Intraosseous Cyst Research Articles

Camptodactyly-arthropathy-coxavara-pericarditis syndrome in Saudi Arabia: Clinical and molecular genetic findings in 22 patients

BackgroundCamptodactyly-arthropathy-coxavara-pericarditis (CACP) syndrome is a rare autosomal recessive disorder caused by mutations in the gene proteoglycan 4 (PRG4), affecting lubricin production, which is an essential protein for joint function. Manifestations vary between affected individuals with camptodactyly, early-onsetnon-inflammatory arthropathy, coxa vara deformity and non-inflammatory pericarditis. ObjectiveTo describe the clinical, laboratory, radiological and genetic findings of CACP syndrome in children from Saudi Arabia. MethodsMedical records of all the children with CACP syndrome seen between June 1990 and June 2012 at King Faisal Specialist Hospital and Research Center, Riyadh were reviewed. The data include gender,age of first disease manifestations,referral diagnosis, clinical and radiological features, and molecular genetic studies as well as functional status at the last follow-upvisit. ResultsTwenty-two patients (15 boys), (clinical and genetic data of 15 patients were previously published) with mean age at diagnosis 3.7 (1–14) years, were included in this cohort study. The referral diagnosis was inaccurate in all patients; juvenile idiopathic arthritis (JIA) was the referral diagnosis in majority of the patients.Six families had more than one affected child. Camptodactyly and large joints arthropathy were present in all the cases. Camptodactyly was observed in the neonatal period in all the patients, while other joint involvement was observed through the 1st year of life. All patients had a normal cardiac evaluation but two children had evidence of pericarditis. All patients had normal inflammatory markers and the result for rheumatoid factor test was negative. Radiological findings included coxa vara with a short femoral neck and flat, irregular femoral heads and intra-osseous cysts, increased joint space, and abnormal modeling of the acetabulum with small iliac wings. Other joints (knees, ankle, elbow and wrist) showed soft-tissue swelling consistent with thick cartilage and abnormal modeling with evidence of intra-articular fluid in majority of the patients. Synovial biopsy from three patients revealed proliferating synovial epithelium with moderate fibro-collagenous densities and multinucleated giant cells, occasional lymphocytes or neutrophils were identified. Previously, a locus responsible for causing CACP syndrome has been reported in eight patients of our cohort; it has been assigned to 1q25-q31. Furthermore, in seven newly diagnosed patients from four unrelated families, five novel mutations were found. All patients were referred to us while they were on NSAIDs, 10 patients used antirheumatic drugs (prednisone and methotrexate) and two patients were treated with etanercept. In all patients, treatment was ineffective apart from mild pain relief. ConclusionCACP syndrome is an autosomal recessive disorder occurring due to mutations in the gene PRG4 encoding lubricin; it is not an uncommon disorder in Saudi Arabia. Pericarditis is rarely seen in our patients. Our data suggest that CACP syndrome may be easily confused with JIA, causing a delay in diagnosis and probably unnecessary treatment with antirheumatic drugs including biologic agents.

Intraosseous ganglion cyst within the L4 lamina causing spinal stenosis

There are rare reports of intraosseous ganglion cysts in the cervical spine. However, to our knowledge, there are no previous reports of these cysts occurring in the lumbar spine. To report a case of symptomatic lumbar spinal stenosis caused by an intraosseous ganglion cyst of the L4 lamina that communicated with the spinal canal. Case report. An 86-year-old woman was referred to our spine service for a 2-year history of anterior thigh and leg pain. Magnetic resonance imaging revealed a benign-appearing intraosseous cyst in the left L4 lamina communicating with a posterior epidural cyst at L4-L5 causing marked spinal stenosis. The patient was treated successfully with a laminectomy and resection. The patient underwent partial laminectomies of L4 and L5 preserving the interspinous ligaments between L5-S1 and L3-L4. The cyst was removed en bloc without violation of the cyst wall. Histopathologic examination revealed focal myxoid changes without a cellular lining of the cyst wall, confirming the diagnosis of intraosseous ganglion cyst. This is the first report to describe an intraosseous ganglion cyst occurring in the lumbar spine. Although spinal stenosis is commonly a result of degenerative joint or disc disease, it occasionally may result from more obscure causes. This case illustrates a patient with an intraosseous ganglion cyst within the spinal lamina resulting in spinal stenosis, treated successfully with a laminectomy and resection.

