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Perez Acosta ME, Meyers AB, Toth MB. Cystic Ganglionosis in a 3-year-old Mimicking Juvenile Idiopathic Arthritis. J Rheumatol 2021; 49:230-231. [PMID: 34782451 DOI: 10.3899/jrheum.210558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ganglion cysts are common periarticular/peritendinous masses, which are thought to form from myxoid degeneration of collagen that becomes encased by connective tissue.1 This differentiates them from synovial cysts, which are lined by synovium.2,3 The presence of numerous ganglion cysts in multiple locations is very rare and has been termed cystic ganglionosis 4.
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Affiliation(s)
- Marcela Edith Perez Acosta
- Marcela Edith Perez Acosta, MD, Rheumatology Fellow, University of Central Florida, Orlando, Florida; Arthur B. Meyers, MD, Cincinnati Children's Hospital, Department of Radiology Cincinnati, Ohio; Mary Bratovich Toth, MD, Division Chief, Rheumatology, Nemours Children's Hospital, Orlando, Florida, USA. Address correspondence to Dr. M.B. Toth, 6535 Nemours Pkwy, Orlando, FL 32827, USA. . The authors declare no conflicts of interest relevant to this article. Written consent to publish the case was obtained from the patient's family. Case reports do not require IRB approval according to the authors' institutions
| | - Arthur B Meyers
- Marcela Edith Perez Acosta, MD, Rheumatology Fellow, University of Central Florida, Orlando, Florida; Arthur B. Meyers, MD, Cincinnati Children's Hospital, Department of Radiology Cincinnati, Ohio; Mary Bratovich Toth, MD, Division Chief, Rheumatology, Nemours Children's Hospital, Orlando, Florida, USA. Address correspondence to Dr. M.B. Toth, 6535 Nemours Pkwy, Orlando, FL 32827, USA. . The authors declare no conflicts of interest relevant to this article. Written consent to publish the case was obtained from the patient's family. Case reports do not require IRB approval according to the authors' institutions
| | - Mary Bratovich Toth
- Marcela Edith Perez Acosta, MD, Rheumatology Fellow, University of Central Florida, Orlando, Florida; Arthur B. Meyers, MD, Cincinnati Children's Hospital, Department of Radiology Cincinnati, Ohio; Mary Bratovich Toth, MD, Division Chief, Rheumatology, Nemours Children's Hospital, Orlando, Florida, USA. Address correspondence to Dr. M.B. Toth, 6535 Nemours Pkwy, Orlando, FL 32827, USA. . The authors declare no conflicts of interest relevant to this article. Written consent to publish the case was obtained from the patient's family. Case reports do not require IRB approval according to the authors' institutions
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[Joint tumors: rare but important differential diagnoses of malignant and benign tumors as well as pseudotumors in rheumatology]. Z Rheumatol 2020; 80:165-175. [PMID: 33289861 DOI: 10.1007/s00393-020-00936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
Abstract
This review article elucidates the differential diagnostics of malignant and benign joint tumors, pseudotumors of the joints and the peri-implant tissue, which are rare but important entities in rheumatology and orthopedic rheumatology. The tissue of origin includes the synovium, peri-implant tissue, peri-articular fibrous tissue and peri-articular osseous tissue. Pseudotumors can be viewed as independent but heterogeneous entities. These are essentially manifested as tumor-like depositions of crystals, calcareous deposits, vascular malformations, ectasia of the synovia and joint capsule tissue and pseudocysts. Other causes for pseudotumors are focal destructive inflammation (e.g. induced by foreign bodies), high grade synovitis and focal fibrinoid necrosis (i.e. rheumatoid nodules). Methodologically, these diagnostics are based on conventional standard staining methods, immunohistochemical analyses of formalin-fixed and paraffin-embedded materials and on molecular diagnostic procedures. The latter are of great importance in cases of benign and malignant joint tumors. The most important immunohistochemical markers with respect to joint tumors are S100, SM-actin, CD68, CD34, STAT6, clusterin, Muc‑4, beta-catenin and MDM2-FISH. The following markers are recommended for the differential diagnostics and typing of periarticular tumor metastases in the pathology of rheumatic diseases: AE1/AE3, CK8, p63, TTF‑1, TGB, PSA, androgen receptor, GATA, CD56, chromogranin, CDX‑2, SAT-B2, SALL4, estrogen and progesterone receptors, CD45LCA, CD30, CD79a and S100. Necrosis, inflammatory infiltrations and reparative inflammatory changes may complicate the histopathological classification. Therefore, a correlation with clinical, microbiological and radiological data in the sense of interdisciplinary synergistic diagnostics may be required.
