sheath on index finger 307. Surgical resection 308. Photomic showing cholesterol laden foam cells 309. Case # 124920 year female with PVNS knee 310. Lateral view 311. R LBone scan 312. Sagittal T-1 MRI 313. Coronal T-1 MRI 314. Coronal gad contrast MRI 315. Case #1250PVNS DOA 68 year male with PVNS and DOA left knee 316. Lateral view showing subchondral erosions 317. Axial T-1 MRI with subpatellar synovial hypertrophy 318. Sagittal T-1 MRI showing extensivesuprapatellar pouch involvement 319. Sagittal T-2 MRI showing fluid in suprapatellar pouch 320. Coronal T-2 MRI withdark signal hemosiderinladen synovitis andbright signal synovialfluid 321. Another coronalT-2 MRISubchondral erosions 322. Case #125134 year male withPVNS kneeSagittal T-1 MRI 323. Sagittal GRE T-2*MRI 324. Another sagittalGRE T-2* MRI 325. Coronal GRE T-2* MRI 326. Case #125223 year male with PVNSsuprapatellar pouch areaCoronal T-1 MRI 327. Coronal T-2 MRI 328. Axial T-2 MRI 329. Case #1253 Sagittal T-1 MRI 19 year male with localized nodular form of PVNS knee 330. Coronal T-1 MRI 331. Coronal T-2 MRI 332. Case #1254 40 year female with PVNS hip joint 333. CT scan 334. Axial T-1 MRI 335. Axial T-2 MRI 336. Case #125532 year male withPVNS hip joint 337. Case #125640 year female withpigmented villonodulartenosynovitis flexorhallicus longus tendonsheathSagittal T-1 MRI 338. Coronal T-1 MRI 339. Axial T-1 MRI 340. Axial T-2 MRI 341. hemosiderinhistiocytesPhotomic showing giant cell activity 342. Case #1256.1 12 year old male with tender lump under heel cord 4 months 343. Sag T-1 PD Gad 344. Axial T-1 T-2Gad 345. Case #12578 year female withGCT tendon sheath2nd toe 346. Sagittal T-1 MRI 347. Coronal T-1 MRI 348. Case #1257.1GCT tendon sheath53 yr female with tender and swollen 2nd toe for 1 yr 349. Cor T-1 T-2 FSGad 350. Axial T-1 T-2 FSGad 351. Sag T-1 T-2Gad 352. Intramuscular Myxoma 353. Case #1258 Axial T-2 Axial Gad46 yr female with painless lump in post axilla for 8 years 354. Sagittal T-2 Sagittal Gad 355. Coronal GadSurgical specimen 356. Case #1258.1 68 year old male with painless lump right shoulder for 1 yr 357. Cor T-1 T-2 358. Sag T-1 T-2 359. Case #1258.2Axial T-1T-259 year male with painless softtissue mass medial calf for 6 mos. Gad Intramuscular myxoma 360. SagittalT-1 T-2Gad 361. Ganglion Cyst 362. Case #1259Axial T-148 yr male withpainless lump inanterior thigh 1 yrT-2 363. Axial GadShows rim enhancementSagittal Gad 364. Case #1260 Ganglion cyst 49 year female with tender lump medial knee for 6 mos 365. Cor T-1 Cor T-2 366. Case #1160.1 Ganglion cyst65 year female with non tender mass over patellar ligament 367. Sag T-1 PD FS 368. Cystic lateral meniscusCase #1261 Axial T-1T-2 49 year male with prior history of subcutaneous ganglion cystremoved from knee area 6 years ago 369. Cor T-1 T-2 370. Case #1261.1Axial T-1 T-2Gad72 year male with painless lumplateral ankle for 1 year 371. Cor STIR Surgical excision 372. Ganglion cystCase #1261.2 Axial T-245 year male runnerWith tender nodule inMedial gastroc head Gad 373. Cor T-2 Gad 374. Case #1261.3 Ganglion cyst 60 year male with mild R hip pain for 1 year 375. Cor T-1 PD Gad 376. Axial T-2 377. Soft Tissue Lymphoma 378. Case #1262 Axial T-1 T-2 Lymphoma100 year old male with chronic edemain legs but recent tender lump in calffor 3 months Gad 379. Sag T-1 STIR Gad