[Intraosseous ganglion in the area of the wrist]

In the differential diagnosis of cystic lesions in bones, the intraosseous ganglion must be included. These tumor-like lesion is rare in the carpus, but often the cause of therapy-resistant pain. Four patients with intraosseous ganglion in the carpus are presented. This bone disease is treated by curettage and bone grafting. Postoperative prognosis is good.

Focal mucinosis (myxoid cyst). Surgical therapy

Myxoid cysts typically arise in association with distal interphalangeal joint arthritis. When myxoid cysts become problematic, surgical excision is a standard treatment with a high cure rate and few complications. The origin, anatomy, and alternative medical and surgical treatment options are discussed.

Histopathology of soft tissue lesions of the foot

Unfortunately, strict regional considerations of neoplasia affecting the hands of feet are not numerous, and detailed accounts of neoplasia confined either to the hands or feet have been published only periodically. This article attempts to remedy the dearth of information by providing a sampling of the types of tumors that affect the foot with photographs and an emphasis on key histologic characteristics.

Synovial cyst at the C1-C2 junction

Intraspinal synovial or ganglion cysts of the cervical spine are rare. We present the third reported case of a degenerative articular cyst of the upper cervical spine, involving the quadrate ligament of the odontoid process. Magnetic resonance examination reveals typical images. A new, more general terminology is proposed.

Juxta-articular myxoma: a clinical and pathologic study of 65 cases

We describe 65 cases of juxta-articular myxoma (JAM) that occurred in the vicinity of large joints, possessed histologic features of a myxoma, and were frequently associated with cystic changes that resembled a ganglion cyst. The vast majority of cases (57, 88%) occurred in the region of the knee; a minority involved the shoulder (three cases), elbow (three), ankle (one), and hip (one) regions. Patients' ages ranged from 16 to 83 years (median, 43 years; mean, 44 years) and nearly three fourths of the patients (72%) were male. Thirty-seven lesions presented as a swelling or mass, 21 were associated with pain or tenderness, and sizes ranged from 0.6 to 12 cm (median, 3.5 cm; mean, 3.8 cm). Duration of symptoms was highly variable, spanning from 1 week to 18 years. Fourteen JAMs were intimately associated with the meniscus and five of these had a concomitant tear; in five other cases JAM was an incidental finding at the time of total knee or hip arthroplasty for severe osteoarthritis. Of 29 cases with follow-up, 10 (34%) recurred: five recurred once, two recurred twice, two recurred three times, and one recurred four times. While the majority of JAMs were correctly diagnosed as benign, a sarcoma was seriously considered or diagnosed in 15 (23%) cases.

Myxoid change within cellular blue naevi: a diagnostic pitfall

We describe four cases of a distinctive myxoid change located in the centre of cellular blue naevi. Because all the reported lesions were large and were present on pressure-exposed locations, the myxoid change is thought to be caused by pressure together with direct repeated minor tissue trauma.

Bilateral scaphoid ganglion cysts in an adolescent

We describe an adolescent girl with symptoms secondary to bilateral, symmetrical ganglion cysts of the scaphoid bones. From the roentgenographic and operative findings, it was believed that the cysts were the penetrating type. The patient is among the youngest reported with carpal bone ganglion cysts and the first with bilateral scaphoid cysts completely described in the English-language medical literature.

Preoperative diagnosis of an extradural cyst arising from a spinal facet joint: case report

A case of a lumbar spinal extradural cyst is reported. An accurate preoperative diagnosis was made using magnetic resonance imaging. Characteristic findings on magnetic resonance imaging obviate the need for any additional radiological studies. The clinical features, radiological findings, and pathogenesis of these lesions are discussed.

[Nerve compression syndrome caused by synovial cyst of the hip joint]

Synovitis of the iliopectineal bursa have been described in pigmented villanodular synovitis, synovial chondromatosis, rheumatoid arthritis, osteoarthritis and necrosis of the femoral head. We report a case of enlargement of such a cyst in necrosis of femoral head and consecutive osteoarthritis, leading to entrapment of the femoral nerve. Simple drainage of the cyst did resolve pain for a short period and only elimination of the primum pathologicum agens did definitively release pain, irradiating to the ipsilateral leg.

The appearances of lumbar intraspinal synovial cysts

Intraspinal synovial cysts most commonly occur in the lower lumbar spine and may cause radicular symptoms. Eight symptomatic patients are described, each of whom had a single synovial cyst with associated facet joint degeneration. Four were at the L4-5 level and two each at L3-4 and L5-S1. Myelography in four patients revealed a posterolateral indentation on the contrast column in each case. Computed tomography (CT) revealed a structure of similar or greater density than the thecal sac in six cases and of gas density in one case. Two of the former cases also contained gaseous elements, three cases had a mildly dense rim and in the eighth case calcification was demonstrated within the cyst. One cyst resolved after facet joint injection with local anaesthetic and steroid.

