EC Pulmonology and Respiratory Medicine

Introduction: Primary synovial chondromatosis (prSynCh) is a metaplastic disorder of the synovial membrane, characterized by chondrocyte differentiation of synovial pluripotent stem cells and by marked chondroid and/or osteoid production.

The cause of stem cell differentiation is unknown. Crystal deposits as pathogenic agents are not mentioned in the literature of primary synovial chondromatosis.

Aim of the Study: The aim of this study was to determine the presence of crystal deposits in the synovial membrane by Bély and Apáthy’s non-staining technique and to verify the metabolic origin of prSynCh.

Patient Population and Methods: Twenty-one surgical specimens of 20 patients with clinically diagnosed and histologically confirmed primary synovial chondromatosis were studied.

Results and Conclusion: The formal pathogenesis of primary synovial chondromatosis corresponded to the descriptions of the pertinent literature, characterized by clean chondromatosis, mixed osteochondromatosis and pure osteomatosis.

The prSynCh was accompanied by marked hydroxyapatite (HA) and calcium pyrophosphate dihydrate (CPPD) crystal deposits, and was characterized by definite chondroid and/or bone formation. The calcium carbonate [CaCO₃] and/or calcium phosphate [CaPO₄] deposition was rare and minimal, suggesting an insufficient mineralization capability.

We assume that prSynCh starts with HA and CPPD crystal deposition, which provokes a nonspecific inflammation, with transformation of the pluripotent stem cells into chondrocytes. The conspicuous chondroid and/or osteoid formation replaces the rare and moderate amorphous mineral deposits, and acts as a second line defense mechanism against inflammation provoked by crystalline agents.

In our view the prSynCh is an imperfect metabolic disorder related to apatite rheumatisms or chondrocalcinosis.

Keywords: Primary Synovial Chondromatosis; Pathogenesis; Calcium Hydroxyapatite; Calcium Pyrophosphate Dihydrate; Apatite Rheumatism; Chondrocalcinosis

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