Ganglion cyst and synovial cyst of the temporomandibular joint. Two case reports

Ganglion cysts and synovial cysts are lesions rarely associated with the temporomandibular joint. Ganglion cysts arise from myxoid degeneration of the connective tissue of the joint capsule, are filled with viscoid fluid or gelatinous material, and have a fibrous lining. Synovial cysts also contain gelatinous fluid and are lined with cuboidal to somewhat flattened cells consistent with a synovial origin. One case of a ganglion cyst and one case of a synovial cyst of the temporomandibular joint are presented, and their differential diagnosis and management are discussed.

Synovial cyst and degeneration of the transverse ligament: an unusual cause of high cervical myelopathy. Case report

A case of cystic degeneration of the transverse ligament located posteriorly to the dens and causing compression to the lower medulla and upper cervical spinal cord is reported. The clinical, pathological, and radiological findings are described and compared to the literature to characterize this syndrome more fully. The advantages of a posterolateral surgical approach are stressed.

[Juxta-facet cysts as space-occupying intraspinal processes]

Ganglionic and synovial cysts (juxta-facet cysts) causing nerve root compression are very rare. Magnetic resonance imaging is the best means of diagnosis. The treatment of choice is surgical removal of the cysts, though spontaneous remissions do occur. CT-guided aspiration of the cysts and corticosteroid injection can lead the symptoms to disappear, but only for a short time. In a retrospective study covering a period of 16.5 years, we discovered 24 juxta-facet cysts (10 ganglionic and 14 synovial cysts) with clinical symptoms in a total of 19,107 lumbar and thoracic operations performed to relieve nerve root compression: 16 cysts were located at the level L4-5,3 at the level L5-S1,2 at L3-4, and 1 each at the levels L2-3, L1-2, and T10-1. Seven patients complained of radicular pain, and the other 17 patients also had neurological deficits. Fourteen cysts were resected, and in 10 cases the lumbar disc was removed simultaneously. The average follow-up in 23 of the 24 patients was 26.6 months. Most (74%) of the patients became free of pain. Pareses disappeared in 89% and sensory deficits in 73% of cases.

Pseudo-synovial cyst arising at the pubic bone region and forming a large femoral-inguinal mass

We describe a patient with rheumatoid arthritis who presented a large femoral-inguinal mass. The mass proved to be a synovial cyst-like structure communicating with rigid cystic lesions at the pubic bone. No obvious communication between the cystic lesions and the hip joint or bursae was seen by hip arthrogram or in surgery. Pathological examination of the cystic lesion at the pubic bone revealed infiltration of multiple rheumatoid nodules with marked fibrinoid necrosis into the bone, with synovium-like tissue on it. However, no synovial tissue was observed in the femoral-inguinal mass. These findings suggest that the femoral-inguinal mass was not a true synovial cyst but can be called a pseudo-synovial cyst arising at the pubic bone region.

Synovial cysts: clinical and neuroradiological aspects

Lumbar and intraneural synovial cysts are uncommon lesions, although their incidence has increased since the introduction of MRI. The authors describe the results of a study comprising 23 patients with synovial cyst (5 lumbar, 19 intraneural). Neuroradiological investigations included CT scan and MRI; however, it was not always possible to diagnose the nature of the lesion. In 18 cases the lesion was removed totally including its capsule; in the other 5 cases it was removed subtotally. Seven of the 23 patients presented a total remission of symptoms/signs, 11 improved and 5 remained unchanged. The importance of treating synovial cysts as radically as possible is discussed together with their most significant clinical and neuroradiological aspects.

Fine-needle aspiration cytology of ganglion cysts

Ganglion cyst is a relatively common lesion resulting from mucoid, cystic degeneration of soft tissues adjacent to a joint space. Aspiration of cyst contents has been increasingly advocated as a diagnostic and, in some instances, therapeutic modality. We report the fine-needle aspiration cytologic (FNAC) findings from seven cases of ganglion cyst. These include the aspiration of thick, gelatinous fluid and a smear comprised of rare histiocytes embedded in a mucoid matrix. Although these findings are nonspecific, we believe that in the appropriate clinical setting, the diagnosis of ganglion cyst can be made with confidence by FNA.

