. 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 2014-09-16, 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
Abdelwahab IF, Hermann G, Kenan S, Klein MJ: Periosteal ganglia: current concept review. Can Assoc Radiol J 49:381-9,1998.
Angelides AC: Ganglions of the Hand and Wrist. In Operative Hand Surgery. DP Green (Ed), Churchill Livingstone, New York, 3rd ed., 1993, pp. 2157-71.
Araboir M, Kitazawa H, Akisue T, Kuroda R, Fujioka H, Doita M, Kurosaka M: Intraosseous ganglion of the phalanx. Clin Imaging 32:73-6,2008.
Bauer TW, Dorfman HD: Intraosseous ganglion: a clinicopathologic study of 11 cases. Am J Surg Pathol 6:207-13,1982.
Brown DM, Young L, Groner JP, Higgs PE, Gilula LA: Intraosseous ganglion of the trapezoid. J Hand Surg 19A:607-8,1994.
Büchler L, Hosalkar H, Weber M: Arthroscopically assisted removal of intraosseous ganglion cysts of the distal tibia. Clin Orthop 467:2925-31,2009.
Carter TE, Detenbeck LC: Intraosseous ganglion cyst of the patella: report of a case. Tex Med 70:95-6,1974.
Cebesoy O: Intraosseous ganglion of the talus treated with the talonavicular joint approach without exposing the ankle joint. J Am Podiatr Med Assoc 97:424-7,2007.
Chen KT: Fine needle aspiration cytology of intraosseous ganglion: a case report. Acta Cytol 52:451-3,2008.
Chen YC, Wang SJ, Shen PH, Huang GS, Lee HS, Wu SS: Intraosseous ganglion cyst of the capitates treated by intralesional curettage, autogenous bone marrow graft and autogenous fibrin clot graft. J Chin Med Assoc 70:222-6,2007.
Daly PJ, Sim FH, Beabout JW, Unni KK: Intraosseous ganglion cysts. Orthopedics 11:1715-9,1988.
DeMaeseneer M, DeBoeck H, Shahabpour M, Hoorens A, Oosterlinck D, Van Tiggelen R: Subperiosteal ganglion cyst of the tibia. J Bone Joint Surg 81A:643-6,1999.
Donahue F, Turkel DH, Mnaymneh W, Mnaymneh LG: Intraosseous ganglion cyst associated with neuropathy. Skeletal Radiol 25:675-8,1996.
Dungan DH, Seeger LL, Mirra JM: Case report 555: Intraosseous ganglion cyst of the distal end of tibia. Skeletal Radiol 18:385-8,1989.
Fealy MJ, Lineaweaver W: Intraosseous ganglion cyst of the scaphoid. Ann Plast Surg 34:215-7,1995.
Helwig U, Lang S, Baczynski M, Windhager R: The intraosseous ganglion: a clinical pathological report on 42 cases. Ach Orthop Trauma Surg 114:14-7,1994.
Kligman M, Roffman M: Bilateral intraosseous ganglia of the scaphoid and lunate bones. J Hand Surg 22B:820-1,1997.
Kligman M, Roffman M: Urografin injection demonstrated soft tissue ganglion communication with an intraosseous ganglion cyst. Bull Hosp Jt Dis 57:96-8,1988.
Kubota C, Kobayashi S, Miyazaki T, Kokubo Y, Yayama T, Uchida K, Sato R, Bangirana A, Baba H: Exceedingly large femoral condyle intraosseous ganglion cyst following high tibial osteotomy. J Orthop Sci 12:592-6,2007.
Lamb MJ, Sharkey PF: Intraosseous ganglion of the greater trochanter. Orthopedics 22:1089-90,1999.
Logan SE, Gilula LA, Kyriakos M: Bilateral scaphoid ganglion cysts in an adolescent. J Hand Surg 17A:490-5,1992.
Magee TH, Rowedder AM, Degnan GG: Intraosseous ganglia of the wrist. Radiology 195:517-20,1995.
Matsumoto K, Hukuda S, Ogata M: Juxta-articular bone cysts at the insertion of the pes anserinus. Report of two cases. J Bone Joint Surg 72A:286-90,1990.
Menendez LR, Chandler DR, Moore TM, Schwinn CP: Diaphyseal intraosseous ganglion. Clin Orthop 227:310-2,1988.
Nakayama H, Yagi M, Yoshiya S: Intraosseous ganglion in the subchondral region of the lateral femoral condyle in an 11-year-old girl: a case report. Sports Med Arthrosc Rehabil Ther Technol 1:25:2009.
Pablos JM, Valdés JC, Gavilán F: Bilateral lunate intraosseous ganglia. Skeletal Radiol 27:708-10,1998.
Patterson RH, Jones M, Tuten R: Intraosseous ganglion cyst of the talus: case report. Foot Ankle 14:538-9,1993.
Sim FH, Dahlin DC: Ganglion cysts of bone. Mayo Clinic Proc 46:484-8,1971.
Tabaddor K, Sachs D, Llena JF, Testaiuti MA: Ganglion cyst of the odontoid process: case report and review of the literature. Spine 27:2019-22,1996.
Tam W, Resnick D, Haghighi P, Vaughan L: Intraosseous ganglion of the patella. Skeletal Radiol 25:588-91,1996.
Tham S, Ireland DC: Intraosseous ganglion cyst of the lunate: diagnosis and management. J Hand Surg 17B:429-32,1992.
Tuzuner T: Penetrating type intraosseous ganglion cyst of the lunate bone. West Indian Med J 54:247-9,2005.
Urayama M, Itoi E, Watanabe H, Sato K, Kame J: Intraosseous ganglion of the glenoid. Orthopedics 22:705-6,1999.
Valls R, Melloni P, Damell A, Sanchez-Flo R: Diagnostic imaging of tibial periosteal ganglion. Eur Radiol 7:70-2,1997.
Van Den Dungen S, Marchesi S, Ezzedine R, Bindou D, Lorea P: Relationship between dorsal ganglion cysts of the wrist and intraosseous ganglion cysts of the carpal bones. Acta Orthop Belg 71:535-9,2005.
Wu KK: Intraosseous ganglion cyst of the middle cuneiform bone of the foot. J Foot Ankle Surg 33:633-5,1994.
Yajima H, Murata K, Kawamura K, Kawate K, Takakura Y: Treatment of intraosseous ganglia and bone cysts of the carpal bones with injectabel calcium phosphate bone cement. Hand Surg 13:167-73,2008.
Yamazaki H, Kato H, Murakami N: Closed rupture of the flexor tendons of the index finger caused by a pathological fracture secondary to an intraosseous ganglion in the lunate. J Hand Surg Eur Vol 32:105-7,2007.
Yi JW, Cho NS, Rhee YG: Intraosseous ganglion of the glenoid causing suprascapular nerve entrapment syndrome: a case report. J Shoulder Elbow Surg 18:e25-7,2009.