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MacMahon J, Carter MJ, Moore M, McSweeney N. Cystic ganglionosis in an 18-month-old child. Arch Dis Child 2020; 105:86. [PMID: 30389679 DOI: 10.1136/archdischild-2018-315793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Jayne MacMahon
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Michael James Carter
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Michael Moore
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
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Maribo Y, Stokbro K, Aagaard E, Larsen SR, Thygesen T. Synovial Cysts in the Temporomandibular Joint: a Case Report and Critical Review of the Literature. J Oral Maxillofac Res 2019; 10:e4. [PMID: 31069041 PMCID: PMC6498815 DOI: 10.5037/jomr.2019.10104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/19/2019] [Indexed: 11/25/2022]
Abstract
Background Synovial cysts of the temporomandibular joint are rare and treatment is based on consensus from cases reporting unilateral successful outcomes. A patient with a synovial cyst is presented, treated with successful surgical excision of the cyst, but without remission of joint symptoms. Furthermore, the case is supplemented by a critical, literature review. Methods This case report deals with a patient with a synovial cyst that presented with temporomandibular joint (TMJ) pain and reduced mouth opening. Magnetic resonance imaging verified a TMJ cyst. Results Surgical excision removed the synovial cyst, and the patient was followed-up for 4 years, with no recurrence of the cyst. Despite successful excision of the cyst, the symptoms did not subside, and the patient is still in treatment. The critical, literature review found 23 case reports describing 24 synovial cysts. In addition, 4 cases were included as their synovial cysts were erroneously described as ganglion cysts. In 4 cases, histological diagnosis could not be confirmed, and they were excluded. All cases described treatment by surgical excision without recurrence. The reported median follow-up was 10 months and postoperative TMJ symptoms were rarely examined or described. Conclusions The temporomandibular joint symptoms may persist despite successful removal of the synovial cyst. Furthermore, the 4 identified synovial cysts, mislabelled as ganglion cysts, represents almost a quarter of the cases of the reported synovial cysts. Correct labelling and reporting of synovial cysts are still imperative to describe the diverse aspects of treatment outcomes following surgical excision.
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Affiliation(s)
- Ynn Maribo
- Department of Oral and Maxillofacial Surgery, Odense University HospitalDenmark
| | - Kasper Stokbro
- Department of Oral and Maxillofacial Surgery, Odense University HospitalDenmark.,Clinical institute, Faculty of Health, University of Southern DenmarkDenmark
| | - Esben Aagaard
- Department of Oral and Maxillofacial Surgery, Odense University HospitalDenmark
| | | | - Torben Thygesen
- Department of Oral and Maxillofacial Surgery, Odense University HospitalDenmark
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Meyer NP, Meyers AB, Szabo S, Vo NJ. A rare case of cystic ganglionosis in a child with associated imaging findings. Skeletal Radiol 2016; 45:419-26. [PMID: 26577814 DOI: 10.1007/s00256-015-2294-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/03/2015] [Accepted: 11/08/2015] [Indexed: 02/02/2023]
Abstract
Ganglia are benign soft tissue masses that are found adjacent to joints and tendons. They can be multifocal but they are rarely more numerous than a few around any given joint. "Cystic ganglionosis" has been used to describe a condition in which multifocal and extensive ganglia are present. We present a rare case of cystic ganglionosis in a Caucasian girl with clinical symptoms detected at 6 months of age. To the authors' knowledge, only a single other case report of cystic ganglionosis is documented in the English medical literature. The ganglia in this case are more extensive, manifested at an earlier age and caused erosions of multiple bones, a rarely observed complication of ganglia. Additionally, radiograph, MR and sonographic images collected over 9 years time allows for a detailed description of the imaging characteristics of this case of cystic ganglionosis, and offers unique insight into the natural history of this diagnosis. Extensive ganglia in multiple locations in a young child should alert clinicians to the possibility of cystic ganglionosis. Disease progression may lead to deleterious effects on bone warranting the use of maintenance imaging and possibly surgical resection of symptomatic lesions.