Hip ganglion: case report and review of the literature

We present an unusual case of a ganglion of the hip. The patient presented with a groin mass initially thought to be inguinal lymphadenopathy, related to a scrotal malignant melanoma excised 2 years earlier. Five similar cases have been previously reported. In all cases the pre-operative diagnosis was wrong (femoral hernia, inguinal lymphadenopathy, inguinal abscess). Only at operative exploration was the correct diagnosis made. The diagnosis of hip ganglion should be borne in mind when a patient presents with an inguinal swelling.

MRI in assessment of the systemic manifestations of rheumatological disease

Magnetic resonance imaging (MRI) has emerged as complementary imaging modality to conventional radiography. The same diagnostic rules that are used in the interpretation of the routine radiographs should be applied to the analysis of MR images with the macroscopic spread of the disease as a main diagnostic clue. MRI has been shown to be a sensitive tool in detecting early arthritic changes and erosions, inflammation in periarticular tendons and tendon sheaths, and in juxtaarticular bursae. MRI plays a pivotal role in diagnosis of arthritis of the craniocervical junction and its complications. It also has been used effectively to detect insufficiency fractures and osteonecrosis. MRI may be important in diagnosing early arthritis, in specifying the differential diagnosis of rheumatic disease, and in selecting subgroups of patients to provide tailored therapeutic regimens.

Atlantoaxial degenerative articular cysts

Cysts associated with spinal joints are not a common cause of neurological symptoms. The authors report a series of five patients with cysts of the atlantodental articulation and review five additional cases from the literature. The patients ranged from 60 to 85 years of age and included three men and seven women. No patient had evidence of rheumatoid arthritis or previous trauma. The cysts caused ventral cervicomedullary compression, did not enhance on magnetic resonance imaging, and were not associated with widening of the anterior atlantodental interval or osseous degeneration of the dens. All patients improved postsurgery. Fusion was required if a transoral procedure was performed. Patients undergoing posterior decompressions were clinically and radiographically stable after operation.

[Synovial cyst of the cruciate ligament. Findings with magnetic resonance in 8 symptomatic cases]

Intraarticular ganglion cysts are uncommon findings: only 30 cases have been reported since the first paper by Caan in 1924 and they were all associated with cruciate ligaments. Many different cystic or pseudocystic lesions are found in articular knee conditions: the most common cystic lesions are popliteal cysts (Baker's cysts), followed by synovial pseudocysts of the posterior cruciate ligament, meniscal cysts and, finally, ganglion cysts of the cruciate ligaments. In our series of 1600 knee MR exams carried out in our MR department since June, 1994, we have found 8 ganglion cysts of the cruciate ligaments. MR studies are always performed on a dedicated 0.2-T permanent magnet (Artoscan, Esaote Biomedica, Genoa, Italy). Five patients were operated on with arthroscopy. The ganglion cysts affected the anterior cruciate ligaments in 4 cases and the posterior cruciate ligaments in 4 cases. The symptoms were mainly pain radiating to the medial side and worsening in forced flexion or extension. The diagnostic suspicion was meniscal tears in 4 patients, chondral lesions in 3 and a loose intraarticular body in one patient. The shape and structure of ganglion cysts in the cruciate ligaments are clearly depicted with MRI. The ganglion cysts in the anterior cruciate ligaments are usually spindle-shaped and within the ligament, while those in the posterior cruciate ligaments have a well-defined outline, with multilocular appearance, and they are usually localized along the ligament, most often on the dorsal aspect. MR signal studies show intermediate signal intensity on SE T1-weighted images and markedly increased signal intensity on SE T2-weighted images. These typical patterns may change depending on lesion content, for instance in the presence of hemoglobin due to an associated angioma. The origin of ganglion cysts in the cruciate ligaments is still unknown, even though many theories have been suggested, including a synovial herniation in ligament fibers, the ectopic inclusion of synovial tissue, a posttraumatic connectival degeneration and, finally, the proliferation of totipotent mesenchymal cells. From a histologic point of view, "synovial ganglion" is a much better definition than "synovial ganglion cyst", because the typical wall of real synovial cysts is missing. The MR patterns are typical of the morphological features described and of the presence of high protein fluid content.

