Yaşar SAĞLIK, RAMAZAN AKMEŞE, Yusuf YILDIZ, Kerem BAŞARIR

İki dizde farklı zamanlarda ortaya çıkan lipoma arboresan: Olgu sunumu

Lipoma arboresan nadir görülen bir eklem içi lezyondur ve en sık dizde görülür. On dört yaşında bir genç kız sağ dizinde altı yıldır yavaş ilerleyen, ağrısız şişlik yakınmasıyla başvurdu. Diz eklem hareketlerinde kısıtlılık yoktu. Manyetik rezonans görüntülemede (MRG) suprapatellar ve retropatellar alanlarda multipl villöz lipomatöz sinovyal proliferasyon gösteren lezyon ve eklemde efüzyon saptandı. Kitle artrotomi ve sinovektomi yapılarak eksize edildi. Patolojik tanı lipoma arboresan olarak kondu. Ameliyattan iki yıl sonra, sağ dizi tamamen asemptomatik olan hastanın sol dizinde de suprapatellar bölgede, ağrısız, hareket kısıtlılığına neden olmayan şişlik gelişti. Sol dizin MRG’sinde suprapatellar ve retropatellar bölgede dallanma gösteren kitle paterni, eklemde efüzyon ve popliteal fossada sinovyal kist saptandı. Artrotomi ve sinovektomi uygulandı. Sol dizdeki bu lezyona da lipoma arboresan tanısı kondu. Olgumuzun, dizde aynı anda iki taraflı tutulum saptanan olgulardan farklılığı, diğer dizdeki lezyonun ilk ameliyattan iki yıl sonra ortaya çıkmasıdır.

Anahtar Kelimeler:

Lipom, Ergen, Yumuşak doku neoplazileri, Manyetik rezonans görüntüleme, Diz eklemi, Tanı, ayırıcı, Artroskopi, Neoplazmlar, ikincil primer

Lipoma arborescens occurring in both knees at different times: a case report

Lipoma arborescens is a rare intraarticular lesion, mainly affecting the knee. A fourteen-year-old girl presented with a slow-growing painless mass in the right knee, of a sixyear history. There were no limitations in the movements of the knee. Magnetic resonance imaging (MRI) revealed multiple lesions showing villous lipomatous proliferation of the synovium in the supra- and retropatellar regions and effusion in the knee joint. The mass was excised with arthrotomy and synovectomy and a histopathologic diagnosis of lipoma arborescens was made. Two years postoperatively, and when the right knee was completely asymptomatic, she developed a similar mass in the suprapatellar region of the left knee. An MRI scan showed a mass lesion in the supra- and retropatellar regions, effusion in the knee joint, and a synovial cyst in the popliteal fossa. Again, arthrotomy and synovectomy were performed and the histopathologic diagnosis was lipoma arborescens. This case differs from simultaneously involved knees in that lipoma arborescens in the contralateral knee developed two years after the inital operation.

Keywords:

Lipoma, Adolescent, Soft Tissue Neoplasms, Magnetic Resonance Imaging, Knee Joint, Diagnosis, Differential, Arthroscopy, Neoplasms, Second Primary,

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1. Hubscher O, Costanza E, Elsner B. Chronic monoarthritis due to lipoma arborescens. J Rheumatol 1990;17:861-2.
2. Dawson JS, Dowling F, Preston BJ, Neumann L. Case report: lipoma arborescens of the sub-deltoid bursa. Br J Radiol 1995;68:197-9.
3. Laorr A, Peterfy CG, Tirman PF, Rabassa AE. Lipoma arborescens of the shoulder: magnetic resonance imaging findings. Can Assoc Radiol J 1995;46:311-3.
4. Noel ER, Tebib JG, Dumontet C, Colson F, Carret JP, Vauzelle JL, et al. Synovial lipoma arborescens of the hip. Clin Rheumatol 1987;6:92-6.
5. Dinauer P, Bojescul JA, Kaplan KJ, Litts C. Bilateral lipoma arborescens of the bicipitoradial bursa. Skeletal Radiol 2002;31:661-5.
6. Wolf RS, Zoys GN, Saldivar VA, Williams RP. Lipoma arborescens of the hip. Am J Orthop 2002;31:276-9.
7. Levadoux M, Gadea J, Flandrin P, Carlos E, Aswad R, Panuel M. Lipoma arborescens of the elbow: a case report. J Hand Surg [Am] 2000;25:580-4.
8. Haasbeek JF, Alvillar RE. Childhood lipoma arborescens presenting as bilateral suprapatellar masses. J Rheumatol 1999;26:683-6.
9. Cil A, Atay OA, Aydingoz U, Tetik O, Gedikoglu G, Doral MN. Bilateral lipoma arborescens of the knee in a child: a case report. Knee Surg Sports Traumatol Arthrosc 2005;13:463-7.
10. Ege G, Akman H. Olgu sunumu: Dizde lipoma arborescens. Artroplasti Artroskopik Cerrahi 2002;13:45-8.
11. Donnelly LF, Bisset GS 3rd, Passo MH. MRI findings of lipoma arborescens of the knee in a child: case report. Pediatr Radiol 1994;24:258-9.
12. Armstrong SJ, Watt I. Lipoma arborescens of the knee. Br J Radiol 1989;62:178-80.
13. Hallel T, Lew S, Bansal M. Villous lipomatous proliferation of the synovial membrane (lipoma arborescens). J Bone Joint Surg [Am] 1988;70:264-70.
14. Sumen Y, Ochi M, Soda Y, Ikuta Y. Lipoma arborescens in bilateral knee joints. Arch Orthop Trauma Surg 1998; 117:105-7.
15. Al-Ismail K, Torreggiani WC, Al-Sheikh F, Keogh C, Munk PL. Bilateral lipoma arborescens associated with early osteoarthritis. Eur Radiol 2002;12:2799-802.
16. Kloen P, Keel SB, Chandler HP, Geiger RH, Zarins B, Rosenberg AE. Lipoma arborescens of the knee. J Bone Joint Surg [Br] 1998;80:298-301.
17. Martinez D, Millner PA, Coral A, Newman RJ, Hardy GJ, Butt WP. Case report 745: Synovial lipoma arborescens. Skeletal Radiol 1992;21:393-5.
18. Soler T, Rodriguez E, Bargiela A, Da Riba M. Lipoma arborescens of the knee: MR characteristics in 13 joints. J Comput Assist Tomogr 1998;22:605-9.
19. Feller JF, Rishi M, Hughes EC. Lipoma arborescens of the knee: MR demonstration. AJR Am J Roentgenol 1994; 163:162-4.
20. Edamitsu S, Mizuta H, Kubota K, Matsukawa A, Takagi K. Lipoma arborescens with hemarthrosis of the knee. A case report. Acta Orthop Scand 1993;64:601-2.
21. Sola JB, Wright RW. Arthroscopic treatment for lipoma arborescens of the knee: a case report. J Bone Joint Surg [Am]1998;80:99-103.
22. Franco M, Puch JM, Carayon MJ, Bortolotti D, Albano L, Lallemand A. Lipoma arborescens of the knee: report of a case managed by arthroscopic synovectomy. Joint Bone Spine 2004;71:73-5.
23. Erselcan T, Bulut O, Bulut S, Dogan D, Turgut B, Ozdemir S, Goze F. Lipoma arborescens; successfully treated by yttrium- 90 radiosynovectomy. Ann Nucl Med 2003;17:593-6.