AN INTRATENDINOUS GANGLION CYST OF THE PATELLAR TENDON: A RARE CAUSE OF ANTERIOR KNEE PAIN.

Ganglion cysts in the knee region can manifest as anterior knee pain. Unlike synovial cysts, these lesions lack synovial epithelial lining and occur secondary to mucoid degeneration of connective tissue because, often in response to chronic irritation and repetitive traumas. However, an intratendinous location is a rare finding. In the knee region, infrapatellar fat pad, the alar folds, and the anterior cruciate ligament are recognized to degenerate into ganglion. There are few case reports describing an involvement of the patellar tendon. We present the clinical case of a 72 years old male patient suffering from anterior knee pain attributed to an intratendinous ganglion cyst of the patellar tendon, obviously after a single traumatic event. After aspiration of the ganglion cyst the patient reported no complaints, and there has been no recurrence during the latest follow-up examination.

Ganglion cyst of temporomandibular joint - A systematic review.

Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic review aimed to discuss the clinical and histopathological features of ganglion cysts of TMJ, to aid in appropriate treatment. A literature search was done and a total of 20 cases were retrieved from published databases such as PubMed, SCOPUS, and Google Scholar. The cyst presented with swelling in all the cases followed by pain (50 %) and trismus (35 %) as other common symptoms. Though CT and MRI proved helpful in determining the location of the cyst, a histopathological examination was essential in concluding its final diagnosis. It is a pseudocyst lined by dense fibro-connective tissue with myxoid tissue degeneration. Histologically, it is essential to distinguish them from the clinically and radiographically similar true cyst of TMJ, synovial cyst. The lining of ganglion cyst is devoid of epithelium and synovial cells. Surgical excision was found to be the treatment of choice with minimal recurrence (10 %) being reported.

Lumbar spinal ganglion cyst: A systematic review with case illustration.

PURPOSE: Ganglion cysts are benign soft tissue lesions found in joints, most commonly wrists. The incidence for juxtafacet cysts, the condition under which spinal ganglion cysts are categorized, is between 0.06% and 5.8%. Spinal ganglion cysts often arise in the most mobile segment of the lumbar spine, L4-L5. Patients commonly present with pain, radiculopathy, and weakness. Conservative management is used, but surgical resection is the most common treatment modality. We aim to review the literature and present a rare case of an L2-L3 situated spinal ganglion cyst, treated with maximal safe resection. METHODS: A systematic review of literature was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were queried using Boolean operators and search terms, "spinal ganglion cyst, lumbar ganglion cyst, and lumbar juxtafacet cyst". Presentation, surgical management, and postoperative course of a 29-year-old male with an L2-L3 spinal ganglion cyst are also described. RESULTS: The search yielded 824 articles; 23 met inclusion criteria. These papers consisted of 27 spinal ganglion cyst cases with disaggregated patient data. 63.0% of patients were male, and 53.4 years (range: 23-86) was the average age at presentation. Mean symptom duration was 1.9 years (range: 3 days-12 years). 70.4% of patients reported complete symptom resolution. 14.8% of cases noted neural foramen involvement. CONCLUSIONS: Spinal ganglion cysts are benign lesions typically presenting with radiculopathy. Maximal safe resection is an effective treatment modality with low complication rates. Future studies are needed to understand if neural foramen involvement leads to increased symptom severity.

Lumbar Synovial Cysts-Should You Fuse or Not?

BACKGROUND: Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown. OBJECTIVE: To test the hypothesis that select patients who underwent decompression with instrumented fusion for lumbar synovial cysts would be less likely to have subsequent surgery (SS) in a 2-year period than patients treated with laminectomy alone. METHODS: This retrospective cohort study was performed using IBM MarketScan Commercial Claims and Encounters Database. Patients who had a lumbar synovial cyst diagnosis and laminectomy surgery with or without fusion surgery were included in this study. Patients were tracked for SS 2 years after surgery. Laminectomy patients were propensity score-matched to laminectomy with fusion (LF) patients using a 2:1 ratio. The log-rank test and Cox regression were used to compare the cumulative incidence of SS between groups. RESULTS: There were 7664 and 1631 patients treated with laminectomy and LF before matching. After matching, there were 2212 laminectomy and 1631 LF patients and patient characteristics were balanced. The 2-year incidence of recurrent SS was 3.1% ([CI]: 2.2%, 4.0%) and 1.7% (95% CI: 0.9%, 2.5%) laminectomy and LF, respectively. Compared with laminectomy, LF had a statistically significant lower risk of recurrent SS (hazard ratio: 0.56 [95% CI: 0.32-0.97]; P -value: .04). CONCLUSION: All patients who had concomitant lumbar fusion showed decreased chance of having a cyst- or noncyst-related recurrence SS when compared with all patients undergoing laminectomy alone, regardless of diagnosis at the time of SS.

Temporomandibular joint synovial cysts: A systematic review of the literature and a report of two cases.

Temporomandibular joint (TMJ) synovial cysts are rare, unlike peripheric locations like the wrist or the knee. They share similar presentations with ganglion cyst, benign and sometimes malignant lesions. Only histopathological analysis confirms diagnosis in some cases, finding a true cyst lined by synoviocytes containing synovial fluid. They seem to be related to an increased articular pressure following trauma. In this study we present two cases of TMJ synovial cyst and a systematic review of the literature. A total of 32 cases were retrieved from published literature in PubMed, Cochrane Library and ClinicalTrials.gov databases using the search terms 'TMJ synovial cyst', 'temporomandibular synovial cyst', 'jaw joint synovial cyst'. Swelling (91.3%) and pain (78.3%) were the most common symptoms. MRI was the most commonly used imaging modality that was found to be beneficial for diagnosis. In almost all cases the cyst was removed under general anesthesia, allowing histopathological examination. Only two patients still had pain after removal of the cyst. No recurrence was observed .

Cervical myelopathy caused by ventrally located atlanto-axial synovial cysts: An open quest for the safest and most effective surgical management. Case series and systematic review of the literature.

OF BACKGROUND DATA: Despite a good understanding of the natural history of spinal synovial cysts (SCs), a widespread agreement regarding their optimal management is still lacking. This is particularly true for SCs occurring at the C1-C2 level, which are rare, but oftentimes lead to a rapidly evolving cervical myelopathy. METHODS: We report a series of 4 patients (M:F ratio=1:1; mean age 63.5 years) presenting with progressive cervical myelopathy secondary to ventrally located C1-C2 SCs. All patients underwent a postero-lateral facet-sparing intradural approach with total excision of the SCs. Functional status was assessed pre- and postoperatively with Nurick scale and the modified Japanese Orthopaedic association grading. Furthermore we conducted a systematic review, following PRISMA guidelines of pertinent literature to contextualize the options for surgical management of such lesions. RESULTS: Complete excision of the SCs was confirmed radiologically and on histological analysis. All measures of functional status improved post-operatively, and no cyst recurrence or need for instrumented fusion were noted during follow up (range from 22 to 88 months). CONCLUSION: Our experience suggests that the facet-sparing intradural approach provides excellent clinical outcomes without causing any C1-C2 instability. This is in keeping with the take home message emerging from our literature review, which confirms that treatment should aim at radical resection of SCs while minimizing the risk of postoperative instability.

Synovial Cysts and Myxomas in 16 Cats.

This report describes the clinical and pathologic characteristics of cystic and myxomatous lesions of synovial joints in 16 cats. The average age was 13.4 years. The elbow was most commonly affected (12/16), and all lesions were unilateral. Degenerative joint disease was a frequent concurrent but bilateral condition. The lesions consisted of fluid-filled cysts lined by synoviocytes (3 cases), solid foci of stellate cells in a myxomatous matrix (2 cases), or a combination of the two (11 cases). In some cases there were areas of transition between the cystic and myxomatous lesions. Mitoses and other features of malignancy were rare to nonexistent. In the 13 cats with follow-up information, the lesion gradually increased in size over a period of years. None of the cats died or were euthanized because of this lesion. We propose that some cats with degenerative joint disease develop synovial cysts, which have the potential to transform to a synovial myxoma.

Cutaneous metaplastic synovial cyst in Ehlers-Danlos syndrome.

Classic Ehlers-Danlos syndrome (EDS) is a connective tissue disorder characterized by laxity. The skin, as one of the organs involved, shows hyperextensibility, which makes it prone to trauma. In this context, it would seem logical for cutaneous synovial metaplasia, which is considered a form of repair, to be commonly found in cases of EDS. However, there are only two previously published cases of synovial metaplasia in EDS. We present a third case in a 56-year-old woman with painful redundant skin in both elbows and knees for whom a skin fold of the left elbow was removed to relieve her symptoms. The biopsy showed preservation of the elastic and collagen fibers. The main alteration was the evidence of dermal cystic spaces lined by fibrinoid rests with focal pseudopapillary projections. However, in some zones the cellular lining was preserved, and it was composed of vimentin-positive, fibroblast-like flat, elongated cells, as well as CD68-positive macrophages. No birefringent particles were found in an examination under polarized light.

Lumbar Juxtafacet Cysts.

AIM: To evaluate the factors affecting the clinical and radiological findings of juxtafacet cyst patients. MATERIAL AND METHODS: Between January 2011 and December 2018, eight patients diagnosed with juxtafacet cyst were reviewed, retrospectively. Patient demographics; signs and symptoms; and neurological examination, radiological, and surgical findings were noted. RESULTS: The mean age was 54 years (range, 34â€"69 years) with five (62.5%) females and three (37.5%) males. There were nine juxtafacet cysts in eight patients. Five cysts (55.5%) were located at the L3â€"L4 level, two cysts (22.2%) at the L4â€"L5 level, and two cysts (22.2%) at the L5â€"S1 level. In all patients with L3â€"L4 cysts, the intercrest line was intersecting the spinal column at L4 vertebral body level. The most frequent symptoms were back pain and radiculopathy. Magnetic resonance imaging and computerized tomography revealed degenerative facet arthropathy in six patients (75%). Three patients (37.5%) had a medical history of trauma. One patient (12.5%) was treated conservatively. Seven patients (87.5%) were advised to undergo surgical treatment. CONCLUSION: Degeneration and instability are the main causes of juxtafacet cysts. They are mainly seen at the L4â€"L5 level due to higher movement capacity of this level. But, if the intercrest line intersects the spinal column at higher levels, degeneration and instability risks move to upper levels, and juxtafacet cysts may occur at the L3â€"L4 or upper levels.

New classification of facet joint synovial cysts.

PURPOSE: Facet cysts develop due to degeneration of the zygapophyseal joints and can lead to radiculopathy and neurogenic claudication. Various surgical options are available for facet cyst excision. The aim was to facilitate surgical treatment of lumbar facet cysts based on a new classification. METHODS: We retrospectively analyzed all patients of the last 10 years in whom a facet cyst was surgically removed (ipsilateral laminotomy, contralateral laminotomy, and segmental fusion). Several radiological parameters were analyzed and correlated with the patients' outcome (residual symptoms, perioperative complications, need for re-operation, need for secondary fusion, facet cyst recurrence). RESULTS: One hundred eleven patients (55 women; median age 64 years) could be identified. Thirty-three (48%) of 69 cases, for which MRI data were available, were classified as medial facet cyst (compressing the spinal canal), 6 facet cysts were localized intraforaminal (9%) and 30 cases (43%) mediolateral (combination of both). The contralateral approach had the lowest rate for revision surgery (7.5%, p = .038) and the lowest prevalence of residual complaints (7.5%, p = .109). A spondylolisthesis and a higher/steeper angle of the facet joints were associated with poorer patient outcome. CONCLUSIONS: Lateral facet joint cysts are best resected by a contralateral approach offering the best outcome while medial cysts are suitable for removal by an ipsilateral laminotomy. The approach of mediolateral cysts can be determined by the width of the lamina and the angle of the joint. Segmental fusion should be considered in cases with detected spondylolisthesis and/or steep facet joints.

Gas containing intraspinal synovial cyst in the lumbar spine: Case report and literature review.

Intraspinal synovial cyst (ISC) is a well-documented pathology. It is sometimes found in the degenerative lumbar spine and can result in neurological disorders. ISC typically contains xanthochromic fluid, blood, inflammatory tissue, and/or osseous structures, enclosed by fibrous tissue. Regarding the treatment modalities, the effectiveness of both nonsurgical management, such as oral analgesics, needle aspiration, and intra-articular injection of corticosteroid drugs, and surgical management, have been reported. Previous studies have described that the ISC can contain gas, which is derived from the vacuum phenomenon of an adjacent facet joint; however, this clinical condition has never been systematically investigated because of its rarity. In the present report, we describe the case of a 68-year-old male with gas-containing ISC in the lumbar spine who was successfully treated with surgical management; additionally, we performed a literature review to discuss the decision-making process for cases of gas-containing ISC. Based on our findings and previous literature, we recommend that considering the peculiarity of the content of such lesions in addition to the ball-valve effect of a synovial cyst, prompt transition to surgical management would be pertinent when nonsurgical treatment cannot achieve satisfactory outcomes in such cases.

Spontaneous regression of extradural intraspinal cysts in a dog: a case report.

