Blau syndrome: a new kindred

Blau syndrome is a rare condition typically defined by granulomatous arthritis, skin eruption, and uveitis occurring in the absence of lung or other visceral involvement. Other characteristic physical findings include synovial cysts and camptodactyly. We describe a new kindred demonstrating autosomal dominant inheritance and anticipation.

Ganglion cysts of the posterior cruciate ligament

Ganglion cysts arising from the posterior cruciate ligament (PCL) of the knee are rare. Thirteen cases have been reported with detailed description in the English literature. In this study, 3 cases of ganglion cyst arising from the PCL of the knee are described and comparatively reviewed with the literature. This case report draws attention to clinical symptoms and signs. We presume that rather than mechanical block, it is changes in the shape and dimension of the ganglion cyst with knee motion and posture that stimulate nerve endings in the synovial membrane, causing the development of knee pain and the limitation of knee motion.

Isolated unilateral hypoglossal nerve paralysis caused by an atlanto-occipital joint synovial cyst

An isolated unilateral hypoglossal nerve lesion is an uncommon cranial nerve palsy. We report a case of isolated hypoglossal nerve paralysis caused by an intra-dural synovial cyst. To our knowledge, this is the first reported case of a twelfth nerve paralysis caused by a synovial cyst. The anatomy of the hypoglossal nerve, its blood supply and the relationship of the nerve to the atlanto-occipital joint are reviewed, along with the common causes of isolated hypoglossal nerve paralysis.

[Ganglions of the wrist: proposals for topographical systematization and natural history]

PURPOSE OF THE STUDY

We looked for the anatomic origin and mechanism of constitution of the so-called "ganglions" of the wrist.

MATERIAL AND METHODS

Fifty-nine formations considered to be synovial ganglions were dissected and removed according to the same protocol by the same surgeon. Eleven were re-examined by a pathologist. All ganglions were extra-articular but had intra- and extra-capsular components. The extra-capsular part was the clinically palpable main cyst. The intra-capsular part was composed of the cystic stalk and its base of implantation. An intra-capsular stalk was present in 58 cases. The stalk was situated between the joint synovium and the capsula which it perforated at a weak point between two ligaments, forming a collar before expanding outwardly. Based on our findings, we propose a topographical systematization and natural history of ganglions of the wrist.

RESULTS

The stalk's implantation base was always located on bone and found in the intermediate area of Colomniati and Soubbotine, which lies outside the articular cartilage between the synovium and the ligamentous capsula. This area is exposed to mechanical stress initiating histological degenerative lesions, particularly mucoid degeneration. At the radiocarpal joint, the stalk's base of implantation was located at the distal end of the lateral dorsal or volar edge of the lunate bone or at the corresponding part of the scaphoid. The collar of the proximal ganglions was situated between the dorsal radiocarpal and transverse scaphotriquetral ligament. The collar of distal dorsal ganglions was situated between the transverse scaphotriquetral and the trapezotriquetral ligament. The collar of the lateral ganglions was situated between the lateral collateral and the transverse ligament. The collar of the volar ganglions was situated between the stylocarpal ligament and the radiolunotriquetral ligament, or between the different stylocarpal ligaments. At the level of the scaphotrapezal joint, the stalk's base of implantation was located near the collateral edge of the distal surface of the joint with the collar between the distal scaphoidal ligaments. The palmar cysts exhibited a collar between the stylocarpal ligaments and the radiolunotriquetral ligament or between the different stylocarpal ligaments.

DISCUSSION

At pathology examination, the lesions were not found to be different from those observed in other connective tissues exposed to overuse or repeated microtrauma (sports, occupational exposure). Anatomic conditions inside the joint capsula excluded extension of the mucoid degeneration transversally. The only issue was through the capsula, allowing the mucus enclosed in the connective tissue fibers to form the main cyst.

