. Intraosseous Ganglion Cyst. PORTNotes. In: OrthopaedicsOne - The Orthopaedic Knowledge Network. Created Feb 16, 2009 16:53. Last modified Jan 05, 2010 10:46 ver.4. Retrieved 2014-12-21, from http://www.orthopaedicsone.com/x/OgEjAQ.
DEFINITION AND PATHOGENESIS
- Identical histologically to soft tissue ganglions
- ? myxofibroblasts may become trapped beneath the periosteum, producing the lesion
- ? hyaluronic acid production with subsequent IM trabecular atrophy
- Rare lesion in distinction to soft tissue ganglions
- Median age of pts is 44 (14-86)
- May be an incidental finding and asymptomatic
- Reported as a source of wrist pain
- Located about the femoral head and neck, and greater trochanter reported to be a cause of hip pain and in the proximal humerus a cause of shoulder pain
- May present with a pathological fx
- Epiphyseal, eccentric lytic lesion, with sclerotic margins, esp involving tibia, distally and proximally
- Bilateral lunate intraosseous ganglia have been reported
- Cortical rim may be incomplete
- Adjacent joint is without degenerative changes
- MRI shows fluid brightly on T2 images (? signal intensity on T1-weighted images)
- Extraosseous component may be shown to communicate with intraosseous cyst on MRI
- Unusual reported locations: odontoid process, glenoid (most inferiorly located)
- Up to 7cm in size, usu. 3-5cm, bulging, with a white outer fibrous surface, usually multilocular
- May extend through the cortex into the joint, esp. with intraosseous ganglia of carpal bones
- Cyst-like structure filled with thick fluid rich in mucin, single or multiloculated
- Resembles a synovial cytst, but doesn't have an epithelial lining
- Myxofibroblasts to typical fibroblasts surrounded by mucinous lakes
DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS
- Subchondral degenerative cytst associated with inflammatory or noninflammatory arthritis
- Primary cystic arthrosis
- Rheumatoid arthritis
- Synovial cyst, intracortical and subperiosteal
DISEASE COURSE AND TREATMENT
- Curettage and bone grafting results in a cure
PERIOSTEAL (SUBPERIOSTEAL) GANGLION
- May be asymptomatic, affects men 37-55 y/o
- Tibia, femur, radius, ilium
- Juxtacortical erosion ? peripheral calcification/thin septations on plain radiographs
- Technetium-99 bone scan may show a mild blush
- MRI: low signal intensity on T1- and high signal on T2-weighted images; ? peripheral gadolinium enhancement
- CT: demonstrates non-continuous peripheral calcification and cortical erosion
- DDx: periosteal ABC, chondromyxoid fibroma
- Marginal excision with cortical curettage is curative
- Multiple ganglia involving bilatreral carpal bones have been reported
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