Periodontoid synovial cyst causing cervico-medullary compression

BACKGROUND

Periodontoid synovial cysts are rare lesions which may produce symptomatic cervico-medullary compression.

METHOD

We report such a patient, whose progressive neurological deterioration required surgical treatment by transoral odontoidectomy and decompression.

RESULTS

The diagnostic and theraputic interventions are described, including a lumbar puncture which precipitated a transient loss of consciousness and respiratory arrest. Surgery achieved clinical improvement, without complications or need for operative stablization. Detailed neuropathology is presented, as well as a literature review.

CONCLUSION

Appropriate neuroradiological assessment is required in patients with suspected cervico-medullary compression, and symptomatic periodontoid synovial cysts may respond well to transoral surgical decompression.

Ganglion cyst in the ligamentum flavum of the cervicothoracic junction

A case of thoracic myelopathy secondary to a ganglion cyst originating from the ligamentum flavum at the C7 T1 level is reported. Magnetic resonance imaging (MRI) demonstrated an extradural oval mass at the C7/T1 level with thecal sac and cord compression. Surgical decompression and excision of the ganglion cyst resulted in a good neurologic recovery. Intraspinal ganglion cysts are rare entities. We review the literature and discuss the pathologic findings, pathogenesis and radiologic presentation of ganglion cysts.

A 24-year-old woman with dorsal wrist swelling

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to orthopedic surgeons. The initial history, physical findings, and roentgenographic examinations are noted on this page. The clinical and roentgenographic diagnoses are presented on page 455.

[Compression of the peroneal nerve by a synovial cyst in a 7-year-old child]

PURPOSE OF THE STUDY

Compressions of the peroneal nerve by synovial cysts are rare. Sixty cases have been described since 1921.

MATERIALS AND METHODS

It concerns extrinsic compression of the peroneal nerve by a synovial cyst, developed from the upper tibiofibular joint, in a seven years old child. As far as we know, this is the youngest age found in the relevant literature. Because of a swiftly appearing painful swelling, along with complete paralysis of the peroneal nerve, an electromyogram and a magnetic resonance imaging were performed, in view to confirm the diagnosis and to clarify cyst topography.

RESULTS

Removal of the cyst led to healing with complete recovery of the peroneal nerve within three months.

DISCUSSION

Both intraneural and extraneural cysts exist. Most authors agree that their source is the upper tibiofibular joint. In case of intraneural cysts, complete removal is sometimes impossible. It seems preferable to make a longitudinal incision in the nerve to lay the tumor flat. Indeed, everything possible should be done to find, then ligature, the pedicle which passes by the articular nerve ending of the peroneal nerve in order to avoid recurrence. Extraneural cysts are sometimes intra- or inter-muscular and create a swelling which is often palpable. It is necessary to remove the cyst carefully and to dissociate it from the nerve endings.

CONCLUSION

In all cases, recurrence is not infrequent. Longer the delay before intervention is less satisfactory the recovery will be.

Intraligamentous ganglion cysts of the anterior cruciate ligament: MR findings with clinical and arthroscopic correlations

OBJECTIVE

Magnetic resonance findings with clinical and arthroscopic correlation of intraligamentous cysts of the anterior cruciate ligament (ACL) are presented.

MATERIALS AND METHODS

Three cases of intraligamentous cysts of the ACL were identified out of 681 knee MRI examinations over a 2-year period. Arthroscopy and postoperative MRI were performed in all three patients, each of whom experienced knee pain with extreme flexion and extension.

RESULTS

In all three cases the intraligamentous cyst was homogeneously hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging relative to the ACL. Two of the three ACL cysts required a 70 degrees scope for adequate visualization and establishment of posteromedial and posterolateral portals for arthroscopic treatment. One cyst could not be visualized arthroscopically and probing of the ACL from the anterior portal resulted in drainage of the cyst. No patient had presence of ACL cyst on follow-up MRI or recurrence of symptoms at a mean of 24 months.

