Joint tumors: rare but important differential diagnoses of malignant and benign tumors as well as pseudotumors in rheumatology

• Published in: Zeitschrift für Rheumatologie Vol. 80; no. 2; pp. 165 - 175
• Main Authors: Liewen, C, Krenn, V T, Arens, N, Dierkes, C, Krenn, V
• Format: Journal Article
• Language: German
• Published: Germany 01.03.2021
• Subjects: Diagnosis, Differential; Humans; Joint Diseases - diagnosis; Neoplasms - diagnosis; Rheumatic Diseases - diagnosis; Synovitis; Joint tumors; Histopathology; Pathologies of joint prostheses; Pseudotumors; Benign and malignant joint tumors
• ISSN: 1435-1250
• DOI: 10.1007/s00393-020-00936-7

This review article elucidates the differential diagnostics of malignant and benign joint tumors, pseudotumors of the joints and the peri-implant tissue, which are rare but important entities in rheumatology and orthopedic rheumatology. The tissue of origin includes the synovium, peri-implant tissue, peri-articular fibrous tissue and peri-articular osseous tissue. Pseudotumors can be viewed as independent but heterogeneous entities. These are essentially manifested as tumor-like depositions of crystals, calcareous deposits, vascular malformations, ectasia of the synovia and joint capsule tissue and pseudocysts. Other causes for pseudotumors are focal destructive inflammation (e.g. induced by foreign bodies), high grade synovitis and focal fibrinoid necrosis (i.e. rheumatoid nodules). Methodologically, these diagnostics are based on conventional standard staining methods, immunohistochemical analyses of formalin-fixed and paraffin-embedded materials and on molecular diagnostic procedures. The latter are of great importance in cases of benign and malignant joint tumors. The most important immunohistochemical markers with respect to joint tumors are S100, SM-actin, CD68, CD34, STAT6, clusterin, Muc‑4, beta-catenin and MDM2-FISH. The following markers are recommended for the differential diagnostics and typing of periarticular tumor metastases in the pathology of rheumatic diseases: AE1/AE3, CK8, p63, TTF‑1, TGB, PSA, androgen receptor, GATA, CD56, chromogranin, CDX‑2, SAT-B2, SALL4, estrogen and progesterone receptors, CD45LCA, CD30, CD79a and S100. Necrosis, inflammatory infiltrations and reparative inflammatory changes may complicate the histopathological classification. Therefore, a correlation with clinical, microbiological and radiological data in the sense of interdisciplinary synergistic diagnostics may be required.