Intraosseous Ganglion Research Articles

Distribution Patterns of Benign and Malignant Bone and Soft Tissue Tumors and Tumor-like lesions in the Hindfoot and Ankle: A 12.5-year Analysis.

Benign and tumor-like lesions of the hindfoot and ankle are common, whereas malignant entities are rare. Accurate evaluation and timely management of these lesions can be challenging, making it crucial to understand their incidence and anatomic localization. This study retrospectively analyzed the distribution of benign and malignant bone and soft tissue tumors in the hindfoot and ankle. This study included patient data from a single center, such as age, sex, histologic diagnosis, and anatomic location over a 12.5 year period. Of the 105 cases reviewed, 19 cases (18.1%) were osseous lesions and 86 cases (81.9%) were soft tissue lesions. The latter were divided into 77 benign and 9 malignant cases, resulting in an overall malignancy rate of 8.6%. The most common osseous lesion was the intraosseous ganglion (n=12). The majority of benign soft tissue lesions (75.3%) were located in the hindfoot, with TGCT, schwannoma, and ganglion cysts being the most common types. The nine malignant cases were distributed among seven entities and were evenly distributed among both regions and sexes. Malignant cases had a higher mean age (59.2 years) compared to benign cases (40.8 years; p=0.001). Tumors, tumor-like lesions, and pseudotumors represent an important aspect of ankle pathology. The majority of focal masses and swellings are benign soft tissue or osseous lesions, but malignant entities can occur and may be mistaken for benign conditions. Preoperative imaging and histopathologic examination are essential, and preoperative presentation to a multidisciplinary tumor board is recommended in unclear cases.

Idiopathic intraosseous ganglion of the distal tibia in a young adult male: A case report with review of literature

Intraosseous ganglion is a benign cystic bony lesion containing viscous and mucinous gelatinous material, which is usually seen in middle-aged individuals. It is similar to soft-tissue ganglion cysts present in other parts of the body. We, hereby, report a rare case of idiopathic intraosseous ganglion of the tibia in a young adult who presented with chronic pain in his lower leg. The patient was subjected to X-ray and MRI investigations and managed by excisional curettage of the lesion and histopathological examination. On histopathology, the diagnosis of intraosseous ganglion was confirmed. On 2-year follow-up, the patient was doing well without any complication and recurrence. This report describes the diagnosis and successful management of intraosseous ganglion at a very rare site in a young individual. More in-depth studies are required to understand the predisposing factors, underlying pathology, early diagnosis, and management of this lesion.

Distribution and Characteristics of Carpal Bone Tumors: A Systematic Review

Abstract Background Carpal bone tumors are rare in the literature, making it difficult to identify their clinical presentation. Purpose This systematic review analyzes the characteristics of published carpal bone tumor cases to identify the most frequent patterns in diagnoses. Attention is paid to the carpal bone involved and type, and patient demographics was performed to summarize published findings. Methods A systematic review was searched on PubMed, Ovid, and Cochrane databases gathering literature on carpal bone tumors. After applying specific criteria, final analysis of the literature yielded 151 patients with 156 carpal bone neoplasms. Results The most common carpal bones involved were the scaphoid (48, 31%), capitate (31, 20%), and hamate (24, 15%). Benign tumors represented the largest majority (133, 85%), followed by metastatic (17, 11%) and primary malignant (7, 5%). The most frequent tumor types were osteoid osteoma (37, 24%), osteoblastoma or giant cell tumor (24, 15%), intraosseous ganglia (21, 13%), and chondroblastoma (14, 9%). Within the metastatic category, most tumors derived from lung carcinoma (10, 59%), followed by renal cell carcinoma (2, 12%). There were three types within the malignant category: chondrosarcoma (3, 43%), hemangioendothelial sarcoma (3, 43%), and osteosarcoma (1, 14%). Conclusion The most frequent carpal bones observed were the scaphoid, capitate, and hamate. Most tumors were benign. The most common tumor types were osteoid osteoma, osteoblastoma, and giant cell tumor. Metastatic carpal tumors were most commonly from lung carcinoma. Chondrosarcoma and hemangioendothelial sarcoma were the most common primary malignancies.

