Features of histological differential diagnostics of a tenosynovial giant cell tumor of diffuse type and non-specific inflammatory lesions of the articular capsule
Tenosynovial giant cell-tumor is a benign tumor of the synovial layer of the joints; for a long time to characterize this nosology, the term “villous- nodular synovitis” was used and considered it as a kind of inflammatory post-traumatic process in the joint capsule, and only in-depth studies of the properties of TSGCT at the molecular and cytogenetic levels proved its neoplastic nature. The purpose — to determine the peculiarities of approaches to differential diagnosis of TSGCT with exudative-proliferative syndromes, based on the clinical and morphological studies of biopsy-resection material. The study was performed on 95 cases of TSGCT of diffuse type of different localization, 56 cases of rheumatoid arthritis and 48 cases of non-specific post-traumatic pigmented synovitis. Grades of expressiveness of morphological indicators were evaluated according to the visual-analog scale from low to high with an increase of x100. Hypertrophic, hyperplastic and inflammatory changes in the articular capsule in cases of nonspecific pigmented synovitis are limited to a synovial layer. Hemosiderin is found in the cytoplasm of synovial cells and in siderophages. Nodular and solid proliferators, signs of invasion in adjacent tissues, are absent, which is an important feature in the differential diagnosis of lesions of the joint capsule, rich in clusters of macrophage siderocytes. At histological examination in isolated tissues in patients with rheumatoid arthritis signs of chronic non-specific productive-infiltrative and exudative inflammation of different activity were found — a cluster of mononuclears and plasmacites with the formation of small lymphoid follicles in its own synovial plate, hyperemia of the microcirculatory bed, and fibrin layers. The difference between the described synovitis from TSGCT is the absence of nodular proliferators, infiltrative changes in the deep departments of the capsule, hemorrhages, clumps of hemosiderin and large epithelioid synovitis, which is characteristic of tumors. TSGCT is characterized by polymorphism of histological changes and different degrees of prevalence in joint structures, which in many cases complicates its differential diagnosis.
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