title: A low recurrence rate is possible with a combination of surgery and radiosynovectomy for diffuse pigmented villonodular synovitis of the knee.
abstract: BACKGROUND
  Diffuse pigmented villonodular synovitis (DPVNS) is an uncommon proliferative disease. After only surgery, recurrence rates are high. This study presents the efficacy of combined surgical and adjuvant radiosynovectomy (RS) in the treatment of DPVNS.
  
  
  METHODS
  Between September 2006 and September 2012, 15 knee joints of 15 patients (10 female and 5 male) with histopathological DPVNS diagnosis with mean age 27 ± 12 years underwent surgery. At mean 14.4 ± 18 weeks postoperatively, RS was applied using 5 mCi (90)Y citrate colloid. Three-phase bone scintigraphy and contrast-enhanced MRI were used to evaluate residual and recurrent tumorous tissues in the joint.
  
  
  RESULTS
  Mean follow-up was 48 ± 22 months. Blood flow and blood pool images showed that 2 patients had marked, 4 had moderate, 6 had mild, and 3 had no uptake. Late static images showed 5 had marked, 10 had moderate (99m)Tc-HDP uptake in the related joint. MRI examination indicated that there was no progression in any of the patients. The disease was determined to be stable in 2, regressed in 9, and totally cured in 4 cases. Bremsstrahlung imaging indicated an even distribution of radionuclide in all the knee joints. There was no evidence of leakage of radioactivity in the total body scans. There was significant improvement in Lysholm knee scores after treatment.
  
  
  CONCLUSIONS
  Adjuvant yttrium-90 radiosynovectomy after surgical excision in the treatment of DPVNS is a reliable and efficient treatment method with successful clinical results. RS treatment can be considered for cases with DPVNS.
authors.affiliation: Department of Nuclear Medicine, Ministry of Health, Ankara Training and Research Hospital, Ankara. drgokko@gmail.com
authors.forename: Gokhan
authors.initials: G
authors.lastname: Koca
authors.forename: Hakan
authors.initials: H
authors.lastname: Ozsoy
authors.forename: Hasan Ikbal
authors.initials: HI
authors.lastname: Atilgan
authors.forename: Sinem
authors.initials: S
authors.lastname: Ozyurt
authors.forename: Koray
authors.initials: K
authors.lastname: Demirel
authors.forename: Hasan
authors.initials: H
authors.lastname: Yiğit
authors.forename: Meliha
authors.initials: M
authors.lastname: Korkmaz
authors.forename: Aylin
authors.initials: A
authors.lastname: Baskin
authors.forename: Abdurahman
authors.initials: A
authors.lastname: Sakaogullari
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozdemir
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012008:Recurrence; D000074402:Synovectomy; D013586:Synovitis, Pigmented Villonodular / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult