Ganglion cyst versus synovial cyst? Ultrasound characteristics through a review of the literature

Gruberi bursitis in rheumatic patients with foot and ankle pain: a retrospective sonographic study

Introduction

Foot and ankle pain is a common problem in rheumatic patients. One often underrecognized cause of this complaint is Gruberi (or subtalar) bursitis. The Gruberi bursa is a structure that originates from the sinus tarsi and extends over the dorsal talar surface. It reduces the friction of the extensor digitorum longus tendon over the convex contour of the head of the talus. On ultrasound, Gruberi bursitis is characterized by a well-defined fluid collection in the dorsolateral foot, located between the talus and the tendon of the extensor digitorum longus. Our study aimed to determine the frequency of Gruberi bursitis in patients with various rheumatic diseases who presented with foot and ankle pain at our institution and to describe its sonographic features in detail.

Materials and methods

A descriptive, observational, retrospective study was conducted on patients over 18 years old who visited a tertiary university hospital between 1 July 2022 and 31 December 2023. Details regarding the patients' medical history, age, gender, and primary rheumatic disease were obtained from their medical records. Descriptive statistics were utilized to present the data.

Results

Of the 608 patients examined for foot and ankle pain at our institution during the study period, 78 cases of Gruberi bursitis were identified in 63 patients. The average age of the participants was 61.7 years (range: 25-85 years), and 71% (n = 45) of the participants were women. The sonographic features of Gruberi bursitis included a monocular, anechoic fluid collection typically located between the extensor digitorum longus tendon and the dorsolateral surface of the head of the talus. The mean largest dimension of fluid collections in the oblique plane (from the sinus tarsi and across the dorsal talus) was 16 mm (range: 8-29 mm).

Conclusion

Gruberi bursitis is easily identifiable through ultrasound due to its characteristic location and appearance. In total, we identified this condition in 9% of our rheumatic patients with foot and ankle pain.

Cystic soft tissue tumours of the dorsal aspect of the wrist have two distinct histological subtypes

In total, 38 patients with cystic dorsal wrist tumours managed with surgical excision were prospectively followed up for 2 years. Tissue was examined histologically after primary surgery and at recurrence. Two distinct tissue types were found: ganglion cyst and synovial cyst.

Approach to Evaluating Superficial Soft Tissue Masses by Ultrasound

The purpose of this article is to give a systematic approach to the ultrasound evaluation of superficial soft-tissue masses. The knowledge of proper technique in image acquisition, the characteristic sonographic appearances of the most common masses, their potential pitfalls, and the location of the lesions can help establish a confident diagnosis. Where the sonographic features of the masses are inconclusive, a percutaneous biopsy is effective in establishing the definitive diagnosis.

Glucose Transporter 1 (GLUT1) Positivity in Ganglion Cysts: A Diagnostic Caveat Due to Overlap With Perineuriomas and Other Fibromyxoid Lesions

Glucose transporter 1 (GLUT1) is a sensitive immunohistochemical marker for perineural cells and certain mesenchymal neoplasms, including chordoma, desmoplastic small round cell tumor, desmoid-type fibromatosis, epithelioid sarcoma, gastrointestinal stromal tumor, myoepithelioma, schwannoma, and undifferentiated pleomorphic sarcoma. In this study, we focus on the morphological and immunohistochemical challenges in differentiating between ganglion cysts and perineuriomas. To our knowledge, no previous studies have explored the potential morphological and immunohistochemical similarities between these two lesions. We retrospectively retrieved cases coded as "ganglion cysts" from our departmental archives. Clinical data included the patient's age, gender, lesion location, and size. All slides were reviewed by two pathologists, and 4-μm-thick formalin-fixed paraffin-embedded tissue sections were subjected to immunostaining for epithelial membrane antigen (EMA) and GLUT1. The study included core biopsies and excision specimens from 14 patients (11 females and three males; M:F ratio: 3.6:1), ranging in age from 20 to 89 years (median: 60 years; mean: 53 years). Lesion locations included the finger (six cases), dorsal wrist (five cases), and the knee, volar wrist, and an unspecified hand site (one case each). Morphologically, 11 ganglion cysts were predominantly cystic, with walls composed of dense fibroconnective tissue and focal myxoid changes. These myxoid areas contained spindled and stellate cells within a myxoid stroma. The remaining three cases exhibited a predominantly solid morphology, characterized by dense fibroblastic-myofibroblastic stroma with limited myxoid degeneration and small spindled and bipolar cells. Scant chronic inflammation was observed in most cases. GLUT1 immunostaining showed membranous patterns in all cases, with some cytoplasmic expression, particularly in stellate cells within the myxoid matrix. EMA staining exhibited focal membranous expression in 12 cases (85.71%) and was negative in two cases (14.29%). These findings highlight the importance of caution when evaluating core biopsies of soft tissue lesions with bland cystic and fibromyxoid histology. The morphological and immunohistochemical similarities between ganglion cysts and perineuriomas may pose a diagnostic challenge and risk of misinterpretation. Awareness of these overlaps is crucial to avoid potential pitfalls in diagnosis.

Ultrasound of palpable lesions: a pictorial review

Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.

Ruptured Baker Cyst on 18 F-FDG PET/CT

ABSTRACT

A 78-year-old woman with diffuse large B-cell lymphoma was referred for an 18 F-FDG PET/CT to evaluate therapy response after 6 cycles of R-mini-CHOP. A new 18 F-FDG accumulation was noticed medial in the upper part of the right lower leg, spreading along the medial head of the gastrocnemius muscle. The shaft-bow-looking curvature, arch sign, of 18 F-FDG revealed a fluid collection on CT. This typical pattern and its specific location are indicative of a ruptured Baker's cyst. It can manifest in 1 or both legs.

Synovial Cyst of the extensor digitorum superficialis: A case report

Background

A synovial cyst is a herniation of synovial tissue through a joint capsule, often mistaken for a ganglion cyst. The key distinctions are that synovial cysts have a synovial cell lining, while a ganglion cyst is delineated by dense fibrous connective tissue. Typically found near joints, synovial cysts are associated with conditions like osteoarthritis, prevalent in females aged 20 to 50. We present a rare case of a synovial cyst in the extensor digitorum superficialis of the right hand.

Case summary

A 53-year-old Hispanic female visited our hand clinic due to a 3-year history of pain on the back of her right hand. At exploration, a 3 × 3 cm soft tumor was identified. Surgery revealed a clear-yellowish mass within the extensor digitorum superficialis tendon. Following the surgery, synovial cyst was confirmed by pathology and the patient was discharged without complications.

Conclusion

This case highlights the rare presentation of an intratendinous synovial cyst and emphasizes the importance of a comprehensive understanding of synovial cysts in the differential diagnosis of hand tumors.

Palsy of Both the Tibial Nerve and Common Peroneal Nerve Caused by a Ganglion Cyst in the Popliteal Area

A ganglion cyst is a benign mass consisting of high-viscosity mucinous fluid. It can originate from the sheath of a tendon, peripheral nerve, or joint capsule. Compressive neuropathy caused by a ganglion cyst is rarely reported, with the majority of documented cases involving peroneal nerve palsy. To date, cases demonstrating both peroneal and tibial nerve palsies resulting from a ganglion cyst forming on a branch of the sciatic nerve have not been reported. In this paper, we present the case of a 74-year-old man visiting an outpatient clinic complaining of left-sided foot drop and sensory loss in the lower extremity, a lack of strength in his left leg, and a decrease in sensation in the leg for the past month without any history of trauma. Ankle dorsiflexion and great toe extension strength on the left side were Grade I. Ankle plantar flexion and great toe flexion were Grade II. We suspected peroneal and tibial nerve palsy and performed a screening ultrasound, which is inexpensive and rapid. In the operative field, several cysts were discovered, originating at the site where the sciatic nerve splits into peroneal and tibial nerves. After successful surgical decompression and a series of rehabilitation procedures, the patient's neurological symptoms improved. There was no recurrence.

Ganglion cyst of temporomandibular joint - A systematic review

Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic review aimed to discuss the clinical and histopathological features of ganglion cysts of TMJ, to aid in appropriate treatment. A literature search was done and a total of 20 cases were retrieved from published databases such as PubMed, SCOPUS, and Google Scholar. The cyst presented with swelling in all the cases followed by pain (50 %) and trismus (35 %) as other common symptoms. Though CT and MRI proved helpful in determining the location of the cyst, a histopathological examination was essential in concluding its final diagnosis. It is a pseudocyst lined by dense fibro-connective tissue with myxoid tissue degeneration. Histologically, it is essential to distinguish them from the clinically and radiographically similar true cyst of TMJ, synovial cyst. The lining of ganglion cyst is devoid of epithelium and synovial cells. Surgical excision was found to be the treatment of choice with minimal recurrence (10 %) being reported.

Cystic lesions and bursae around the knee: do they matter in knee osteoarthritis?

The cause of knee osteoarthritis (OA) and knee pain associated with OA is not well understood. Periarticular cystic lesions and bursae around the knee are among the most common morphologic features identified on MRI in the setting of OA. Despite widespread association of these lesions with knee OA and their inclusion in semiquantitative MRI scoring assessment systems for knee OA, the role that these lesions play in the development of knee pain and OA remains uncertain. In this discussion, we review the cystic lesions and bursae most commonly associated with OA of the knee, examine their relation and role in whole organ imaging assessments of OA, and present the literature investigating the associations of periarticular cysts and cyst-like lesions with knee pain and OA.

The current trend of proximal tibiofibular ganglion cyst: A summary of 7 case series and 61 case reports

Purpose

To review the different types of ganglion cysts surrounding the proximal tibio-fibular joint, their management options, outcomes, and recurrence.

Design

Descriptive analytical review.

Results

7 case series consisting of a total of 159 patients and 61 case reports consisting of 80 patients (with three patients having bilateral pathology) were included in this review. (Total cysts 159 + 83 = 242). The mean age was 41 years, and 71 % of the patients were males. 96.5 % of the cases were managed operatively, out of which 98 % of patients felt improvement in local symptoms and 71.5 % had improvement in neurological symptoms. Complete excision of the cyst is the primary mode of operative management. Many added procedures with complete excision are to mitigate the risk of recurrence. The recurrence rate of aspiration, simple excision alone, simple excision with recurrent articular branch neurectomy, and simple excision with PTFJ procedures were 77 %, 56 %, 11.5 %, and 0 %, respectively. Outcomes beyond recurrence were poorly reported.

Conclusion

There is not enough literature regarding the topic from which any formal systematic review can be done. Our summary suggests that aspiration alone or with steroid injection is associated with the highest recurrence rates among all the procedures. Complete excision with recurrent articular branch neurectomy should be the primary management. Revision cyst excision in isolation is an inadequate treatment option, therefore should be done in conjunction with PTFJ arthrodesis, which reduces the recurrence rates. Better quality studies are needed that report patient-centered outcomes and morbidities following PTFJ procedures.

Localized tenosynovial giant cell tumor in children

Background

To investigate the clinical characteristics and surgical efficacy of localized tenosynovial giant cell tumors in children.

Methods

The clinical data, surgery, and follow-up results of 17 children with localized tenosynovial giant cell tumors who visited our hospital from 2011 to 2021 were collected for statistical analysis.

Results

The median patient age was 7 years and 8 months, and the ratio of males to females was 1.43 (10/7). The predilection of disease was similar in hands and feet, and the common presenting symptom was mass. One patient experienced recurrence after surgery, and one child had postoperative functional limitations.

Conclusion

Extremities are common sites of localized tenosynovial giant cell tumors in children. Complete surgical resection helps reduce the recurrence rate.

Level of evidence

Level III.

Differential Diagnosis of Metatarsalgia

Lesser (or central) metatarsalgia is defined as pain in the forefoot under or around the lesser metatarsals and their respective metatarsophalangeal joints. Two common causes of central metatarsalgia are Morton's neuroma (MN) and plantar plate (PP) injury. Because both clinical and imaging features overlap, establishing the correct differential diagnosis may be challenging. Imaging has a pivotal role in the detection and characterization of metatarsalgia. Different radiologic modalities are available to assess the common causes of forefoot pain, so the strengths and weakness of these imaging tools should be kept in mind. It is crucial to be aware of the pitfalls that can be encountered in daily clinical practice when dealing with these disorders. This review describes two main causes of lesser metatarsalgia, MN and PP injury, and their differential diagnoses.

Differential diagnosis and treatment of foot drop caused by an extraneural ganglion cyst above the knee: A case report

BACKGROUND

One of the causes of foot drop is compression of the common peroneal nerve caused by space-occupying lesions such as a synovial cyst or a ganglion cyst. Most previous reports have involved compressive common peroneal neuropathy by intraneural ganglion cysts and synovial cysts. Compression of the peroneal nerve by extraneural ganglion cysts is rare. We report a rare case of compressive common peroneal neuropathy by an extraneural ganglion cyst.

CASE SUMMARY

A 46-year-old man was hospitalized after he reported a right foot drop for 1 mo. Manual muscle testing revealed scores of 1/5 on dorsiflexion of the right ankle. Hypoesthesia and paresthesia on the right lateral leg and foot dorsum were noted. He was diagnosed with a popliteal cyst by using electrophysiologic study and popliteal ultrasound (US). To facilitate common peroneal nerve (CPN) decompression, 2 cc of sticky gelatinous material was aspirated from the cyst under US guidance. Electrical stimulation and passive and assisted active ROM exercises of the right ankle and strengthening exercises for weak muscles using elastic band were prescribed based on the change of muscle power. A posterior leaf spring ankle-foot orthosis was prescribed to assist the weak dorsiflexion of the ankle. Follow-up US revealed that the cystic lesion was growing and magnetic resonance imaging demonstrated compression of the CPN by the cystic mass. The cyst was resected to prevent impending compression of the CPN.

CONCLUSION

Precise diagnosis and immediate treatment are important in cases of compressive common peroneal neuropathy caused by an extraneural cyst.

The management of foot and ankle ganglia: A scoping review

PURPOSE

A ganglion cyst is a benign soft tissue swelling filled with hyaluronic acid and other mucopolysaccharides. Whilst they most commonly present in the wrist region, their occurrence in the foot and ankle is not rare. This scoping review aims to systematically map and summarise current evidence regarding the management of ganglia of the foot and ankle, whilst identifying areas for further research.

METHODS

This scoping review follows the frameworks of Arksey and O'Malley, Levac and Peters. A comprehensive search strategy was used to identify relevant articles, before a two-stage screening process was performed independently by two reviewers.

RESULTS

A total of 2286 unique articles were identified, of which 12 were included in the review. A variety of conservative and surgical treatment strategies are reported, showing good outcomes. An overall pooled recurrence rate of 29.5% was seen across 8 studies. Aspiration alone showed the highest recurrence rate (78.1%), followed by aspiration and steroid injection (62%), steroid injection alone (37.5%) and surgical excision (17.6%). The pooled complication rate across six studies was 21/261 (8.0%), with the most common complication being paraesthesia, reported in 14/261 (5.4%) patients.

CONCLUSIONS

There is a lack of high-quality research currently regarding the treatment of foot and ankle ganglia. Limited evidence suggests that there could potentially be associations between time to treatment, ganglion location and extent of surgical resection and recurrence rate. However, further research is required before any definitive conclusions can be drawn.

Pediatric chest wall masses: spectrum of benign findings on ultrasound

A palpable finding along the chest wall is a frequent indication for pediatric US. Accurate identification of benign lesions can reassure families and appropriately triage children who need follow-up, cross-sectional imaging, or biopsy. In this pictorial essay, we review chest wall anatomy, illustrate US techniques and discuss key US imaging features of common benign lesions and normal variants.

Cystic Ganglionosis in a 3-year-old Mimicking Juvenile Idiopathic Arthritis

Ganglion cysts are common periarticular/peritendinous masses, which are thought to form from myxoid degeneration of collagen that becomes encased by connective tissue.¹ This differentiates them from synovial cysts, which are lined by synovium.^2,3 The presence of numerous ganglion cysts in multiple locations is very rare and has been termed cystic ganglionosis ⁴.

Temporomandibular joint synovial cysts: A systematic review of the literature and a report of two cases

Temporomandibular joint (TMJ) synovial cysts are rare, unlike peripheric locations like the wrist or the knee. They share similar presentations with ganglion cyst, benign and sometimes malignant lesions. Only histopathological analysis confirms diagnosis in some cases, finding a true cyst lined by synoviocytes containing synovial fluid. They seem to be related to an increased articular pressure following trauma. In this study we present two cases of TMJ synovial cyst and a systematic review of the literature. A total of 32 cases were retrieved from published literature in PubMed, Cochrane Library and ClinicalTrials.gov databases using the search terms 'TMJ synovial cyst', 'temporomandibular synovial cyst', 'jaw joint synovial cyst'. Swelling (91.3%) and pain (78.3%) were the most common symptoms. MRI was the most commonly used imaging modality that was found to be beneficial for diagnosis. In almost all cases the cyst was removed under general anesthesia, allowing histopathological examination. Only two patients still had pain after removal of the cyst. No recurrence was observed .

Acupuncture treatment of dorsal wrist ganglion: Case report

Ganglion cysts are benign soft tissue tumors most commonly encountered in the hand. The most widely used approaches are watchful waiting, non-operative aspiration, steroid injection and surgical removal, but these are often associated with high recurrence rates and complications. We report the case of a 38-year-old female graphic designer who presented to the acupuncture outpatient department with chief complaint of an enlarging, painless lump on the left wrist for 5 months. Ultrasound analysis demonstrated a 1.8 * 1.07 cm mass lesion on the dorsum of the left wrist. Her wrist range of motion was approximately 40° active flexion and 30° active extension. Discomfort was the maximum during wrist extension. For each acupuncture treatment, three needles (0.30 mm in diameter, 40 mm in length) were inserted transversely at an angle of 15° and to a depth of 15-20 mm. When the needles were removed after the first treatment, ultrasound analysis showed that the mass lesion decreased in size from 1.8 cm to 1.72 cm, and further to 1.55 cm the following day. The patient underwent treatment every other day for a total of six treatments over a three-week period. By the end of the sixth visit, the cyst had become insignificant in size. The treatment outcome suggests that acupuncture may have effects in perforating the cyst wall and promoting the absorption of the gelatinous fluid within the cyst. Acupuncture may be a viable treatment option with reduced complications and potential faster recovery time for dorsal wrist ganglions.

Recurrence of Ganglion Cysts Following Re-excision

Background

The recurrence of ganglion cysts after surgical excision has a reported rate of 4% to 40%. Recurrence rate after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a secondary excision procedure.

Methods

With Institutional Review Board approval, we retrospectively identified by CPT code and reviewed charts of patients who had recurrent ganglion cyst excision performed over a five-year period (2010 - 2014). Recurrence was defined as reappearance of a cyst in the same area as it was previously. Demographic information including recurrences and revision surgeries was collected in addition to outcome variables such as patient satisfaction, pain levels, and functional limitations.

Results

Out of the 42 revision cases identified 20 patients were reached. Mean time to recurrence of the cyst after the first ganglion cyst excision was 2.5 years (range: 1 month - 12 years). After the second ganglion cyst excision, three patients (15%) had a recurrence, each occurring within one year (mean: 11 months; range: 9-12). One of the three patients underwent a third successful ganglion cyst excision. The other two patients declined surgical intervention to date. Patients without a second recurrence (n=17) reported an average pain score of 0.1 (range: 0-2) on a scale of 1-10. Three (18%) reported some difficulty with day-to-day activities due to their scar. Seven (41%) patients reported at least transient numbness or tingling. Mean satisfaction was 9.8 on a scale of 1-10, and 100% reported that they would undergo another ganglion cyst excision should they ever have another recurrence.

Conclusion

Patients should be advised about the risk of recurrence after re-excision of ganglion cysts, which was noted to be 15% in our cohort. This rate of recurrence is similar to that of primarily excised cysts.

Unusual Presentation of Extensor Tendon Rupture Caused by a Dorsal Wrist Synovial Cyst

Synovial cysts are juxta-articular-fluid–filled collections that are lined by synovial cells, distinguishing them from a very close cystic lesion, which is the ganglion cyst. They usually present with pain and unpleasant appearance; here we present a case of wrist synovial cyst that caused extensor tendon rupture. A 50-year-old woman presented to our clinic with a cystic lesion on the dorsum of her wrist, with an inability to extend her index finger. The lesion was found intraoperatively engulfing the extensors of the index and causing a rupture. The cyst was excised and the tendon was reconstructed; pathology report confirmed the lesion as synovial cyst. Synovial cysts and ganglion cysts are two different entities but they have been used interchangeably in the literature; pathology is the only way to differentiate between them because they usually present with identical scenarios. None of them were reported to cause extensor tendon rupture, as presented in our article. Synovial cysts can cause rupture to extensor tendons if they arise from the sheath, and it is better to anticipate synovial cyst and remove it surgically before causing any further damage, if the lesion appeared to rise from the tendon sheath on further imaging.

Ultra-high-frequency ultrasound of superficial and musculoskeletal structures in the pediatric population

Because of its relatively low cost, lack of ionizing radiation and great versatility, US is considered the imaging modality of choice to evaluate a large variety of pediatric conditions. Imaging of superficial structures and small anatomical parts can be at times limited with standard US. Recent advances in technology yielded ultra-high-frequency US systems that are capable of scanning with frequencies as high as 70 MHz and resolutions of 30 μm. This technology, approved by the United States Food and Drug Administration, has not been widely used in the clinical setting. It has the potential to become a powerful diagnostic tool in clinical practice, especially in the evaluation of infants, given their inherent body habitus. Our main objective is to discuss the use of ultra-high-frequency US at a tertiary care center. This pictorial essay presents a gamut of pediatric pathologies pertaining to imaging of the soft tissues and the superficial and musculoskeletal structures. Our aim in this pictorial essay is to highlight and illustrate the role of ultra-high-frequency US in improving the depiction of common and less common pathologies. We think it also helps to gain a new understanding of the normal anatomy in the pediatric population and to display specific features not shown by standard US and, in certain cases, ones that lead to a change in diagnosis.

Cytomorphological Evaluation of Synovial Lesions in a Tertiary Care Centre in North India: A Retrospective Study

Background:

Numerous pathological processes involve synovium and periarticular tissues that are characteristic and in some cases specific to a particular disease. Synovial fluid is a thick, stringy fluid found in the cavity of synovial joint. Examination of the synovium plays a key role in the diagnosis of many joint diseases.

Aims:

The aim of this study was to study the spectrum of synovial lesions on fine needle aspiration cytology (FNAC) and to compare the cytological diagnosis with histopathological findings.

