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Subchondral Cyst

DEFINITION AND PATHOGENESIS

  • A secondary juxta-articular cyst associated with an inflammatory or non-inflammatory (degenerative) arthridity

IMPORTANCE

  • One of the four cardinal radiographic findings in arthritis: joint space narrowing, subchondral sclerosis, osteophyte formation, and subchondral cysts

CLINICAL FEATURES

  • Symptoms of degenerative joint disease dominate

RADIOLOGIC FEATURES

  • Subchondral lucency with sclerotic rim
  • MRI reveals lesion filled with fluid

GROSS PATHOLOGY

  • Mucinous material within the cyst

HISTOLOGIC FEATURES

  • Synovial lining to the cyst

DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS

  • Same as intraosseous ganglion cyst, although associated radiologic findings give supporting diagnostic evidence

DISEASE COURSE AND TREATMENT

  • Non-steroidal anti-inflammatory Rx, activity modification, assistive devices, ultimately, total joint replacement

SPECIAL CONSIDERATION

INTRAOSSEOUS PNEUMATOCYST

  • Gas containing cysts of the sacrum or ilium ? vacuum phenomena in the SI joint reportedly asymp-tomatic and an incidental finding

REFERENCES

Fisher ER, Gruhn J, Skerrett P: Epidermal cyst in bone. Cancer 11:643-8,1958.
Mirra JM: Cysts and cyst-like lesions of bone: Subchondral cyst. In Mirra JM, Picci P, Gold RH (eds): Bone Tumors: Clinical, Radiologic and Pathologci Correlations. Philadelphia, Lea & Febiger, 1989, p 1312.
Mollan RA, Wray AR, Hayes D: Traumatic epidermoid cyst of the ulna: report of a case. J Bone Joint Surg 64B:456-7,1982.
Monu JUV, Crotty JM, Pope TL, Jr: Intraosseous pneumatocyst of the iliac bone. Clin Orthop 330:190-2, 1996.
Silas SI, Resnik CS, Levine AM: Bilateral primary cystic arthrosis of the acetabulum. A case report. J Bone Joint Surg 78A:775-8, 1996.

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