Synovial cavernous hemangioma with juxta-articular hemangioma in a 29-year old woman: A case report

Introduction

Synovial hemangiomas are a rare benign vascular malformation that most commonly affects the knee joint, usually involving the anterior compartment. Histopathology examination is considered the gold standard for the diagnosis of synovial hemangioma. Surgical excision, either done per arthroscopy or per arthrotomy, is the treatment of choice.

Presentation of case

This study presents a 29-year-old female admitted to our hospital in March 2020 who complained of continuous pain, swelling, and recurrent haemarthroses without a history of trauma for six months. The anteroposterior and lateral plain radiographs of the left knee showed no abnormality. An ultrasound of the left knee showed lobulated hypoechoic lesions in intra-articular and infra-suprapatellar pouches. Multiple vessels within the lesion with the low-velocity venous flow have appeared in color-Doppler imaging. Magnetic resonance imaging (MRI) of the left knee showed an irregular soft tissue mass in intra-articular fossa that infiltrating infra-suprapatellar pouches along to vastus medialis muscle (juxta-articular areas) measuring about 87 × 72 × 75 mm. Synovial effusion and bone erosions were notable. Fine-needle aspiration cytology (FNAC) offered hemarthrosis.

The excisional biopsy obtained from the lesion and imprint cytology performed immediately after tissue removal. The cytologic diagnosis was compatible with a benign vascular neoplasm. The histologic exam confirmed synovial hemangioma.

Discussion

Synovial hemangioma is a rare benign tumor of vascular origin arising from synovium-lined tissues, and often affects adolescents and young adults. Synovial hemangioma is often associated with an adjacent cutaneous or deep soft tissue hemangioma. It is a vascular malformation that contains variable amounts of adipose, fibrous, and muscle tissue, as well as thrombi in the vessels. At present, MRI has become the modality of choice for the evaluation of hemangiomas. The final diagnosis established with the histologic examination. The choice treatment is surgical excision.

Conclusion

Although synovial hemangioma is a rare condition, be considered for non-specific clinical symptoms. However, an early diagnosis of synovial hemangioma is fundamental for adequate treatment.