Material and Methods:

This retrospective diagnostic analytical study was carried out in the Department of Pathology. Sixty-six patients with suspected synovial lesions referred from other departments who underwent FNAC during 1 year from January 2017 to December 2017 were included in the study. The slides along with records of the patients were retrieved and findings recorded. Histopathological evaluation was performed wherever possible and compared with cytological diagnosis.

Results:

Non-neoplastic lesions accounted for 80.3% cases followed by benign tumors (15.2%). Ganglion cyst was the commonest non-neoplastic lesion (60.6%, 40/66), while tenosynovial giant cell tumor was the commonest neoplasm (12.1%, 8/66) observed in our study. Solitary case of synovial sarcoma was also observed. Histopathological evaluation was performed in 14 cases and FNAC had overall diagnostic accuracy of 85.7% in diagnosis of these lesions.

Conclusions:

FNAC is a useful tool with high diagnostic accuracy in the evaluation of synovial lesions.

Effect of fire needle for ganglion cysts: A protocol of systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Ganglion cysts (GCs) are tumor-like lesions that often occur in the soft tissues, which are mostly caused by the degeneration of mucin produced by the joint capsule and tendon sheath on the carpal dorsal joints of extremities. GCs may appear asymptomatic as benign tumors, but some patients also seek treatment because of the pain caused by these fluid-filled cysts. As a kind of complementary and alternative therapy, there have been some studies published in China which have proved that the fire needle has a better therapeutic effect on ganglion cyst. The purpose of this systematic review is to evaluate the efficacy of fire needle in the treatment of GCs.

METHODS

PubMed, EMBASE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database were searched by 2 reviewers from the inception until August 2020. The original study that randomised control trials of fire needle for GCs will be selected and is not limited by country or language. In addition, researches in progress, the reference lists and the citation lists of identified publications will be retrieved similarly. Study selection, data extraction, and assessment of the quality will be performed independently by 2 reviewers who have been trained prior to data extraction. A meta-analysis will be conduct if the quantity and quality of the original studies included are satisfactory; otherwise, a descriptive analysis will be conducted. Review Manager V5.4: (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) software will be using for data synthesis and assessment the risk of bias according by Cochrane Handbook.

RESULT

This study will provide a comprehensive review of current evidence for the treatment of fire needle on GCs.

CONCLUSION

The conclusion of this study will provide a judging basis that whether the treatment of GCs with fire needle is effective.

INPLASY REGISTRATION NUMBER

INPLASY202080032.

Bone Tumors Occurring in the Soft Tissues: A Review of the Clinical, Imaging, and Histopathologic Findings

Although rare in everyday practice, malignancies that classically arise from bone or cartilage have been reported to arise de novo in various soft tissues in the body, resulting in a diagnostic challenge for the clinician, radiologist, and pathologist. Differential diagnoses of bone tumors often depend on anatomic location of the lesion. For example, the classic location of osteosarcoma is in the metaphysis of long bones about the knee. Histologically osteosarcoma is characterized by tumor cells that directly produce osteoid, bone, or cartilaginous matrix. In extraskeletal osteosarcoma, the clinical and radiologic picture is very different from a conventional osteosarcoma. They occur in older patients, present as a soft tissue mass often coincidentally following trauma and have a worse prognosis. The imaging characteristics are often nonspecific with mineralized elements in a well-defined soft tissue mass. The mineralized elements may or may not be visible. Magnetic Resonance sequences demonstrate a well circumscribed soft tissue mass with hemorrhagic and enhancing solid components. The pathologic features of extraskeletal osteosarcoma on a microscopic scale are identical to that of skeletal lesions. Likewise, conventional chondrosarcomas present in older patients with a growing, painful soft tissue prominence most commonly involving the long tubular bones. In extraskeletal chondrosarcoma however, the presentation is in somewhat younger patients with a painful soft tissue prominence typically in the head (meninges), neck, or upper leg. The pathologic features are most often that of a myxoid chondrosarcoma which is characterized by strands of small cells over a myxoid matrix. Imaging features include chondroid matrix, heterogenous contrast enhancement, and amorphous internal calcification on Computed Tomography. On Magnetic Resonance sequences the matrix has a low signal on all sequences, and variable inhomogeneity depending on grade of the lesion. Other extraskeletal bone tumors include Ewing's sarcoma and osteoid osteoma amongst other lesions. Although these malignancies may be rare clinical entities, they often exhibit characteristic clinical, imaging, and histopathological findings although differing in treatment and prognosis. Knowledge of these and other common mimicking lesions will help guide the clinician and radiologist to make an accurate diagnosis.