Premature cystic lesions in shoulders of elite junior javelin and volleyball athletes: a comparative evaluation using 3.0 Tesla MRI

The purpose of this study was to evaluate clinical and magnetic resonance imaging (MRI) findings in the shoulders of high performance competitive junior javelin athletes and volleyball players. The hypothesis was that structural lesions already exist in young and asymptomatic overhead athletes. Thirty-one healthy high performance junior elite athletes were included. Group 1 consisted of 15 male javelin throwers (mean age, 17.7 ± 0.8 years) and group 2 of 16 male volleyball players (16.9 ± 1.0 years). Questionnaire-based interviews, comprehensive clinical examination, and shoulder scoring systems (visual analog scale [VAS] and Constant-Murley Score) were completed. Bilateral shoulder imaging was performed using a 3.0 Tesla MRI. The Constant-Murley Score of group 1 was 95.5 ± 3.6 and 94.7 ± 4.6 points for group 2. Group 1 demonstrated a mean VAS of 0.9 ± 1.6 and group 2 a mean of 0.6 ± 0.8 points. Postero-superior intraosseous cysts of the humeral head were detected in 73.3% of all javelin throwers in the dominant shoulder, but only in 13.3% in the nondominant shoulder (P = .008). In the volleyball group, such cyst formation was rarely seen in 12.5% in the dominant versus 6.3% in the nondominant shoulder (P = .66). A high percentage of junior elite athletes already demonstrate osseus signs of overloading especially in the group of javelin athletes, although none had a history of prior shoulder pathology. Therefore, junior overhead athletes might be at risk for the early development of structural lesions at the insertion of the posterior rotator cuff similar to lesions already known for adult athletes, even though they do not present clinical signs of overuse at that age.

Kyste synovial intraosseux du capitatum : à propos d’un cas

Intraosseous cyst of the carpal bones is a rare cause of wrist pain. Few cases have been reported. We report a rare case of intraosseous ganglion cyst of the capitate, in a girl aged 16 who plain of chronic pain of the right wrist. The radiological assessment showed an osteolytic lesion with marginal sclerosis. The diagnosis was confirmed by histopathology and treatment consisted of curettage with autologous cancellous bone graft. At 8 months follow-up, the capitate is fully consolidated and the functional result is satisfactory.

Mucoid degeneration of the anterior cruciate ligament: frequently under-diagnosed entity in MRI

ObjectiveThe purpose of our study was to describe the MR appearance of mucoid degeneration of the anterior cruciate ligament and to address its clinical significance. Patients and methodsA database search of 2000 knee MRI examinations revealed 32 examinations (Chart 1) with reported mucoid degeneration of the anterior cruciate ligament. ResultsOf 32 examinations that met imaging criteria, all patients (100%) had different degrees of mucoid degeneration. Associated ganglia were seen in eight patients; located in the proximal ligament in four examinations (12.5%) and the distal ligament in two (6%) and involved the mid-portion of the ligament in two (6%).Intra-osseous cysts were noted distally in 15 examinations (47%), proximally in four (12.5%) and on both sides in six (19%). All our patients had accessible medical records; no clinical evidence of instability was reported.Four patients who underwent arthroscopy had an intact anterior cruciate ligament at that time. ConclusionAnterior cruciate ligament mucoid degeneration has specific MRI features and should not be misdiagnosed as partial or total tear, and typically not associated with ligament instability.

Treatment of symptomatic para-articular intraosseous cysts by percutaneous injection of bone cement

To describe the technique and clinical outcome of percutaneous injection of bone cement in the treatment of symptomatic para-articular intraosseous cysts. Five patients (three men, two women; mean age 35years) with painful para-articular intraosseous cysts were treated by percutaneous injection of bone cement under combined fluoroscopic and computed tomography (CT) guidance. The lesions were all located in weight-bearing bones, involving the acetabulum, proximal tibia, distal tibia, talus, and calcaneus, respectively. The average amount of bone cement injected was 2.1ml (range, 0.6-3.5ml). Calcium phosphate cement was used in four cases and acrylic cement in one case. There were no immediate or delayed complications. Full pain relief was obtained between 1 and 4weeks after treatment. All patients made a complete recovery and were pain-free at their last visit. Percutaneous injection of bone cement was a safe and efficient technique in the management of symptomatic para-articular intraosseous cysts in our population.

Intraosseouss degenerative cyst of the axis approached via transcervical extrapharyngeal avenue

Intraosseous degenerative cysts (IDC) of the cervical spine are rare. IDC within C2 have been reported in three articles only. We report a patient with neck pain due to a IDC within C2. We discuss the differential diagnosis of these lesions and the surgical approaches to reach this complex anatomical region.

Endoscopic Excision of an Intraosseous Forehead Dermoid Cyst in a Child

Abstract Purpose: Endoscopic excision of benign forehead masses in children aims to avoid conspicuous scarring and disfigurement. We present a video of an endoscopic-guided excision of an intraosseous dermoid cyst located in the mid-forehead. Case Presentation: A 10-month-old, dark-skinned boy was seen for an asymptomatic mid-forehead mass that was noted soon after birth. The mass was firm and fixed. Computed tomography scan demonstrated a 1-cm intraosseous mass in the mid-forehead consistent with a dermoid cyst. The mass did not penetrate the inner table of the cranium. The child was operated on at age 18 months by a team comprised of a pediatric general surgeon and a head and neck surgeon with extensive experience in facial plastics. The mass was removed through a single, vertical scar 2 cm above the hairline, using a combination of endoscopic and classic instruments. The procedure resulted in excellent cosmesis without any visible scar, and high parent satisfaction. Conclusions: Endoscopic excision of ...

