Ganglion cysts arising in unusual locations

Triggering of Thumb by a Ganglion Cyst of the Flexor Tendon Sheath at A1 Pulley: A Case Report

Introduction:

Ganglions of the wrist and hand are commonly seen but the most common sites are in the dorsum of the wrist followed by the volar side in the distal forearm at the wrist crease. The Ganglion cysts arising from the flexor tendon sheath are rare and only a few are reported in the literature.

Case Report:

We report a rare case of a ganglion cyst of the flexor tendon sheath at A1 pulley of thumb in a 35-year-old male who came with the complaint of chronic triggering of the left thumb. The histopathological examination confirmed the ganglion which was removed from the A1 pulley area.

Conclusion:

A1 pulley ganglion causing trigger thumb is uncommon entity. Although, traditional treatment for this is conservative or aspiration. High recurrence is observed. When it comes to preservation of fine movements such as thumb, aggressive approach involving exploration and excision of cyst gives good functional outcome and reduces chance of recurrence.

Association of Lumbar Synovial Cysts with Facet Effusion

To show the frequent association of synovial cysts and facet effusion.

MR studies of 26 patients with lumbar synovial cysts were reviewed for sex/age incidence, anatomic location, multiplicity of cysts and associated pathologies. All studies were reviewed for presence of facet effusion.

26 patients had 39 MRI documented synovial (17 females, 9 males). Age distribution: 41 – 79 years. Location of cysts: L4/5 = 29, L3/4 = 6, L5/S1 = 3, L1/2= −;1. 36 synovial cysts showed facet effusion. 19 patients also had facet effusions at adjoining motion segments or at contralateral joints. Synovial cysts were found in anterior (n=20), posterior (n=13), anterior-posterior (n=3) positions. 18 patients had cysts localized to one single facet joint, 8 patients showed synovial cysts at multiple facet joints.

The frequent coexistence of synovial cysts and facet effusion in our material suggests a causal relationship. External herniation of synovium from a fluid expanded joint space appears to be the most plausible pathologic mechanism.

Lumbosacral intraspinal extradural ganglion cyst in a cat

Case summary

A 16-year-old neutered female domestic shorthair cat was referred for chronic history of reluctance to jump, stiffness of the tail and lower back pain. Mild pelvic limb ataxia, reduced perianal reflex and lumbosacral discomfort were present on neurological examination. On magnetic resonance imaging, a well-defined rounded structure of 3 mm in diameter was identified on the right dorsal aspect of the epidural space at L7–S1, causing displacement of the cauda equina. The lesion was hyperintense to spinal cord parenchyma on T2-weighted images and hypointense on T1-weighted images, consistent with a fluid-filled structure. A Lumbosacral dorsal laminectomy was performed. A clear fluid-containing structure was identified between the right L7 nerve root and the cauda equina. Following surgical excision, histopathology confirmed the cystic nature of the lesion and revealed thick disorganised sheaths of fibrocollagenous tissue and flattened mesenchymal cells lining the luminal part of the cyst wall. A diagnosis of intraspinal ganglion cyst was made. The cat recovered uneventfully. Seven months after surgery euthanasia was performed for unrelated reasons; no neurological deficits were present.

Relevance and novel information

This is the first reported case of intraspinal ganglion cyst in a cat. Intraspinal extradural cysts should be considered among other differential diagnoses for cats with lumbosacral myelopathy/radiculopathy.

Surgical treatment of an aseptic fistulized acromioclavicular joint cyst: a case report and review of the literature

An acromioclavicular joint cyst is an uncommonly reported condition, which seems to result from a massive rotator cuff tear and degenerative osteoarthritis of the acromioclavicular joint. We present the case of an 81-year-old man affected by an acromioclavicular joint cyst, associated to a massive rotator cuff tear, proximal migration of the humeral head and osteoarthritis of the gleno-humeral joint. The mass was 7 x 2.5 cm in size and the overlying skin presented a fistula that drained clear synovial-like fluid. Plain X-ray examination of the left shoulder showed proximal migration of the humeral head migration and osteoarthritis of the gleno-humeral joint, and further MRI evaluation confirmed the clinical diagnosis of a complete rotator cuff tear and observed a large subcutaneous cyst in communication with the degenerative acromioclavicular joint. The patient underwent surgical excision of the cyst and lateral resection of the clavicle to prevent disease recurrence. To the best of our knowledge, this is the first reported case of an acromioclavicular joint cyst complicated by an aseptic fistula resulting from multiple aspirations.

Imaging diagnosis--degenerative intraspinal cyst associated with an intervertebral disc

A 6-year-old neutered male Rottweiler had chronic episodic signs of thoracolumbar pain and inability to stand that did not improve after rest and nonsteroidal antiinflammatory medication. In magnetic resonance images, an extradural mass was identified between the spinal cord and the T13/L1 intervertebral disc; the mass was compressing the cord in a dorsoventral direction. The lesion had a low signal intensity rim that enhanced slightly after gadolinium administration, and contents with similar signal intensity to cerebrospinal fluid. The lesion was removed surgically by severing its attachments to the annulus fibrosus. The histologic diagnosis was degenerative intraspinal cyst. The origin of such cysts, and their relationship to synovial and ganglion cysts is discussed.