Inconsistent Use of Terminology and Different Treatment Outcomes of Venous Adventitial Cystic Disease: A Proposal for Reporting Standards

Adventitial cystic disease (ACD) is a very rare condition characterized by the accumulation of a cyst filled with gelatinous substance in the adventitia of a vessel adjacent to the joint area. The cyst usually compresses the vessel lumen, causing claudication or leg swelling. The disease usually affects the popliteal artery. However, several cases of venous ACDs particularly in the common femoral or external iliac vein have been reported. The definition, diagnosis, and optimal treatment of ACD remain controversial because of its rarity and the inconsistent use of terminology. The heterogeneity of the reported cases is more prominent in venous ACD. Herein, the accurate terminology of cysts correlated to the joint (synovial cyst, ganglion cyst, and adventitial cyst) and the pathogenesis, anatomy, and optimal therapy of venous ACD are discussed in detail to establish reporting standards for future studies.

Bilateral synovial cysts of the temporomandibular joint

Synovial cysts very rarely affect the temporomandibular joint (TMJ). On review of the literature, there are 29 reported cases of unilateral synovial cysts of the TMJ. We present a case of bilateral synovial cysts occurring at the TMJs.

Ultrasound as a diagnostic and interventional aid at point-of-care in dermatology clinic: a case report

Ultrasound is currently underutilized in dermatology practice. However, ultrasound provides clinicians with precise and unique information on cutaneous and subcutaneous lesions, while minimizing costs and complications related to more common and invasive diagnostic methods. We report a patient who presented with a tender subcutaneous mass that was diagnosed and treated using point-of-care ultrasound-guidance at the dermatology clinic. Ultrasound revealed features consistent with a ganglion cyst, which was subsequently injected with triamcinolone acetonide under ultrasound-guidance with the resolution of symptoms upon follow-up one month later. Our study demonstrates the utility of ultrasound as an effective, time-efficient diagnostic and interventional aid that can modify dermatology practice.

Role of FNAC in diagnosing lesions of hand and wrist

BACKGROUND

Swellings in the hand and wrist are frequently encountered in clinical practice and fine needle aspiration cytology (FNAC) is used as a primary diagnostic modality in most of them. A wide spectrum of lesions can be encountered at these sites. The aim of this study was to report the prevalence and spectrum of hand and wrist lesions and evaluate the diagnostic role of FNAC.

METHODS

All the patients who presented with palpable lesions in the hand or wrist between January 2011 and July 2016 were reviewed, retrospectively.

RESULTS

1312 cases were subjected to FNAC of hand and wrist swellings, of which 1136 (86.6%) cases were satisfactory. Age ranged from 5 months to 90 years with M: F = 0.7:1. 138 (12.1%) were diagnosed as inflammatory lesions, 875 (77.0%) as benign, non-neoplastic (tumor-like) lesions and 123 (10.8%) were neoplastic lesions. The inflammatory lesions included 75 cases of synovitis, 30 cases of tuberculosis, 28 cases of abscess, one case of cysticercosis, two cases of gout, and fat necrosis each. In the benign, non-neoplastic (tumor-like) lesions, the most common lesion was ganglion (775 cases). The neoplastic lesions included 78 benign lesions with the most common being giant cell tumor of tendon sheath (61 cases). There were 40 cases of mesenchymal lesions, four cases of appendageal tumors and one case of malignancy (squamous cell carcinoma). Mesenchymal lesions accounted for 3.5% (40/1136) cases.

CONCLUSION

FNAC is very useful and simple investigation for early diagnosis of lesions of hand and wrist. The lesions encountered at these sites most commonly are benign.

Ultrasonography as a Diagnostic, Therapeutic, and Research Tool in Orthopaedic Surgery

Ultrasonography is an imaging modality that facilitates the diagnosis of pathology and injection therapy without exposing the patient to radiation. In addition, ultrasonography has become popular because of its portability, low cost, and production of real-time tomographic images that provide a cross-sectional view of anatomic structures. Despite its benefits and widespread adoption in general medicine and other specialties, however, ultrasonography is not as well adapted as a diagnostic and research tool in orthopaedic surgery. An understanding of the basic principles of ultrasonography and the evidence supporting its use can aid the orthopaedic surgeon in applying this modality appropriately in clinical practice.

Sonographic Characteristics of Apocrine Nodular Hidradenoma of the Skin

Nodular hidradenomas are benign sweat gland-derived tumors that can produce clinical and dermatoscopic misdiagnoses. Histologically, these tumors can be classified into eccrine and apocrine subtypes. We present the sonographic characteristics of 6 cases of apocrine nodular hidradenomas, which, to our knowledge, is so far the largest series reported. A detailed sonographic analysis included layers, body location, shape, diameters, echostructure patterns, and vascularity. Two sonographic signs not previously reported in these or other common dermatologic lesions were detected: "snow falling" and "fluid-fluid level." The sonographic characteristics of apocrine nodular hidradenomas can support their earlier and more precise diagnosis.