CONCLUSION

Knowledge of these different processes enabled a topographical systematization useful for complete surgical or arthroscopic removal of the ganglion. Complete resection would prevent recurrence.

Cutaneous metaplastic synovial cyst

Metaplastic synovial cyst of the skin is a recently recognized entity characterized by an intradermal nodule that usually occurs at the site of previous surgical trauma. Histologically, the lesion demonstrates a cystic structure with villous-like projections and a lining resembling hyperplastic synovium. We have studied two patients with rheumatoid arthritis, aged 46 and 55 years, who presented with cystic nodules localized on the thumb and great toes, respectively, without any history of previous trauma or surgical procedures performed in the areas. The presence of vimentin and CD 68 positivity of the cells lining the cyst walls supports the similarities between normal and metaplastic synovium. We hypothesize that constant pressure on the great toe, repeated manipulation of the finger, and chronic inflammation around the affected joints may have played roles in the pathogenesis of the lesions in our patients.

[Suprascapular nerve entrapment by a ganglion cyst: a case report]

A twenty-two-year-old male patient presented with complaints of muscle atrophy and shoulder pain. Clinical and radiological studies showed a ganglion cyst near the spinoglenoid notch and a diagnosis of compression of the inferior branch of the suprascapular nerve was made. Following open excision of the cyst by a posterior approach, the patient's complaints subsided. A year after the operation recurrence of the lesion was detected. Arthroscopic control showed no intrarticular lesion. The patient still experiences minimal pain from time to time.

A giant ganglion cyst that developed in the infrapatellar fat and partly extended into the knee joint

Ganglion cysts of the knee joint usually present near the lateral meniscus. Their size varies, and they may be encased in single or multiple capsules. Few case reports on ganglion cysts of the knee joint have been reported. We report a giant ganglion cyst that developed in the patellar fat and partly extended into the joint. The ganglion cyst was exposed in the meniscosynovial junction and was electrically evaporated at the anterior horn. No recurrence has occurred to date, and the patient has returned to his previous level of activity.

Ganglion cyst of the temporomandibular joint

We report a case of cystic lesion in a 37-year-old woman. The patient had an oval-shaped lesion adjacent to the temporomandibular joint. Thick fibrotic tissue and muscle were observed microscopically, but the epithelium lining was not observed. The lesion was diagnosed as a ganglion cyst. The patient's general medical history was non-contributory. High performance liquid chromatography (HPLC) and mass spectrophotometry (MS) revealed some proteins from the fluid in the lesion, such as a filaggrin precursor, dystroglycan, a polyprotein of the hepatitis C virus, and proteins originating from bacteria. The follow-up examinations revealed no recurrence. The probable pathogenesis of the lesion is discussed.

Prevalence and size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections in asymptomatic knees on MR imaging

OBJECTIVE

The purposes of this study were to evaluate the prevalence and determine the size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections on MR images of asymptomatic knees.

MATERIALS AND METHODS

MR images of 102 asymptomatic knees were evaluated with regard to the prevalence of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections. The MR examinations were performed in patients (mean age, 42.8 years; age range, 18-73 years) with clinically suspected meniscal lesions in the contralateral knee. The craniocaudal, anteroposterior, and mediolateral diameters of detectable abnormal fluid collections were measured.

RESULTS

Medial meniscal cysts (mean size [craniocaudal x anteroposterior x mediolateral], 9 x 6 x 13 mm) were found in four asymptomatic knees. Neither lateral meniscal cysts nor ganglionic cysts of the cruciate ligaments were identified. Twenty-six synovial cysts of the popliteal space (Baker's cyst)-consisting of 11 gastrocnemius portions (mean size, 19 x 8 x 10 mm) and 15 semimembranosus portions (mean size, 20 x 7 x 9 mm)-were found in 19 knees. Twenty-four (92%) of these cysts had a maximal diameter of 30 mm or less. Fluid-filled bursae were found in 49 knees. The deep infrapatellar bursa was most commonly involved (42 knees; mean size, 6 x 3 x 5 mm). Fluid-filled anserine bursae (mean size, 27 x 12 x 10 mm) were detected in five knees.