Distal femoral intraosseous ganglia: cause or result of a degenerative process: 17-year follow-up of a case

We report a case of recurrent, resistant, huge, multilocular intraosseous ganglia cyst localized at the distal femur. A 25-year-old man presented with left knee pain. Imaging studies and histological analysis confirmed the diagnosis. Treatment was curettage and bone grafting. Long-term follow-up revealed degenerative changes at radiographs and MRI. This case may contribute to make distinction between degenerative subchondral cyst and intraosseous ganglia cyst and help to understand pathogenesis of this entity.

Bone Readaptation Method for the Treatment of Intraosseous Dentigerous Cyst : Report of a case

Bone Readaptation Method for the Treatment of Intraosseous Dentigerous Cyst : Report of a case

Endoscopic treatment of posteriorly localized talar cysts

This study presents the short-term follow-up results from our case series of patients with posteriorly localized intraosseous talar cysts. Patients were treated via hindfoot endoscopy in the prone position. We evaluated six ankles of five patients treated with hindfoot endoscopy for intraosseous cysts localized to the posterior portion of talus. Three patients were men and two were women. The median age of the patients was 34 (22-40) years. The bilateral case was treated with a sole operation. The median preoperative AOFAS score was 69 (38-72) points. Additionally, all patients were found to have flexor hallucis longus (FHL) tendinitis in clinical and radiologic evaluations; large os trigoni were detected in five affected ankles. Debridement of scar tissue and FHL tendinitis, resection of os trigoni, and curettage and grafting of the cysts were completed endoscopically with one surgery. The cavities were filled with autografts in all patients except one. Hydroxyapatite was used in one case. The pathologic diagnoses were intraosseous ganglia in three feet and simple bone cysts in the remainder. The preoperative diagnoses were unchanged postoperatively. The median postoperative follow-up was 27 (12-74) months. In all patients, graft union was confirmed with computed tomography. The median AOFAS score improved to 90 (75-100) points postoperatively. There were no complications. All patients were satisfied with their results. Hindfoot endoscopy can be used for the treatment of intraosseous talar cysts that are posteriorly localized. Significant advantages of this method include lower morbidity and shorter postoperative hospitalization time. Hindfoot endoscopy is a safe and effective method for treating talar cystic lesions and is an attractive option for experienced arthroscopic surgeons. IV.

Mandibular Ramus Epidermal Inclusion Cyst

Epidermal inclusion cyst in the mandibular ramus is a very rare condition. Intraosseous epidermal cysts are benign cysts appearing clinically as radiolucent lytic bone lesions. Definitive diagnosis is made with histopathologic examination. Treatment is simple curettage and grafting if the defect is large. We present a case of a 78-year-old man who was admitted to our clinic with the complaints of swelling in the cheek and preauricular area of 8 years' duration. In computed tomography scan, a cystic mass measuring 6.5 × 4.5 cm with necrotic center causing expansion in the left ramus mandibula and thinning and rupture of the cortex was found. The mass was reported to extend to the zygomatic arch superiorly and masticator space minimally. Simple curettage was performed. Histopathologic examination revealed epidermal inclusion cyst. A case of mandibular ramus epidermal inclusion cyst is presented.

Intraosseous Epidermoid Inclusion Cyst Presenting as a Paronychia of the Hallux

Intraosseous epidermoid inclusion cysts are rare benign bone lesions that occur most commonly in the skull and in the distal phalanges of the fingers. Herein we report a case of an intraosseous epidermoid inclusion cyst occurring in the distal phalanx of the left hallux. Only six occurrences of this lesion have been described in the foot. This patient's presentation, with active drainage (initially appearing as purulent discharge from an acutely tender ingrown hallux nail) and a known inoculation event accompanied by severe peripheral vascular disease, make this case unique.

Minimally Invasive Bone Grafting of Cysts of the Femoral Head and Acetabulum in Femoroacetabular Impingement: Arthroscopic Technique and Case Presentation

Femoroacetabular impingement (FAI) has been recently established as a risk factor in the development of osteoarthritis of the hip. Intraosseous cysts are commonly seen on imaging of FAI. In most cases these cysts are incidental and do not require specific treatment at the time of surgical treatment of hip impingement. However, in some cases the cysts may mechanically compromise the acetabular rim or femoral neck. We present a technique for treating such cysts with an all-arthroscopic technique using a commercially available bone graft substitute composed of cancellous bone and demineralized bone matrix placed within an arthroscopic cannula for direct delivery into the cysts. This technique may be of benefit to surgeons treating FAI with an all-arthroscopic technique.