Cystic Disease of the Groin Presenting as Compression of a Femoral Vessel

In this study, we describe our diagnosis and treatment of two patients who presented with femoral vessel compression caused by a cystic lesion in the groin. One case was diagnosed as adventitial cystic disease (ACD) of the common femoral artery resulting in leg claudication and the other was diagnosed as a ganglion cyst (GC) causing femoral vein compression and unilateral leg swelling. The operative findings differed between these two cases with respect to the dissection of the cyst and femoral vessel, but the postoperative histological examination results were similar. The pathogenesis of ACD and GC is not fully understood, and further investigation is needed to delineate the exact pathology of these uncommon conditions.

Ultrasound of the Gruberi Bursa With Cadaveric and MRI Correlation

OBJECTIVE

The purpose of this study was to describe the appearance and ultrasound characteristics of the Gruberi bursa using a cadaveric model and retrospective ultrasound imaging review.

MATERIALS AND METHODS

For the cadaveric study, ultrasound of the dorsolateral ankle of a foot-ankle specimen was performed and was followed by injection of latex between the extensor digitorum longus (EDL) tendons and the talus and dissection. For the ultrasound imaging review, the radiology database was searched for ultrasound studies performed from September 15, 2000, through April 1, 2015, to identify subjects with a dorsolateral foot or ankle fluid collection detected on ultrasound. Images were retrospectively reviewed to characterize the location and size of the fluid collection, assess for the number of locules, and evaluate the compressibility of the fluid collection. It was determined whether the ultrasound findings were significantly different from chance: CI and p values were obtained from performing a test for one proportion.

RESULTS

Dissection of a cadaveric specimen revealed latex within a well-defined region between the EDL tendons and the dorsolateral talus; this location is consistent with a Gruberi bursa. For the image review, the imaging examinations of 162 subjects (age range, 16-88 years; 31 male subjects and 131 female subjects) were reviewed. On the ultrasound images, a fluid collection with its epicenter between the dorsolateral talus and EDL was found in 93% of ankles. Of the fluid collections identified on ultrasound, 98% were unilocular and 94% were anechoic. Of these fluid collections, 133 were assessed for compressibility, and 89% were compressible. The positive findings for a Gruberi bursa that were different from chance (p < 0.0001) were a fluid collection being located between the EDL tendons and the dorsolateral talus and being unilocular, anechoic, and compressible.

CONCLUSION

The Gruberi bursa characteristically is located between the EDL and the talus; on ultrasound, the Gruberi bursa is most commonly unilocular, anechoic, and compressible.

A rare case of cystic ganglionosis in a child with associated imaging findings

Ganglia are benign soft tissue masses that are found adjacent to joints and tendons. They can be multifocal but they are rarely more numerous than a few around any given joint. "Cystic ganglionosis" has been used to describe a condition in which multifocal and extensive ganglia are present. We present a rare case of cystic ganglionosis in a Caucasian girl with clinical symptoms detected at 6 months of age. To the authors' knowledge, only a single other case report of cystic ganglionosis is documented in the English medical literature. The ganglia in this case are more extensive, manifested at an earlier age and caused erosions of multiple bones, a rarely observed complication of ganglia. Additionally, radiograph, MR and sonographic images collected over 9 years time allows for a detailed description of the imaging characteristics of this case of cystic ganglionosis, and offers unique insight into the natural history of this diagnosis. Extensive ganglia in multiple locations in a young child should alert clinicians to the possibility of cystic ganglionosis. Disease progression may lead to deleterious effects on bone warranting the use of maintenance imaging and possibly surgical resection of symptomatic lesions.

Spectrum of MRI features of ganglion and synovial cysts

Ganglion and synovial cysts occur mainly, but not necessarily, in association with osteoarthritis. Presentation varies widely, ranging from small, incidentally detected, asymptomatic lesions to giant ones that might be the source of symptoms, either due to their compressive effect on adjacent structures or due to complications, such as rupture. On magnetic resonance imaging they are typically presented as smooth, well-circumscribed, thin-walled, unilocular, and homogeneously T2-hyperintense lesions. An identifiable thin stalk communicating to the joint space is not infrequent. Nevertheless, depending on their age, anatomic location, and eventual complication, they might have many distinct appearances, including septae and internal debris, which the radiologist must be familiar with in order to accurately differentiate them from worrisome cystic-like lesions. With regard to this diversity, some illustrative cases are presented.