Glenohumeral Joint Ganglion Cyst and Other Rare Cysts of the Axilla

Although ganglion cysts have been reported to arise from almost any joint, those arising from the glenohumeral joint producing an axillary mass are extremely rare. We report what we believe to be the eighth such case and describe its management. The unusual differential diagnosis and aids to diagnosis of axillary cysts are reviewed. Specific issues regarding axillary space ganglions are emphasized.

The extraforaminal juxtafacet cyst as a rare cause of L5 radiculopathy: a case report

STUDY DESIGN

This is a report of a case.

OBJECTIVE

To document the clinical, radiographic, and histologic characteristics of a lumbar extraforaminal juxtafacet cyst.

SUMMARY OF BACKGROUND DATA

Spinal juxtafacet cysts develop most frequently at the dorsal aspect of the zygapophysial joint, sometimes in the posterolateral area of the canal. In one case, they have been described in the foraminal and extraforaminal region.

METHODS

Description of the case report.

RESULT

The authors report one case of a strictly extraforaminal juxtafacet cyst responsible for L5 sciatica.

CONCLUSIONS

Juxtafacet cysts of the spine represent an infrequent cause of sciatica, usually when they grow in the canal, or more exceptionally when they occupy the foraminal or extraforaminal areas.

Acute traumatic myelopathy secondary to a thoracic cyst in a professional football player

STUDY DESIGN

Case report of acute traumatic myelopathy secondary to thoracic synovial cyst in a professional football player.

OBJECTIVE

To emphasize examination for myelopathy and describe the radiographic and magnetic resonance findings of a rare source of traumatic myelopathy.

BACKGROUND

Magnetic resonance imaging is the best initial evaluation for myelopathy in a traumatic setting. Heightened awareness during evaluation of a player involved in a traumatic incident allowed the diagnosis of potential cord damage and paralysis.

METHODS

A subject with symptoms resulting from a direct blow to the back was evaluated for myelopathy, with diagnosis assisted by magnetic resonance imaging used to pinpoint the source of the disorder.

RESULTS

The diagnosis allowed a surgical excision of the traumatic synovial cyst and full recovery of the injured football player.

CONCLUSIONS

Awareness during examination for myelopathy in an acutely injured athlete is imperative to prompt the clinician to order the proper diagnostic studies and thereby embark on a surgical correction of the problem.

Intraspinal synovial cysts: 10-year experience at the Ochsner Clinic

OBJECT

Although synovial cysts commonly involve the joints of the extremities, they are also found in the spinal canal. When symptomatic, they produce signs and symptoms consistent with nerve root and spinal cord compression. In this report the authors review the clinical presentations, radiological studies, and operative findings in 28 patients with intraspinal synovial cysts treated surgically at the Ochsner Clinic between 1988 and 1998.

METHODS

The medical records and radiological studies obtained in 28 patients (31 intraspinal synovial cysts) were analyzed. Twenty-nine (94%) of the cysts were located in the lumbar, one in the thoracic (T8-9), and one in the cervicothoracic (C7-T1) spine. Sixteen (57%) of the 28 patients presented with radicular pain. The remaining patients presented either with neurogenic claudication (25%) or with radicular pain and an associated neurological deficit (18%). Each cyst was located adjacent to a facet joint in which there was evidence of degenerative disease.

CONCLUSIONS

Intraspinal synovial cysts are uncommon lesions most often found in the lumbar spine at the L4-5 level. They are invariably associated with facet degeneration and respond very well to surgical therapy.

Ganglion of the hip joint--we present a logical approach to the exploration of a mass in the femoral triangle

Hip joint ganglion is a rare cause of a mass in the femoral triangle. Our patient presented with a swelling in the groin and a history of femoral hernia repair 5 years previously. Pre-operative assessment with ultrasound suggested a possible femoral artery aneurysm. We propose that safe exploration of a mass closely related to the femoral vessels must include vascular control.

Ganglion cyst involvement of peripheral nerves

Despite their benign histological appearance and the current literature composed primarily of case reports with favorable outcomes, ganglion cysts involving peripheral nerves (GCPNs) can cause permanent neurological deficits. The authors present a 27-year Louisiana State University Medical Center (LSUMC) experience with the surgical management of GCPNs. From 1968 to 1995, 27 patients were surgically treated for 27 cysts that involved nerves at nine locations. Cysts of the peroneal nerve were the most common, comprising 52% of the cases. Motor deficit, pain, and sensory changes were present in 83%, 78%, and 48% of cases, respectively. A history of acute trauma was noted in 22%. The mean follow-up duration in these cases was 61 months. Motor recovery was good in only 58% of cases and was related to the severity of the preoperative motor deficit. Pain resolved or was significantly improved in 89% of cases. Five patients underwent nine procedures before referral to LSUMC for treatment of recurrence of their ganglion cysts. None of these patients suffered recurrence after undergoing surgery at LSUMC. However, four additional patients (17%) experienced a total of six recurrences after undergoing their initial procedure. The mean time to recurrence for the patient group as a whole was 16 months. On the basis of their experience, the authors conclude that GCPNs can behave in an aggressive fashion. Patients should be counseled preoperatively about the potential for limited motor recovery and a significant chance for recurrence.

