LETTER TO EDITORS

To the editors

I enjoyed the beautifully illustrated case report "A case of villonodular synovitis of the shoulder in an adolescent: imaging and pathologic diagnosis" by Costallat et al. in the January-February 2009 issue of the Brazilian Journal of Rheumatology. I would like to raise for discussion another possible consideration that might be discussed since neither the MRI nor histopathology was quite consistent with typical villonodular synovitis. The text and figures shown suggest a very diffuse inflammatory process without the hemosiderin, foamy lipid laden macrophages and monotonous stromal proliferation often seen. The giant cells are striking but can be seen in precisely the location shown in rheumatoid synovitis.¹ I don't know of any reports of these in JIA.

Can you tell us more about the findings at surgery? Were there nodular lesions? Perhaps only time will tell but JIA can begin in one joint and JIA can be associated with a positive ANA. Certainly I would not suggest any change in treatment but careful follow-up can be of interest.

H. Ralph Schumacher, MD

Professor of Medicine, University of Pennsylvania

Division of Rheumatology

VA Medical Center, 151K, University & Woodland Aves. Philadelphia, PA 19104 U.S.A. Editor-chefe, JCR: Journal of Clinical Rheumatology Tel: [phone], Fax: [phone]. E-mail: [e-mail] Website: http://www.med.upenn.edu/synovium

Reference

1. Grimley PM, Sokoloff L. Synovial giant cells in rheumatoid arthritis. Am J Pathol 1996; 49:931-954. Collins DH. The pathology of articular and spinal diseases. Arnold: London; 1949.

Publication Dates

• Publication in this collection
  08 Sept 2010
• Date of issue
  Aug 2010