CONCLUSION

Meniscal cysts may be present in asymptomatic knees, at least on the medial side. Synovial cysts of the popliteal space can be found in approximately one fifth of asymptomatic knees. Their maximal diameter is usually smaller than 30 mm.

Arthroscopic ganglion cyst excision in the anterolateral aspect of the knee

We present a case of ganglion cyst of the knee treated arthroscopically. Ganglion cysts typically arise from the anterior or the posterior cruciate ligament. In this case of an anomalous location, a 3.5-cm mass arose directly from the anterolateral articular capsule, lying over the lateral meniscus, displacing Hoffa's fat pad and joining the pretibial bursa. We removed it arthroscopically using only medial portals to avoid cystic wall damage and fluid leakage from the lateral portal. Arthroscopic evaluation was performed starting from the inferomedial portal to assess the cyst location, and shifting to the mid patellar portal. From that portal, we were able resect the cyst, opening the wall and shaving and aspirating the myxoid fluid.

[Suprascapular nerve entrapment at the spinoglenoid notch secondary to a ganglion cyst]

Suprascapular neuropathy may occur as a result of traction, direct trauma, repetitive microtraumas, and extrinsic compression. A thirty-one-year-old man presented with non-traumatic complaints of right shoulder pain and stiffness. After exclusion of other causes associated with shoulder pain, a diagnosis of suprascapular nerve entrapment was considered. Electromyographic activity of the right shoulder was compared with that of the left side and involvement of the infraspinatus muscle was detected, with the supraspinatus muscle appearing normal. Magnetic resonance imaging revealed a ganglion cyst around the spinoglenoid notch. The patient underwent arthroscopic examination and open cyst excision. Arthroscopy did not show any labral tears. Pathological diagnosis was made as a cystic ganglion. On follow-up examinations, the patient's complaints disappeared and only minimal infraspinatus muscle atrophy was observed. Suprascapular nerve entrapment should be considered in the differential diagnosis of posterior shoulder pain.

[A case of a ganglion cyst originating from the hip joint and surgical outcome]

Ganglion cysts are the most common soft tissue tumors of the hand, wrist, and foot. However, those originating from the hip joint are not so frequent. This case report presents a 36-year-old woman who complained of pain in the right groin. A diagnosis of atypical ganglion cyst of the hip was made and the lesion was surgically removed. The diagnosis was confirmed histopathologically. No complaints were observed after a follow-up period of 18 months.

Giant intraosseous cyst-like lesions in rheumatoid arthritis report of a case

The term "intraosseous synovial cyst" is used to designate both the epiphyseal cyst-like lesions seen in patients with rheumatoid arthritis (RA) and mucoid cysts, which occur in a different setting. We report the case of a patient in whom a 4-cm cyst-like lesion developed in the left tibia 18 years after onset of RA and 6 years after osmic acid synovectomy of the left knee. Positive contrast arthrography and magnetic resonance imaging visualized a communication between the lesion and the joint space. Preexisting bone and joint lesions and increased intraarticular pressure play a major role in the genesis of cyst-like lesions in RA. In our patient, the osmic acid synovectomy may have contributed to the development of the lesion. "Synovial cyst" is a misnomer for these giant lesions, which are geodes rather than cysts. Despite their low incidence, these lesions deserve attention because they raise diagnostic and therapeutic problems.

Cutaneous metaplastic synovial cyst: unusual presentation with "a bag of worms"

BACKGROUND

Cutaneous metaplastic synovial cyst (CMSC) is a rare cystic tumor that is unfamiliar to most dermatologists. A traumatic history usually precedes its onset. CMSC is often misdiagnosed as suture granuloma clinically. A correct diagnosis requires histopathologic examination to reveal its characteristic features, that is, a cystic tumor line by synovium-like structure.