Ganglions in the Hand and Wrist: Advances in 2 Decades

Ganglion cysts represent the most common soft-tissue mass in the hand and wrist. Ganglion cysts are most commonly encountered at the dorsal or volar aspects of the wrist, although cysts may arise from the flexor tendon sheath, interphalangeal joint, and extensor tendons. Intraosseous and intraneural ganglion cysts have also been described. Diagnosis of ganglion cysts relies primarily on history and physical examination. Transillumination and aspiration of masses may be useful adjuncts to diagnosis. Imaging such as radiography and ultrasonography may be indicated to evaluate for associated conditions, such as degenerative joint disease, or to rule out a solid or heterogeneous mass. Advanced imaging such as MRI is generally reserved for patients in whom occult ganglions, intraosseous ganglions, or solid tumors, including sarcoma, remain a concern. Treatment of ganglion cysts includes observation, aspiration or puncture with possible corticosteroid injection, and surgical excision. Nonsurgical management may result in cyst resolution in over 50% of patients. Surgical excision is associated with recurrence rates of 7% to 39%. Advances in surgical techniques have allowed surgeons to conduct arthroscopic ganglion excision, with recurrence rates similar to those of open management. This study highlights the advances in diagnosis, treatment, and outcomes that have taken place over the past 2 decades for this common condition affecting the hand and wrist in the adult population.

Intraosseous Ganglion Cyst of the Talus Treated With Curettage and Bone Grafting Through a Medial Malleolus Osteotomy.

Intraosseous ganglion cyst (IGC) of the talus is a rare entity. There is no consensus regarding the best surgical approach to the talus. In this study, we evaluated the outcomes of curettage and bone grafting of the talus IGC via medial malleolus osteotomy. Seventeen patients with talus IGC who were treated between 2002 and 2020 using curettage and bone grafting through a medial malleolus osteotomy were included. The outcome measures were ankle range of motion (ROM), pain, and function. The ankle pain was evaluated by the visual analog scale (VAS). The ankle function was evaluated by the Toronto extremity salvage score (TESS) and Musculoskeletal Tumor Society (MSTS) score. The study population included 10 men and 7 women with a mean age of 34.9 ± 18.8 years and a mean follow-up of 5.4 ± 3 years. The mean size of the lesion was 2.6 ± 0.8 cm. Postoperatively, mean ankle dorsiflexion and plantar flexion were 19.4 ± 5.8 degrees and 36.7 ± 5.3 degrees, respectively. The mean VAS was 0.9 ± 1.1. The mean MSTS score and TESS were 96.2 ± 3.5 and 94.5 ± 4.1, respectively. Two patients developed ankle osteoarthritis after 3 years (1 stage I and 1 stage II). One of these patients (stage II) also had recurrence after 6 months (recurrence rate: 6.7%). Talus IGC could be adequately managed with curettage and bone grafting through a medial malleolus osteotomy. Even so, mild pain and reduced ankle ROM remain in some patients. Level IV, retrospective cohort study.

Correction: Diagnosis and Treatment of Intraosseous Ganglion in the Ankle Region.

Correction to: Diagnosis and Treatment of Intraosseous Ganglion in the Ankle RegionZ Orthop Unfall eFirstDOI: 10.1055/a-1938-8449

Bilateral intraosseous ganglion of the talus

A bony cyst that is an intraosseous ganglion of benign nature that includes epiphyseal and metaphyseal zones of large bones. Intraosseous ganglion is an uncommon ganglion in talus and in all the cases described in literature where patient had unilateral cyst and had symptoms over ankle joint. No case has been reported with bilateral talus region causing complication with the subtalar joint. A 28-yr-old male presented to our OPD with complain of pain over bilateral ankle for last 9 months. Although ankle motions were within acceptable norms, painful, the subtalar movement was painfully reduced. The radiographic examination of both the foot and ankle confirmed no abnormalities. MRI testing of bilateral ankle revealed cystic lesion involving posterior aspect of talus communicated with the subtalar joint, measuring (1.6x1.2cm) over right and (1.3x1.0cm) over left side. The patient was treated by multiple drill hole and PRP installation. After three months, the clinical outcome was outstanding, and the patient was able to resume his usual activities with full painless range of motion. Bilateral intraosseous ganglion of talus is incredibly rare. Multiple drill holes or curettage should be employed to treat symptomatic patients.

