J Korean Foot Ankle Soc.  2019 Mar;23(1):35-38. 10.14193/jkfas.2019.23.1.35.

Tenosynovial Bilateral Lipoma Arborescens of the Ankle in Adults

• Gwak HC
• Kim DH
• Roh SM
• Choo HJ
• Kim YJ
• Jeong JW
• Jung SH

• KMID: 2440583
• DOI: http://doi.org/10.14193/jkfas.2019.23.1.35

Abstract

Lipoma arborescens or synovial lipomatosis is a rare disorder that is characterized by mature fat infiltration of the hypertrophic synovial villi, most frequently affecting the supra-patellar pouch of the knee. This paper presents a case of lipoma arborescens of the ankle joint bilaterally in an adult patient with involvement of both the intra-articular synovium and the synovial sheath of the tendons around the ankle.

Keyword

Lipoma arborescens; Ankle; Tendons; Peroneal tendon sheath; Magnetic resonance imaging

MeSH Terms

Adult*
Ankle Joint
Ankle*
Humans
Knee
Lipoma*
Lipomatosis
Magnetic Resonance Imaging
Synovial Membrane
Tendons

Figure

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  Figure 1 Photographs of the right ankle (A) and the left ankle (B) show soft-tissue swelling around lateral malleolus. Soft and movable mass-like lesion (A: 5×7 cm size, B: 4×6 cm size) was observed.

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  Figure 2 Internal oblique radiographics of the right ankle (A) and the left ankle (B) show soft tissue swelling of the postero-lateral ankle.

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  Figure 3 (A, B) Ultrasound scan, longitudinal view, shows encasement of the extensor tendons by the thickened synovium (black arrows). A Large amount of joint effusion in lateral aspect of both ankles (white arrows).

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  Figure 4 (A) Axial proton density-weighted magnetic resonance image showing high signal intensity within the peroneus brevis tendon at the postero-lateral malleolar level representing longitudinal tear (black arrow). The peroneus longus tendon (white arrow) is normal. (B) Axial T2-weighted fat-suppression magnetic resonance image at the corresponding level shows fluid collection with frond-like proliferations of the synovium of the involved tendon sheaths and ankle joint, with low signal intensity of the hyperplastic fat tissues (white arrows).

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  Figure 5 (A) The Anterior talofibular ligament is thin and has irregular margin and suspicious disruption of contour, meaning a chronic partial tear (black arrow). (B) Axial T2-weighted fat-suppression magnetic resonance image at the corresponding level shows fluid collection with frond-like proliferations of the synovium of the involved tendon sheaths and ankle joint, with low signal intensity of the hyperplastic fat tissues (white arrows).

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  Figure 6 (A, B) Intraoperative photographs demonstrate abundant fat within the opened peroneal tendon sheath and partial tear of peroneus longus tendon in both ankles (black arrows). (C) There is a longitudinal split tear of the peroneus brevis tendon (black arrow).

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  Figure 7 Gross photos of mass which are lipoma arborscence with abundant fat tissue and remnant of peroneus longus tendon in left ankle (A: 2×5 cm sized, 3.5 cm sized mass) and in right ankle (B: 2×2.5 cm sized, 6×6 cm sized mass).

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  Figure 8 (A) Photomicrographs of excised synovium showing a lipomatous infiltrate within the synovium. On low power, a fatty infiltrate is seen in the synovium, giving it a lobular or villous contour (H&E stain, ×40). (B) High magnification shows mature adipose cells deep to a hyperplastic layer of synovial cells with scattered inflammatory cells and small plexiform vessels (H&E stain, ×40).

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