OBJECTIVE

To describe a case of CMSC encountered during dermatologic surgery practice. We present an unusual case with elongated projections.

METHODS

A case report and literature review are presented.

CONCLUSION

The differential diagnosis of tender cutaneous cysts should include CMSC. Projections from the cyst wall may attain significant size and give the intraoperative impression of a "bag of worms."

Association of spondylarthropathies with lumbar synovial cysts

Intraspinal synovial cysts presenting with lower back pain and radiculopathy are well known but rare. They are associated with facet joint arthopathy, generally degenerative in nature. Spinal synovial cysts have not been described in spondyloarthropathies (SpA). We report a case of a 66-year-old man with a chronic undifferentiated SpA who presented with severe weakness of both legs. A centrally located spinal cyst was encountered on MRI and led to excision of a highly inflammatory synovial cyst. This association may not be fortuitous and be related to inflammation of the facet joint in SpA.

Morphology and topography of intraosseous ganglion cysts in the carpus: an anatomic, histopathologic, and magnetic resonance imaging correlation study

PURPOSE

To assess the morphology, topography, frequency, and etiology of intraosseous carpal ganglions.

METHOD

Two hundred and eighty formalin fixed cadaveric wrists (mean age 80.3 +/- 9.7 years, range 40 to 101 years) were radiographed. Fifty specimens suspicious for cyst-like bone lesions underwent magnetic resonance imaging (T1w and proton density-fat-saturated images, 1.5T). Dissection, articular surface assessment, and histological examination were performed. Cystic lesions with adjacent destruction of the hyaline cartilage were classified as degenerative and were excluded.

RESULTS

In 27 of the 50 specimens, 48 ganglion cysts (GC) were found. Prevalence of GC was 9.6%. Of 48 intraosseous carpal GC, 41 (85%) were in a peripheral location; 27/48 (56%) were located at the palmar carpus. GC had a macroscopic and microscopic relationship to the insertion of degenerated ligaments. They developed near longitudinally orientated bone surfaces, which serve as insertion for ligaments and are exposed to tension loading.

CONCLUSIONS

Unlike degenerative cysts, ganglion cysts do not erode the hyaline articular cartilage and almost always have a continuity with the capsular ligaments. Intraosseous carpal ganglion cysts are probably the result of mucoid degeneration of adjacent ligaments.

[The juxtaacetabular ganglion]

A juxtaarticular ganglion (JAG) is a rare tumor-like lesion of the acetabulum, causing chronic hip disability. Due to its location, a JAG is a special form of an intraosseous ganglion. There is a lack of histological criteria to differentiate a JAG from an osteoarthritic cyst. The clinical findings of a JAG are determined by its proximity to the joint gap and its extraarticular extension. In a case report the necessary diagnostics as well as the therapeutic consequences are discussed.

Synovial cyst of the pulp of the little finger--origin from the wrist joint

Synovial cysts of the pulp of the little finger in three elderly patients were shown by arthrography to arise from leakage of synovial fluid from the wrist joint into the ulnar bursa and thence into the flexor synovial sheath in the digit. Distant as well as local sources of the contents of synovial cysts should be considered when the local anatomy permits communication between a degenerate joint and an adjacent tendon sheath.

Serpiginous ganglion cyst of the foot mimicking cutaneous larva migrans

A patient had a serpiginous lesion on the foot that turned out to be a ganglion cyst. This lesion is more common on the hands. On the lower extremity, ganglion cysts tend to have a misleading clinical appearance. Histologic examination shows pseudocysts formed by mucoid degeneration of collagen structures. The pathogenesis is unclear. Many ganglions are asymptomatic, but pain occurs in 50% of cases. Management of symptomatic lesions is surgical excision. Recurrence is possible.

