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Beitragstitel Mechanical hip pain in an adolescent patient in a rare combination of a femoroacetabular CAM-type impingement and a localized intra-articular tenosynovial giant cell tumor.
Beitragscode P51
Autoren
  1. Franziska Kocher Kantonsspital HFR-Fribourg Vortragender
  2. Nadine Kaiser Clinic for Pediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
  3. Andrea Marrazzini
  4. Ines Raabe HFR - Hôpital Cantonal Fribourg
  5. Kai Ziebarth Clinic for Pediatric Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 1 | Kinder
Abstract Introduction
Intra-articular localized tenosynovial giant cell tumors are occasional synovia proliferations; mostly affecting large joints. The worldwide estimated incidence is 1.8 per million in the general population per year; children seem to be less affected. These benign tumors may lead to cartilage damage resulting in joint destruction and premature osteoarthritis.

Materials and Methods
Case report and review of literature.

Results
A 14-years old girl with increasing left sided hip pain and progressive loss of motion consulted the outpatient clinic. Physical examination was suspicious for a femoroacetabular CAM-type impingement (FAI) with a limited painful internal rotation of 20° (contralateral side 40°) and a positive impingement test. X-rays and arthro-MRI with a decreased offset of the femoral head-neck-junction confirmed a FAI. Additionally, it revealed an intra-articular, sharp limited nodular proliferation of the synovia belonging to the antero-inferior femoral neck. Due to the symptomatic, almost circumferential deformity at the femoral head-neck junction and a concomitant soft-tissue tumor, a surgical hip dislocation according to the original technique of Ganz et al. was favored over of an arthroscopic resection. After performing the capsulotomy and hip dislocation, we identified and resected a well-circumscribed, intra-articular nodular pedunculated lesion probably in association with the capsule or the transverse ligament. Correction of femoral head-neck offset was performed.
Histological exam confirmed a giant cell tumor with the typical microscopic pattern of foamy histiocytes and stroma with admixed mononuclear component including hemosiderin deposits, histiocytes-like cells, epithelioid cells and scattered giant cells .

At 6 weeks postoperative, she regained a pain free hip function with 110° of flexion and 50° internal rotation. Standard x-ray showed a centered femoral head without signs for an avascular necrosis.

Conclusions
Localized intra-articular tenosynovial giant cell tumors are an occasional cause of mechanical hip pain in children. These benign synovial proliferations can rarely be found in the pediatric population. Even in the presence of an obvious cause of mechanical hip pain like femoroacetabular impingement, we recommend further imaging, especially if it has an impact on the choice of the surgical approach or technique. Complete excision is crucial to reduce the risk of premature degenerative changes and recurrence.