CONCLUSION

Intraligamentous cyst of ACL is a rare cause of knee pain. It should be suspected in patients having chronic pain with extremes of motion. Magnetic resonance findings are diagnostic and help to guide arthroscopy.

Synovial cysts in cats

The clinical and radiographic appearance and histological findings in three cats with cystic extensions of the elbow joint capsule are described. The condition was only temporarily alleviated by surgical excision or drainage. In all cases the condition was associated with osteoarthritis.

Giant ganglion of the proximal tibiofibular joint: a case report

Ganglions of the tibiofibular joint are a rare condition. The exact tissue of origin could not be accurately determined despite the use of CAT scanning. At surgery a giant ganglion of the tibiofibular joint was resected with preservation of the peroneal nerve.

MRI appearance of meniscal cysts

PURPOSE

The purpose of this study was to review the MRI criteria for the distinction of meniscal cysts from other cystic lesions in the knee so that appropriate treatment may be planned.

DESIGN

A retrospective review of 62 knee MRI scans possibly showing meniscal cysts was performed. The type of meniscal tear, the appearance of the connection between the cyst and the meniscal tear, and the location, size, morphology, and signal characteristics of the meniscal cysts were recorded. Other types of fluid collections that had been mistaken for meniscal cysts were described.

PATIENTS

Sixty-two patients were studied, ages 16-79 years, 61% male, 39% female.

RESULTS AND CONCLUSIONS

Most of the meniscal cysts (91%) occurred immediately adjacent to the meniscal tear (98% horizontal cleavage tears, 49% anterolateral), with the tear leading directly into the cysts. In two cases, the cyst had dissected into the soft tissues distant from the meniscus and a connecting stalk was visualized. Fluid collections in normal bursae and recesses that had been mistaken for meniscal cysts had no direct connection to a meniscal tear. MRI can be used to distinguish meniscal cysts from other fluid collections that may mimic meniscal cysts. Pitfalls can be avoided by familiarity with the normal bursal and capsular anatomy, and by the application of specific diagnostic criteria.

Intraneural ganglion of the common peroneal nerve in a 4-year-old boy

The case history of a 4-year-old boy with an intraneural ganglion of the common peroneal nerve is presented. These lesions are rare, more commonly affect males, and typically present with a painful foot-drop. A mass is often palpable adjacent to the neck of the fibula. Our patient has made a good recovery after surgery.

Synovial cysts of the lumbar spine: diagnosis, surgical management, and pathogenesis. Report of eight cases

BACKGROUND

Synovial cysts are uncommon extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. Most of these lesions occur in the lumbar spine at the L4-5 level and to a lesser extent at the L5-S1 and L3-4 levels.

METHODS

A retrospective study involving eight patients seen by the neurosurgery service from January 1, 1989, to May 30, 1994, was analyzed. The type, duration, and distribution of symptoms were evaluated, along with the patient's age and sex. All patients had lumbosacral spine x rays and magnetic resonance imaging. Four had a computed tomography-myelogram of the lumbar spine. All patients underwent a laminectomy or hemilaminectomy and cyst excision, and all were followed for a minimum of 1 year. The presence of a synovial cyst was confirmed by histopathology.

RESULTS

Of the eight patients, seven had dramatic pain relief with five having complete resolution of pain. The single care of persistent pain was found to be due to scar tissue at the operative site. All five cases of preoperative lower extremity weakness showed complete resolution. Dysesthesia was either unchanged or decreased.

CONCLUSIONS

Surgery is a safe, effective treatment for patients with lumbar synovial cysts and is the treatment of choice for these lesions.

Digital nerve compression by hyperplastic Pacinian corpuscles. A case report and immunohistochemical study

A 68-year-old lady developed digital pain within days of the excision of a palmar ganglion. This was found to be due to a mass of hyperplastic Pacinian corpuscles compressing the digital nerve. Immunohistochemistry was carried out on the resected corpuscles using antisera to a range of neuropeptides. Possible mechanisms of hyperplasia are discussed.