Bilateral symptomatic synovial cysts of the lumbar spine caused by calcium pyrophosphate deposition disease: a case report

STUDY DESIGN

A case of bilateral symptomatic facet joint synovial cysts arising in association with calcium pyrophosphate deposition disease is reported.

OBJECTIVE

To present a previously unreported cause for symptomatic synovial cysts of the lumbar spine.

SUMMARY OF BACKGROUND DATA

Synovial cysts of the facet joints occur most commonly in association with degenerative disease of the spine in older individuals. The association of these cysts with trauma, rheumatoid arthritis, spondylolysis, and kissing spinous processes also has been reported. These cysts can cause symptoms and signs from direct compression of the dura. Chondrocalcinosis has not been previously reported to cause symptomatic synovial cysts.

METHODS

A 67-year-old woman presented with right lower limb sciatica caused by a right L4-L5 facet joint cyst, which resolved after surgical decompression. A year later, she presented with left lower limb sciatica caused by development of a new L4-L5 facet joint cyst, which also resolved after surgical decompression.

RESULTS

Histopathologic examination of each cyst showed a cyst wall of fibrous tissue with synovial lining, inflammation, and granulation tissue. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate.

CONCLUSIONS

In patients with a history of gout or pseudogout, a rare possibility of a synovial cyst should be considered in the differential diagnosis during investigation for the cause of neural compression resulting in sciatic syndrome.

Far lateral extraforaminal lumbar synovial cyst: report of two cases

OBJECTIVE AND IMPORTANCE

We present two cases of a far lateral extraforaminal synovial cyst at the L5-S1 level of the spine. Neither case was diagnosed as a synovial cyst before surgery because of their atypical location. Only one other case of an extraforaminal synovial cyst, located at L4-L5, has been reported in the literature.

CLINICAL PRESENTATION

Both women presented with radicular leg pain and examination findings consistent with L5 root compression.

INTERVENTION

During surgery, the cyst was not associated with the facet joint. One cyst was adherent to the nerve root. Both cysts were completely resected, with excellent pain relief.

CONCLUSION

These cases serve as a stimulus to look outside the spinal canal and foramen in patients with symptoms suggesting nerve root compression. Far lateral extraforaminal synovial cyst should be included in the differential diagnosis.

Fine needle aspiration cytology of bursal cyst

OBJECTIVE

To evaluate the cytomorphology of bursal cyst and assess the efficacy of aspiration cytology in its diagnosis and treatment.

STUDY DESIGN

Nineteen cases of bursal cyst seen over four years were studied. Material was obtained by fine needle aspiration. The smears were stained with May-Grünwald-Giemsa stain and hematoxylin and eosin.

RESULTS

Eight cysts were in the popliteal fossa, 4 on the elbow, 3 on the knee, 2 on the shoulder and 2 in the calf. Gelatinous material was aspirated in all the cases. In some cases the cyst collapsed after aspiration. The key diagnostic features were hypocellular smears in a mucoid background. Histiocytelike (synovial) cells were seen lying in all cases and as pseudopapillary structures in two.

CONCLUSION

The presence of a cyst at a classic location with aspiration of gelatinous material and the presence of singly occurring histiocytelike cells in a mucoid background in smears is diagnostic of bursal cyst. The procedure is therapeutic in some cases.

[Atypical ganglion cysts]

Intra- or para-articular ganglion cysts are frequent and can develop at some distance from the joints. The authors describe examples of typical and atypical ganglion cysts, namely meniscal cyst, intra-articular cyst, intraosseous cyst, intraneural cyst of tibial nerve, adventitial cyst of popliteal artery, and para-articular cyst of the hip, filled with gas of presumed articular origin. The diagnosis of a ganglion cyst can be difficult when there is no evident articular communication. If demonstration of communication is necessary (in case of uncertain diagnosis or for preoperative assessment), the best procedure is arthrography followed by a CT scan 1-2 hours after the injection.