Peripheral keratocystic odontogenic tumour: a case report

AbstractPeripheral keratocystic odontogenic tumour is a rare disease occurring in the gingiva and displaying histopathological characteristics similar to keratocystic odontogenic tumour. The patient was a 63‐year‐old man complaining of gingival swelling in the mandibular premolar region. A raised mass lesion 15 mm in diameter covered with normal epithelium was observed on the buccal gingiva of the left mandibular premolar region. Panoramic radiography and computed tomography excluded intraosseous cyst or tumour. Needle aspiration examination revealed paste‐like, pale yellow contents. The raised lesion was surgically resected. Histopathologically, the cyst wall comprised squamous epithelium with parakeratosis. Peripheral keratocystic odontogenic tumour was diagnosed.

Diagnostic Exercise: Intraosseous Epidermoid Cysts in the Third Phalanx of a Dressage Mare

An 11-yr-old Dressage mare had abnormal gait, and an abscess of the left hoof was suspected but not observed. Radiographic and computerized tomographic evaluations showed a large cystic lesion near the apex of the pedal bone, and a smaller, similar lesion at the lateral wing. Sagittal sections through the affected member revealed two intraosseous cysts at the third phalanx. Histologic and histochemical results characterized the lesions as intraosseous epidermoid cysts of the third phalanx.

Diagnostic Exercise: Intraosseous Epidermoid Cysts in the Third Phalanx of a Dressage Mare

An 11-yr-old Dressage mare had abnormal gait, and an abscess of the left hoof was suspected but not observed. Radiographic and computerized tomographic evaluations showed a large cystic lesion near the apex of the pedal bone, and a smaller, similar lesion at the lateral wing. Sagittal sections through the affected member revealed two intraosseous cysts at the third phalanx. Histologic and histochemical results characterized the lesions as intraosseous epidermoid cysts of the third phalanx.

Chondromyxoid Fibroma of the Foot: An Uncommon Presentation

We report a chondromyxoid fibroma of the proximal phalanx of the left third toe in a 35 year old woman, a rare site for this tumor. The radiological appearance of a trabeculated lytic lesion with sclerotic margins and soft tissue extension raised the possibility of other entities such as intraosseous epidermoid cyst, aneurysmal bone cyst, chondroblastoma, osteoid osteoma and chondrosarcoma as well as infections like pyogenic, tuberculous and leprous dactylitis. However the typical microscopic picture of lobules of cartilage separated by fibrocellular tissue and scattered osteoclasts confirmed the diagnosis. The tumor was successfully treated by curettage and bone grafting using a dorsal and plantar 2 incision technique and has no recurrence at 4 year follow up. In this article we present our experience with this case and discuss the differential diagnosis of a solitary lytic lesion in the phalanges of the toes.

Arthroscopically Assisted Treatment of Intraosseous Ganglions of the Lunate

Intraosseous ganglia (IOGs) of the lunate are a relatively rare, but by no means insignificant, condition because treatment by traditional open curettage and bone grafting can lead to ongoing pain and stiffness of the wrist.An arthroscopically assisted minimally invasive technique of debridement and grafting of the lunate IOG is discussed, as well as the history of the condition, indications and contraindications, surgical technique with postoperative rehabilitation, and potential complications.The outcomes of 8 patients with persistent symptoms and typical radiographic and bone scan findings were assessed independently preoperatively and postoperatively by using a modified Green and O'Brien wrist score. The intraosseous cyst was drilled under arthroscopic and fluoroscopic guidance via either a volar or dorsal portal, depending on the position identified on the computed tomography scan. Average follow-up time was 3.8 years (range, 1-5.6 yrs). All patients returned to employment within 4 months. Wrist scores improved 34 points, from 51 to 85 points, by 1 year after surgery, with trabeculation being noted within the grafting lunate. The greatest improvements were seen in visual and analog pain scores, reducing from 68.3 to 11.2, and flexion-extension arcs, which increased from 98 to 114 degrees.The technique of arthroscopically assisted debridement of IOGs of the lunate is safe, with minimal morbidity and recurrence of symptoms during the follow-up period.

Intraosseous Epidermoid Cyst of Distal Phalanx of Fingers

Intraosseous epidermoid cysts of fingers are uncommon lesions. We reported two cases with intraosseous epidermoid cysts of distal phalanx of fingers. Case 1 was a 61-year-old woman with a swelling of the left middle finger without history of trauma. Case 2 was a 47-year-old male with a crushing injury of his right thumb. On radiographic findings, a well-circumscribed osteolytic lesion in distal phalanges was noted. Unexpectedly, histological examinations showed intraosseous epidermoid cyst.