Systemic pathology: tenosynovial giant cell tumour: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Systemic pathology: tenosynovial giant cell tumour

Sample item

A 30-year-old man has recurrent haemorrhagic knee effusions. MRI shows blooming from haemosiderin, and the synovium is villous and rusty brown. Histology shows sheets of mononuclear cells, multinucleated giant cells and haemosiderin-laden macrophages. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Pigmented villonodular synovitis

Pigmented villonodular synovitis (diffuse tenosynovial giant cell tumour) is a benign neoplastic proliferation of synoviocytes with CSF1 rearrangement, causing recurrent haemarthrosis and haemosiderin deposition. It can erode bone and recurs after excision. Synovial sarcoma is a biphasic malignancy with a t(X;18) translocation.

Option by option

  • A. Synovial sarcoma

    Synovial sarcoma is a spindle and epithelial malignancy with t(X;18), not a haemosiderin-rich villous synovium.

  • B. Pigmented villonodular synovitis (correct)

    Correct. Haemosiderin-laden macrophages, giant cells and villous brown synovium indicate PVNS.

  • C. Rheumatoid synovitis

    Rheumatoid synovitis shows pannus, plasma cells and lymphoid follicles in a polyarticular disease.

  • D. Synovial chondromatosis

    Synovial chondromatosis shows cartilaginous loose bodies and not haemosiderin.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Pigmented villonodular synovitis. Pigmented villonodular synovitis (diffuse tenosynovial giant cell tumour) is a benign neoplastic proliferation of synoviocytes with CSF1 rearrangement, causing recurrent haemarthrosis and haemosiderin deposition.

Why is "Synovial sarcoma" not the answer?

Synovial sarcoma is a spindle and epithelial malignancy with t(X;18), not a haemosiderin-rich villous synovium.

Why is "Rheumatoid synovitis" not the answer?

Rheumatoid synovitis shows pannus, plasma cells and lymphoid follicles in a polyarticular disease.

Why is "Synovial chondromatosis" not the answer?

Synovial chondromatosis shows cartilaginous loose bodies and not haemosiderin.

What concept does this question test?

It tests Systemic pathology: tenosynovial giant cell tumour in Pathology. It can erode bone and recurs after excision. Synovial sarcoma is a biphasic malignancy with a t(X;18) translocation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic pathology: tenosynovial giant cell tumour?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.