Diagnosis and Treatment of Intraosseous Ganglion in the Ankle Region.

To investigate the diagnosis and treatment of intraosseous ganglion cyst in the ankle region. A retrospective analysis was performed on the diagnosis and treatment of 18 patients with intraosseous ganglion in the ankle region from January 2005 to March 2016. There were 11 males and 7 females, with an average age of 40.4 years (22-74 years). Thirteen of these had mild intermittent localized pain in the ankle and five were asymptomatic and fortuitously found on images. According to the location of the intraosseous ganglion cyst, nine were located in the distal end of tibia, seven were in the distal end of the fibula, and two were in the talus. After curettage of intraosseous ganglion, 15 cases were filled with autogenous iliac bone and 3 cases with artificial bone. Fifteen cases were diagnosed with radiographs and CT scans, two cases with MR images, and one case was confirmed by postoperative pathology. The cyst contents were jelly-like material with sclerotic bone margins. The mean size of the intraosseous ganglion cyst was 1.5cm × 1.5cm × 1cm. Hematoxylin and eosin (H&E) staining of the tissue showed fibrous tissue, collagenous fiber, mucoid, and a few fibroblasts. Eighteen cases were followed up for 11 months to 10 years, with an average of 5.4 years. No recurrence was found. Sixteen patients were asymptomatic after surgery. Two cases of ankle pain occurred at 1 year and 6 months postoperatively, respectively. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the mean AOFAS ankle-hindfoot score improved from 78.2±13.7 points preoperatively to 97.3±4.5 points at the final follow-up. For the intraosseous ganglion cyst in the ankle region, whether there are clinical symptoms or not, the cyst should be curettaged and the cavity should be filled with bone graft. The operation result is satisfactory.

Arthroscopic Treatment of Intraosseous Ganglion Cysts of the Carpus.

ObjectiveTo investigate the application and the clinical efficacy of wrist arthroscopy in the treatment of carpal intraosseous ganglion cysts (IGCs).MethodsA retrospective case study method was adopted to analyze the clinical data of 28 patients with carpal IGCs admitted to the Sixth Hospital of Ningbo from April 2012 to January 2019. A hypodensity in the bone was shown by X-ray before the operation, with hypodensity and cystic change in the bone being confirmed by computed tomography and magnetic resonance imaging. Arthroscopic open window of the wrist, cystectomy, and autologous iliac bone graft implantation were conducted. Regular postoperative X-ray combined with CT follow-ups were conducted to observe the healing after bone implantation. Patients were followed up regularly and assessed by the Modified Mayo Wrist Score in four aspects of the postoperative pain, wrist mobility, grip, and function to provide an objective overall assessment of the therapeutic outcome.ResultsAll 28 patients were followed up for 8–16 months, with an average follow-up duration of 10 months. After the operation, pain disappeared completely for 25 patients, and 3 cases showed significant improvement. All cases were pathologically confirmed as ganglion cysts and had first-stage bony healing after bone grafting with an average healing time of 10.8 weeks. The grip returned to normal for all patients, and wrist flexion and extension were the same as the healthy wrist for 25 patients, with a Modified Mayo Wrist Score of excellent in 19 cases and good in 9 cases. No recurrence was observed.ConclusionIn patients with symptomatic carpal IGCs, the application of arthroscopic open window, cystectomy, and autologous bone graft implantation could achieve satisfactory clinical therapeutic effects.

