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Intraosseous Ganglion Cyst

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

IMPORTANCE

  • Rare lesion in distinction to soft tissue ganglions

CLINICAL FEATURES

  • 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

RADIOLOGIC FEATURES

  • 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)

GROSS PATHOLOGY

  • 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

HISTOLOGIC FEATURES

  • 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
  • Osteoarthritis
  • Primary cystic arthrosis
  • Rheumatoid arthritis
  • Gout
  • Tuberculosis
  • Chondroblastoma
  • GCT
  • PVNS
  • Synovial cyst, intracortical and subperiosteal

DISEASE COURSE AND TREATMENT

  • Curettage and bone grafting results in a cure

SPECIAL CONSIDERATIONS

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

  • Multiple ganglia involving bilatreral carpal bones have been reported

REFERENCES

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