Synovial ganglia of the central pivot of the knee

Five patients with intraarticular synovial ganglia of the knee were treated by arthroscopic surgery. These synovial cysts were found in the intercondylar fossa and appeared to originate from the cruciate ligaments. In 3 patients the ganglia were the only pathologic finding, solely responsible for the pain and functional impairment. In the other 2 patients the ganglia were accompanied by other intraarticular lesions. The diagnostic procedure (radiography, arthrography, CT, MRI, arthroscopy), confirmed the validity of CT scan and MRI in detection, differential diagnosis, and location of the ganglia in all cases. Arthroscopy enabled us to directly observe, biopsy, and remove the ganglia, resulting in immediate disappearance of symptoms and no relapse after a minimum follow-up of 20 months.

[Hygromas of the wrist joint in children]

The authors discuss their experience in the treatment of 45 children with hygromas of the wrist joint. Morphological and radiological studies confirmed the conception of the pathogenesis of hygromas which is based on that a hygroma is a transformed synovial capsule of the joint and the communication between them functions along the type of a valve. Problems of terminology and therapeutic tactics are discussed. The specific features of the operation and the results of treatment are described. The percentage of recurrences reduced from 15.4 to 7.7%.

Massive intrapelvic synovial cyst as a complication of total hip replacement arthroplasty: a case report

The authors report a case of massive intrapelvic synovial cyst complicating total hip arthroplasty in a 35-year-old woman with rheumatoid arthritis. The clinical presentation raised the possibility of a coincidental soft-tissue malignant tumour. This was ruled out by ultrasonography, computed tomography, fine-needle aspiration with examination of cells and culture and, ultimately, by image intensification in the operating room during aspiration of the cyst and injection of the adjacent hip joint with Hypaque. The authors conclude that perforation of the acetabular floor at total hip arthroplasty was likely the precipitating event. After 1 year there was no indication for surgical excision of the cyst.

Nerve sheath ganglion of the superficial radial nerve

Nerve sheath ganglia are infrequent and most commonly involve the peroneal nerve. We describe the previously unreported involvement of the superficial branch of the radial nerve.

Chromoblastomycosis with malignant transformation and cutaneous-synovial secondary localization. The potential therapeutic role of itraconazole

A case of neoplastic transformation of lesions of chromoblastomycosis is reported in a 67-year-old farmer from French Guyana. An interesting aspect of this case was the appearance of new cutaneous lesions of chromoblastomycosis, in a different site from the original lesion, and the presence of an infected synovial cyst. The potential therapeutic role of itraconazole is discussed.

[Rare occurrence of villonodular synovitis of both shoulder joints]

Presentation of the radiological, histological, and clinical findings in one patient with bilateral villonodular synovitis of the shoulder is made. This synovitis is a nonmalignant disease entity of controversial origin and nature.

Deep vein obstruction and leg swelling caused by femoral ganglion

We present a case of a rare ganglion cyst originating from the hip joint and compressing the common femoral vein producing signs and symptoms that mimicked a deep vein thrombosis. Excision of the mass promptly restored normal venous return. This condition has not been previously reported in the English-language medical literature.

Autosomal dominant granulomatous arthritis, uveitis, skin rash, and synovial cysts

In 1985, Blau reported a family with 11 members in four generations affected by granulomatous arthritis, iritis, skin rash, and periarticular synovial cysts. We report a second family with these abnormalities, thereby confirming this syndrome as a distinct familial entity with transmission compatible with autosomal dominant inheritance. Affected members in our family included a mother and two daughters. Disease onset was at 10 months to 8 years of age. Each had uveitis, symmetric polyarthritis, and synovial cysts overlying the ankle and wrist joints. In addition, both daughters had an intermittent generalized erythematous papular rash that on biopsy revealed noncaseating granulomatous infiltration. All three patients improved during alternate-day steroid therapy. Recognition of this disorder as distinct from other, more common causes of arthritis is important because of the apparent autosomal dominant transmission and because of the excellent responses to low-dose steroid therapy.

Squamous cell carcinoma with prominent myxoid stroma

Three cases of a squamous cell carcinoma with a prominent myxoid stroma are reported. One case in a 70-year-old woman had presented as a lump in the breast, the other two presented as polypoid lesions of the larynx and cervix uteri in a 65-year-old man and 61-year-old woman, respectively. The carcinomatous component was immersed in abundant extracellular mucosubstances. In addition to occasional squamous pearls, it displayed immunocytochemical evidence of high-weight keratin present in the neoplastic cells and, in one case, desmosomal attachment under electron microscopy. The extracellular mucosubstances proved to be similar to those seen in connective tissue. The differential diagnosis with histologically similar lesions has been taken into consideration, and it has been suggested that this newly described entity showing abundant myxoid stroma has to be distinguished from numerous benign and malignant myxoid soft tissue tumors.

Calcified synovial cyst of the cervical spine: CT and MR evaluation

A case of calcified synovial cyst of the cervical spine was diagnosed by a combination of imaging modalities. Curvilinear calcification associated with posterior elements, well seen by CT, suggested the correct diagnosis. Magnetic resonance showed a curvilinear region of low signal intensity corresponding to the calcification.

MR imaging of lumbar juxtaarticular cysts

Three surgically proven cases of lumbar extradural juxtaarticular cysts were examined by magnetic resonance (MR) imaging. The highly variable MR signal patterns are presented.