Ganglion cyst of the odontoid process. Case report and review of the literature

STUDY DESIGN

This case report illustrates that although it is rare, a ganglion cyst can occur intraosseously in the odontoid process.

OBJECTIVES

The tissue diagnosis was established by surgical resection of the cyst membrane and evacuation of the cyst content. The patient tolerated the procedure well, and the hospital course was uneventful.

SUMMARY OF BACKGROUND DATA

Synovial cyst of the spine is uncommon and is usually found in the lumbar region. Its occurrence in the cervical spine is rare, and no cases in the odontoid process, to the authors' knowledge, have been reported.

METHODS

This patient was evaluated initially for neck pain, which led to radiographic studies depicting the lesion. It raised the suspicion of metastatic neoplastic process, although the search for primary source proved to be negative. A biopsy was indicated.

RESULTS

Surgical findings consisted of mucoid material field cavity lined by a thin membrane. The cyst was excised, and pathologic evaluation confirmed the diagnosis of synovial cyst.

CONCLUSION

The correct radiographic diagnosis of this patient was not made because of lack of experience with such lesions in this location. The authors hope that this case report helps raise the awareness of clinicians in considering this diagnosis when facing similar radiographic presentation.

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.

Treatment of cysts of the acromioclavicular joint with shoulder hemiarthroplasty

A chronic cyst overlying the acromioclavicular joint was managed in four patients, between July 1988 and September 1991. All patients had had previous unsuccessful aspiration and excision of the cyst with recurrence. Each cyst was associated with a chronic, massive defect of the rotator cuff; superior migration of the humeral head; and degenerative osteoarthrosis of the glenohumeral joint. All patients had complained of pain and limitation of motion (mean forward elevation, 95 degrees; mean external rotation, 20 degrees; and mean internal rotation, to the spinous process of the second lumbar vertebra). All procedures consisted of a large-humeral-head hemiarthroplasty, with no operative treatment directed at the cyst or the acromioclavicular joint. At an average of twenty-seven months (range, fifteen to thirty-six months) after the operation, the patients were all pain-free and had not had a recurrence of the cyst. The average postoperative range of motion was 130 degrees of forward elevation, 30 degrees of external rotation, and internal rotation to the spinous process of the first lumbar vertebra.

Gas-containing ganglia of the hip

Three cases of ganglia related to the hip containing gas are presented. Gas may be shown by conventional radiography, linear tomography or computed tomography. All three cases had advanced degenerative disease of the joint. In degenerative disease, ganglia form through a pathway which allows the transfer of intra-articular gas into the ganglion. It is important to differentiate this phenomenon from overlying bowel gas and other causes of gas within soft tissues. It is the most specific radiological feature of ganglia around the hip.

A ganglion of the temporomandibular joint: a case report

Ganglion cysts of the TMJ are rare and accurate preoperative diagnosis is not usually made, although theoretically this might be possible with arthrography. Treatment of the condition is surgical but, if a positive diagnosis can be made, a period of conservative management could be attempted if the cyst is not excessively painful or surgery is contraindicated for any reason.

Synovial cysts of the hip joint and iliopsoas bursitis: a spectrum of imaging abnormalities

Synovium-related soft tissue disease around the hip constitutes a spectrum ranging from isolated iliopsoas bursitis to pure articular synovial herniations without bursal involvement. The clinical, pathologic, and radiographic features of these entities are discussed as they pertain to the variety of underlying disorders which predispose to their occurrence. Nine case reports are utilized to illustrate the variable clinical and radiographic presentations which may be encountered. Based upon these cases as well as those in the literature, an imaging algorithm has been developed which should eliminate unnecessary studies and allow prompt and accurate diagnosis.

A Ganglion Arising over the Acromioclavicular Joint: A Case Report

Ganglion cysts are a common entity arising around joints and tendon sheaths. We present a previously unreported location for a ganglion and review the various theories on etiology, pathogenesis, and treatment. With yet another unusual location for ganglia, over the acromioclavicular joint, we propose ganglia should be considered in the differential diagnosis of masses arising near any synovial joint or tendon sheath.

Lumbar nerve root compression by synovial cysts of the ligamentum flavum. Report of four cases

Synovial cysts of the ligamentum flavum, measuring 1 cm in diameter, caused compression of the lumbar nerve roots in four patients. The authors discuss the association of these cysts with advanced focal spondylosis, and speculate on their etiology.

Posttraumatic lumbar epidural true synovial cyst. Case report

✓ A case is reported of posttraumatic epidural true synovial cyst causing cauda equina compression. Surgical therapy resulted in satisfactory recovery.