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Affiliation(s)
- Nathan P Meyer
- Department of Radiology, Medical College of Wisconsin & Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Arthur B Meyers
- Department of Radiology, Medical College of Wisconsin & Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Sara Szabo
- Department of Pathology, Medical College of Wisconsin & Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Nghia J Vo
- Department of Radiology, Medical College of Wisconsin & Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
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Ganglion and Synovial Cyst of the Temporomandibular Joint: A Case Report and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e524. [PMID: 26495237 PMCID: PMC4596449 DOI: 10.1097/gox.0000000000000494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 07/22/2015] [Indexed: 12/21/2022]
Abstract
Ganglion and synovial cysts of the temporomandibular joint (TMJ) are rare. Although histopathological findings differ, clinical presentation is comparable. This study adds a case report of a ganglion of the TMJ to existing literature and a review of all available case reports on ganglion and synovial cysts of the TMJ. Including our own case report, we reviewed 49 cases of ganglion and synovial cysts of the TMJ. They occurred in a female:male ratio of 3:1, at an median age of 46 years (range, 11-64 years). Patients mainly presented with preauricular swelling and pain. After imaging, the ganglion or synovial cyst was most commonly excised under general anesthesia. No recurrences were described.
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Rao A, Nandikoor S, Mallarajapatna G, Meghanathan P. Unusual presentation of an usual condition-cystic ganglionosis. BJR Case Rep 2015; 2:20150231. [PMID: 30364382 PMCID: PMC6195920 DOI: 10.1259/bjrcr.20150231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/05/2015] [Accepted: 08/23/2015] [Indexed: 11/05/2022] Open
Abstract
Cystic ganglionosis is an unusual benign condition, which presents as multiple ganglion cysts involving multiple joints. The case we report here is probably the first case of an adult reported in the literature. The only other case of multiple ganglion cysts reported in the literature is that of an 11-year-old child with ganglion cysts in multiple joints. A 57-year-old female presented with an approximately 4-year history of pain and swelling below the left knee and in the right hand. An MRI of the left knee showed multiloculated cystic-intensity lesions around the knee joint with intra-/extra-articular and intraosseous components. Similar lesions were noted around the right knee joint, right wrist and ring finger. With all the above findings and in view of multiple joint involvement, the possibility of cystic ganglionosis or multiple giant ganglion cysts was considered and confirmed by biopsy of one of the knee lesions. It is because of this rarity and the unusual presentation involving multiple joints that we have reported this case. The importance of the diagnosis is that unnecessary surgical intervention and hospitalization can be avoided, provided the patient's symptoms are not severe.
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Affiliation(s)
- Anuradha Rao
- Department of Radiology, Apollo Hospitals, Bangalore, India
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Heng-Kun W, Yan-Ling G, Wen-Feng Z, Zhe S, Ren-Xin W, Xiao-Tao Z. Ganglion cyst of the temporomandibular joint. ACTA ACUST UNITED AC 2014; 115:62-4. [PMID: 24412035 DOI: 10.1016/j.revsto.2013.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 05/31/2013] [Accepted: 09/25/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Ganglion cyst of the temporomandibular joint is a rare disease, which may arise from myxoid degeneration of the collagenous tissue of the temporomandibular joint capsule, without epithelial or endothelial lining. We report a case of cystic lesion in a 40-year-old female patient. OBSERVATION The patient had a left pre-auricular oval-shaped swelling without any articular symptoms. The pathological analysis after surgical removal allowed diagnosing the lesion as a ganglion cyst of the left temporomandibular joint. DISCUSSION We made a literature review and noted that this condition was predominant in female patients. We recommend using MRI for diagnostic purposes and surgery as the best therapeutic alternative.
