This article has Open Peer Review reports available.
Synovial hemangiohamartoma presenting as knee pain, swelling and a soft tissue mass: a case report
© Senol et al.; licensee BioMed Central Ltd. 2012
Received: 13 February 2012
Accepted: 15 May 2012
Published: 18 July 2012
We present a case of a patient with juxtaarticular hemangiohamartoma with a synovial extension associated with hemorrhagic synovitis and recurrent spontaneous hemarthrosis.
A 21-year-old Caucasian woman was admitted to our hospital complaining of pain and swelling at her knee for 6 months. In the magnetic resonance imaging, T2-weighted and fat-suppressed scans revealed a mass with high signal intensity just posterior to the patellar tendon. We performed an excisional biopsy of the mass through an anterior longitudinal incision. Excised material included arterial and venous vascular structures, which were found to be spread among the fat, connective and peripheral nerve tissues microscopically.
Although hemangiohamartomas are not true neoplasms, they may cause knee pain, swelling and hemarthrosis that warrant surgical resection. This lesion, although rare, should be considered in the differential diagnosis, especially in teenagers and young adults.
Synovial and subsynovial hemangiomas are very rare benign lesions that are classified by pathologists as hemangiohamartomas when admixed with fat, connective tissue and peripheral nerve structures [1, 2]. The predominant type of vascular channel during pathological examination reveals the lesion as cavernous, capillary, arteriovenous or venous.
Recurrent non-traumatic hemarthrosis with pain and palpable mass are among the common findings experienced by the patient . Magnetic resonance imaging (MRI) is usually the diagnostic tool for detection of the extent and characteristics of the lesion [4, 5].
Complete open excision decreases the potential for local recurrence, but localized lesions can be treated arthroscopically [6–8]. In this article, we present a case of juxtaarticular hemangiohamartoma with a synovial extension associated with hemorrhagic synovitis and recurrent spontaneous hemarthrosis.
A 21-year-old Caucasian woman was admitted to our hospital complaining of pain and swelling at her knee for the past 6 months. Her pain and swelling were especially aggravated by physical activities.
The radiologists included synovial sarcoma in the differential diagnosis, and we performed an excisional biopsy of the mass through the anterior longitudinal incision. We decided to perform open surgery because of the unknown characteristics of the lesion. The lesion, which measured 3cm × 2cm, was excised fully.
Synovial hemangiomas and hemangiohamartomas are two entities that are both rare and similar in nature. Hemangiohamartomas involve the synovia with the fat and connective tissue. In addition to pain, swelling and palpable mass, they may cause hemarthrosis  and were first described by Eugène Bouchut in 1856 [3, 10].
The differential diagnosis for hemangiohamartoma should include pigmented villonodular synovitis, synovial sarcoma, rheumatoid arthritis, juvenile chronic and arthritis, hemophilic arthropathy and lipoma arborescens.
Arthroscopic excision in cases of focal or pediculated and appropriate-size lesions may be an alternative to open surgical resection. In cases of pure synovial hemangioma, selective embolization of feeder vessels might also be an alternative to surgery [11–13].
Plain radiographs are usually of poor diagnostic value. In less than 5% of patients, periosteal reaction, cortical destruction, discrepancy in leg length or even arthropathy simulating hemophilia may be seen [12, 13]. MRI is the most useful diagnostic tool, especially on T2-weighted images, on which the lesion exhibits a high signal due to blood in vascular spaces .
Although hemangiohamartomas are not true neoplasms, they may cause knee pain, swelling and hemarthrosis that warrant surgical resection. This lesion, although rare, should be considered as part of a differential diagnosis, especially in teenagers and young adults.
Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
No funding was received for this case study.
- Yercan HS, Okcu G, Erkan S: Synovial hemangiohamartomas of the knee joint. Arch Orthop Trauma Surg. 2007, 127: 281-285. 10.1007/s00402-006-0140-7.View ArticlePubMedGoogle Scholar
- Visuri T: Recurrent spontaneous haemarthrosis of the knee associated with a synovial and juxta-articular haemangiohamartoma. Ann Rheum Dis. 1990, 49: 554-556. 10.1136/ard.49.7.554.View ArticlePubMedPubMed CentralGoogle Scholar
- Vakil-Adli A, Zandieh S, Hochreiter J, Huber M, Ritschl P: Synovial hemangioma of the knee joint in a 12-year-old boy: a case report. J Med Case Rep. 2010, 4: 105-10.1186/1752-1947-4-105.View ArticlePubMedPubMed CentralGoogle Scholar
- Llauger J, Monill JM, Palmer J, Clotet M: Synovial hemangioma of the knee: MRI findings in two cases. Skeletal Radiol. 1995, 24: 579-581.View ArticlePubMedGoogle Scholar
- Narváez JA, Narváez J, Aguilera C, De Lama E, Portabella F: MR imaging of synovial tumors and tumor-like lesions. Eur Radiol. 2001, 11 (12): 2549-2560. 10.1007/s003300000759.View ArticlePubMedGoogle Scholar
- Wirth T, Rauch G, Rüschoff J, Griss P: Synovial haemangioma of the knee joint. Int Orthop. 1992, 16: 130-132.View ArticlePubMedGoogle Scholar
- Meislin RJ, Parisien JS: Arthroscopic excision of synovial hemangioma of the knee. Arthroscopy. 1990, 6: 64-67. 10.1016/0749-8063(90)90101-I.View ArticlePubMedGoogle Scholar
- De Schrijver F, Geens S: Recurring hemarthrosis of the knee due to synovial hemangioma: report of two cases of which one was treated successfully by arthroscopic excision. Acta Orthop Belgica. 2000, 66 (1): 86-92.Google Scholar
- Linson MA, Posner IP: Synovial hemangioma as a cause of recurrent knee effusions. JAMA. 1979, 242: 2214-2215. 10.1001/jama.1979.03300200044024.View ArticlePubMedGoogle Scholar
- Bouchut E: Tumeur erectile de l’articulation du genou. Gaz Hop (Paris). 1856, 29: 379-381.Google Scholar
- Cotten A, Flipo RM, Herbaux B, Gougeon F, Lecomte-Houcke M, Chastanet P: Synovial haemangioma of the knee: a frequently misdiagnosed lesion. Skeletal Radiol. 1995, 24: 257-261.PubMedGoogle Scholar
- Ramseier LE, Exner GU: Arthropathy of the knee joint caused synovial hemangioma. J Pediatr Orthop. 2004, 24: 83-86. 10.1097/01241398-200401000-00016.View ArticlePubMedGoogle Scholar
- Resnick D, Oliphant M: Hemophilia-like arthropathy of the knee associated with cutaneous and synovial hemangiomas: report of 3 cases and review of the literature. Radiology. 1975, 114 (2): 323-326.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.