BACKGROUND: Extradural intraspinal cysts are fluid accumulations that appear to be associated with increased motion at vertebral joints. CASE PRESENTATION: We report the spontaneous regression of lumbar and lumbosacral cysts (presumably synovial cysts) and the unusual occurrence of an S1-2 extradural intraspinal cyst in a dog. The dog presented with lumbosacral pain. Six extradural intraspinal cysts were observed on high-field magnetic resonance imaging from L5-6 to S1-S2. The cysts between L5-6 and L7-S1 ranged from 0.12 to 0.44cm2 at their largest area. The largest cyst was located at S1-2 (left), measuring 0.84 cm2 at its largest view. The dog was medically managed. A follow-up magnetic resonance imaging scan was obtained 3.5 years after the first imaging. All cysts except the one at S1-2 had reduced in size. Mean reduction in size was 59.6% (35-81%). CONCLUSIONS: In summary, we report a case with multiple extradural intraspinal cysts that underwent spontaneous regression of all but one cyst during a 3.5-year follow-up period. Whether this is a single occurrence, or is part of the natural history of these cysts in the lumbosacral region of dogs, remains to be established. Spontaneous regression of intraspinal cysts had not been described in dogs.

Sudden Onset of Paraparesis Caused by a Hemorrhagic Thoracic Synovial Cyst.

BACKGROUND: Hemorrhage is a rare presentation of spinal synovial cysts, which are usually located in the lumbar spine. They may cause an epidural hematoma and compression of the cauda equina. Infrequently, they may be located in the thoracic spine. CASE DESCRIPTION: We present a case of sudden onset paraparesis caused by hemorrhage in a synovial cyst at a midthoracic level. Clinical, radiologic, and histologic findings are described. CONCLUSIONS: This report describes a unique case of hemorrhagic synovial cyst at the mid-thoracic spine. These lesions are rarely located in the cervico-thoracic spine but should be included in the differential diagnosis of myelopathy.

Bilateral synovial cysts of the temporomandibular joint.

Synovial cysts very rarely affect the temporomandibular joint (TMJ). On review of the literature, there are 29 reported cases of unilateral synovial cysts of the TMJ. We present a case of bilateral synovial cysts occurring at the TMJs.

[Lumbar synovial cysts: literature review and original long-term results after microsurgical resection]. / Die lumbalen Synovialzysten: Literaturreview und originäre Langzeitergebnisse nach mikrochirurgischer Resektion.

BACKGROUND: Intraspinal lumbar vertebral joint cysts are an unusual cause of nerve root compression symptoms and do not differ clinically from the symptoms of a herniated disc. PATHOGENESIS: The cysts originate from the small vertebral joints and, depending on their size, compress the nerval structures. The affected vertebral joints typically show activated arthritic circumstances, which are associated with degenerative spondylolisthesis in about 50% of cases. In the majority of cases, MRT and CT can be used for diagnostic purposes. The exact etiology has not been fully clarified; various factors such as activated arthritis of the vertebral joints appear to be the major cause. TREATMENT: Treatment options include conservative, semi-invasive and surgical therapy. Conservative and semi-invasive treatment methods lead to temporary improvement. The result of surgical treatment, however, is excellent in a complete resection of synovial cysts. In In rare cases, an initial fusion is necessary in rare cases.

Atlantooccipital Synovial Cyst with Isolated Hypoglossal Nerve Palsy: Case Report of Nonfusion Surgical Approach and Review of Literature.

BACKGROUND: Isolated hypoglossal nerve palsy caused by an atlantooccipital synovial cyst is a rare lesion, with fewer than 5 cases reported in the literature. CASE DESCRIPTION: Our patient presented with acute hypoglossal nerve dysfunction. Our differential included neoplasm, trauma, stroke, multiple sclerosis, or other inflammatory/infectious etiology. Imaging revealed a peripherally enhancing, extradural focus in the left premedullary cistern, most likely consistent with a synovial cyst. CONCLUSIONS: A left suboccipital craniectomy was performed in the region of the left hypoglossal canal, in which a cystic structure was noted at the occipital condyle and C1 vertebral junction. The nerve was adequately decompressed via aspiration of the cyst. Postoperatively, the patient substantially improved. Although rare, synovial cysts must be included in the differential diagnosis of atlantooccipital lesions.

High resolution MRI of nail tumors and tumor-like conditions.