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Affiliation(s)
- W Heng-Kun
- Department of oral and maxillofacial surgery, Weihai municipal hospital, Weihai 264200, Shandong province, PR China.
| | - G Yan-Ling
- Department of stomatology, Weihai women and children hospital, Weihai 264200, Shandong province, PR China
| | - Z Wen-Feng
- Department of oro-maxillofacial head and neck surgery, hospital of stomatology, Wuhan university, Wuhan 430079, Hubei Province, China
| | - S Zhe
- Department of oro-maxillofacial head and neck surgery, hospital of stomatology, Wuhan university, Wuhan 430079, Hubei Province, China
| | - W Ren-Xin
- Department of oral and maxillofacial surgery, Weihai municipal hospital, Weihai 264200, Shandong province, PR China
| | - Z Xiao-Tao
- Department of oral and maxillofacial surgery, Weihai municipal hospital, Weihai 264200, Shandong province, PR China
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SAMESHIMA T, SHIBAHASHI K, NOZAKI T, AKABANE A, KIHARA A, HORIUCHI H, MORITA A. Atlantoaxial Intraspinal Juxtafacet Cyst. Neurol Med Chir (Tokyo) 2013; 53:125-8. [DOI: 10.2176/nmc.53.125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Akio MORITA
- Department of Neurosurgery, NTT Medical Center Tokyo
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Marchalik D, Lipsky A, Petrov D, Harvell JD, Milgraum SS. Dermatologic Presentations of Orthopedic Pathologies. Am J Clin Dermatol 2012; 13:293-310. [DOI: 10.2165/11595880-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Spinner RJ, Wang H. The First Described Joint-Associated Intraneural Ganglion Cyst. Neurosurgery 2011; 69:1291-8. [DOI: 10.1227/neu.0b013e3182237299] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Object
The mechanism responsible for exceptional examples of intraneural ganglia with extensive longitudinal involvement has not been understood. Such cases of intraneural cysts, seemingly remote from a joint, have been thought not to have articular connections. Decompression and attempted resection of the cyst has led to intraneural recurrence and poor neurological recovery. The purpose of this report is not only to clarify the pathogenesis of these cysts, but also to discuss their treatment based on modern concepts of intraneural ganglia.
Methods
Two examples of extreme longitudinal propagation of intraneural ganglia are presented.
Results
A patient with a moderate tibial neuropathy was found to have a tibial intraneural ganglion. Prospective interpretation of the MR imaging study demonstrated the cyst's origin from the posterior portion of the superior tibiofibular joint (STFJ), with proximal extension within the sciatic nerve to the lower buttock region. Communication between the STFJ and the cyst was confirmed with direct knee MR arthrography. The tibial intraneural cyst was treated successfully by a relatively limited exposure in the distal popliteal fossa: the cyst was decompressed, the articular branch disconnected, and the STFJ resected. Postoperatively, the patient improved neurologically and there was no evidence of recurrent cyst on postoperative MR imaging. A second patient, previously reported by another group, was reexamined 22 years after surgery. This patient had an extensive peroneal intraneural ganglion that extended into the sciatic nerve from the knee to the buttock; no joint connection or recurrent cyst had initially been described. In this patient, the authors hypothesized and established with MR imaging the presence of both: a joint connection to the anterior portion of the STFJ from the peroneal articular branch as well as recurrent cyst within the peroneal and tibial nerves.
Conclusions
This paper demonstrates that extreme intraneural cysts are not clinical outliers but represent extreme examples of other more typical intraneural cysts. They logically obey the same principles, previously described in the unified articular (synovial) theory. The degree of longitudinal extension is probably due to high intraarticular pressures within the degenerative joint of origin. The generalizability of the mechanistic principles is highlighted by the fact that these 2 cases, involving the tibial and the peroneal nerve respectively, both extended well distant (that is, to the buttock) from the STFJ via their respective articular branch of origin. These extensive intraneural cysts can be treated successfully by disconnecting the affected articular branch and by resection of the joint of origin, rather than by a more aggressive operation resecting the cyst and cyst wall.
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Affiliation(s)
| | | | | | - Kimberly K. Amrami
- 1Departments of Neurologic Surgery,
- 3Radiology, Mayo Clinic, Rochester, Minnesota
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