Although the nail is a small anatomical structure, it can be affected by various tumors and tumor-like conditions. Because of the distinctive nail anatomy, the clinical presentation of tumors is modified, thus rendering the diagnosis challenging. As nail biopsy and surgery are painful procedures associated with an increased risk of permanent onychodystrophy, pre-operative diagnosis is desirable. Although conventional radiographs are still the first-line radiologic examination for the assessment of bony structures beneath the nail matrix, they do not allow detailed evaluation of the phalangeal soft tissues. High resolution MRI allows accurate detection and mapping of nail lesions and can suggest a specific diagnosis. This review focuses on high resolution MRI of nail tumors and tumor-like lesions. We review the nail anatomy and the optimal MRI protocol. We then discuss a variety of tumors and tumor-like lesions in relation to the clinical presentation, anatomic location, histological features and imaging characteristics. We herewith describe common benign tumors (glomus tumor, onychomatricoma, keratoakanthoma, fibroma, subungual exostosis, hemangioma, chondroma, pyogenic granuloma), malignant tumors (subungual melanoma, subungual squamous cell carcinoma), as well as tumor mimics (mucoid cyst, epidermoid cyst). Although not entirely specific, MRI is a valuable tool in treatment planning of these tumors.

Unprecedented recurrence of carpal tunnel syndrome by metaplastic synovial cyst in the carpal tunnel.

Metaplastic synovial cyst (MSC) is a benign cystic lesion observed after surgical intervention and recurrent skin trauma. Because of its rarity, the etiology is not fully understood. The most emphasized etiologic factors are recurrent surgical procedures and cutaneous pathologies, which cause cutaneous fragility and abnormal wound formation. In the literature, MSC is exemplified as a mass that can be observed by the naked eye and palpated. All patients had a history of previous surgical procedures in the area. In the present case, we report a 48 -year-old woman with recurrent carpal tunnel syndrome due to a MSC. This report showed that MSC can be detected at deeper locations than the regions described in the literature. To our knowledge, this is the first report of MSC causing carpal tunnel syndrome recurrence. It is thought that previous operations are the most important etiologic factor in MSC occurrence.

An evidence-based etiology study of synovial cyst of knee cruciate ligament: a real or pseudo-cyst.

PURPOSE: Synovial cyst of knee cruciate ligament (SCKCL) is a rare condition but can cause severe knee pain. The understanding of its etiology is relatively poor. This current study aimed to elucidate the pathogenesis of SCKCL based on a series of histo- and cytopathological examination. METHODS: Ten SCKCL patients who underwent arthroscopy were enrolled, among five patients claimed past knee injury. Hematoxylin & eosin staining was conducted to the cyst wall tissue sections and Papanicolaou staining to the cyst fluid smear. Prussian blue staining was employed to both the wall section and fluid smear. Immumohistochemical staining for mesothelial cells (MC), epithelial cells (CK), vascular endothelial cells (CD31), monocytes (CD68), and hematogenous stem cells (CD117) were taken to elucidate the possible involvement of various cell types in the development of SCKCL. RESULTS: No erythrocyte was discovered in the fluid; however, Prussian blue stained hemosiderin particles were found in the cyst wall and fluid, suggesting past hemorrhage in all patients. Abundant lymphocytes and plasmocytes were observed in the cyst wall and fluid. In addition, the cyst lining was infiltrated with abundant CD68(+) monocytes while only few MC(+) mesothelial cells were sporadically observed in four samples. The cyst submucosa was also diffused with abundant CD68(+) monocytes and proliferated capillaries stained with CD31. CD117-positve hematogenous stem cells were sporadically observed in eight specimens. CONCLUSION: Our findings provided evidence that SCKCL is not a mature synovial cyst but rather an inflammatory pseudo-cyst. It may have resulted from past minor hemorrhage and intra-ligament chronic inflammation.

Compressive radial neuropathy by a synovial cyst during pregnancy: A clinical case report.

RATIONALE: Compressive radial neuropathy by a synovial cyst in the radial tunnel during pregnancy is a rare occurrence. The management of radial nerve compression caused by a synovial cyst in a pregnant patient is a surgical dilemma owing to the fetal and maternal risks of treatment. PATIENT CONCERNS AND DIAGNOSIS: A 37-year-old pregnant woman presented with progressive forearm pain at the gestational age of 12 weeks. A cyst was identified via musculoskeletal ultrasound and magnetic resonance imaging examinations in the radiocapitellar joint causing radial compressive neuropathy. INTERVENTIONS: After regional nerve block and surgical removal of the cyst, the patient's forearm pain was alleviated without neurological deficits. OUTCOME: symptoms from nerve compression were improved after surgical treatment LESSONS:: This report illustrates the case of a pregnant woman presenting a compressive neuropathy by an enlarged cyst possibly due to the unbalance of growth factors during pregnancy. With proper diagnosis and timely surgical intervention, such patients can achieve good neurologic recovery without maternal or fetal complications.