Primary bone tumors and tumor-like lesions of the wrist: a single-center experience

Aim: The incidence of primary bone tumors of the wrist is increasing. The aim of this study was to examine the characteristics, treatment protocols, complication rates, and functional outcomes of bone tumors of the wrist treated in a tertiary orthopedic oncology center.
 Material and Method: We retrospectively analyzed 93 patients with bone tumors located in the wrist (63 distal radius, 23 distal ulna, 7 carpal bone) who were operated on between 2005 and 2020. Demographic information was recorded. Functional outcomes were evaluated with the Musculoskeletal Tumor Society System (MSTS) scoring system.
 Results: There were 57 male and 36 female patients. The average follow-up period was 32 months (range 16-163). There were 82 benign and 11 malignant lesions. Distal radius was the most common site of involvement. The most common type of benign tumor in the distal radius and distal ulna was the giant cell tumor (GCT; 26 and 10 patients, respectively). Among the malignant tumors in the distal radius, 5 were Ewing sarcoma, and 2 were osteosarcoma. All patients with malignant lesions underwent wide surgical resection and free vascularized fibular graft (FVFG) reconstruction. Of the malignant tumors in the distal ulna, 3 were Ewing sarcoma, and 1 was osteosarcoma. These were treated with wide resection and FVFG reconstruction (n=3) and wide resection and fibular strut graft (n=1). The rarest site for tumors in the wrist was the carpal bones. Carpal bone lesions included scaphoid (n=5) and lunate (n=2) tumors. In all of these patients, pathological examination indicated intraosseous ganglion cysts. The average MSTS score of all patients was 27 (range 24-30). Of the 36 patients with GCT, 4 (11%) developed local recurrence. One patient with Ewing sarcoma developed local recurrence and underwent secondary amputation. Distant lung metastasis was observed in 5 of 8 patients with Ewing sarcoma. 
 Conclusion: Our study confirmed that bone tumors in the wrist are rare. Most benign tumors can be treated with curettage and cement augmentation. For malignant tumors, it is possible to restore function with FVFG.

Intraosseous ganglion cyst mimicking chondrosarcoma on MRI: a case report

BackgroundThe intraosseous ganglia is a benign cyst, rarely locate in the olecranon process. As intraosseous ganglia can mimic malignant bone tumor, computed tomography (CT) is important for diagnosis even when magnetic resonance imaging (MRI) suggests malignant bone tumor, such as chondrosarcoma.Case presentationIn this paper, we report a 42-year-old woman with intraosseous ganglia in the olecranon process of the ulna. She complained pain in right elbow for 3 weeks. MRI revealed an intraosseous mass which initially diagnosed as chondrosarcoma. However, followed computed tomography (CT) demonstrated scattered intralesional gas and no underlying mineralization, and we can exclude chondrosarcoma from diagnosis.ConclusionsThe intraosseous ganglia can mimic bone tumor in MRI; therefore, CT is essential for accurate characterization of bone tumor. Even if MR imaging strongly suggests chondrosarcoma of the bone, CT should be performed as additional study.

Arthroscopic Bone Graft for Intraosseous Lunate Bone Ganglion

Intraosseous lunate bone ganglia (ILBG) are known to be a cause of chronic wrist pain and disability. Standard treatment consists of curettage and autologous bone grafting. Open procedures have shown good results with few recurrences, but with frequent stiffness or persistent pain. Arthroscopic techniques are more recent and seem very reliable. Several arthroscopic techniques have been reported for ILBG approach and treatment. The present study describes an approach that preserves all the lunate cartilage of both radiocarpal and midcarpal surfaces. The surgical technique allows easy and direct access to the bone ganglia, passing through the intermediate portion of the scapholunate ligament, with the scope in the 1-to-2 portal and instrumentation through the 3-to-4 portal. The rest of the procedure is straightforward: curettage and bone grafting are performed through this specific approach, similarly to other techniques. This an easy and accurate approach that avoids any damage to the major cartilage surfaces of the lunate, with easy and reliable access to the intraosseous lunate bone ganglion, allowing cyst curettage and autologous bone graft in a proper and noninvasive way.

Recurrent intraosseous spindle myoepithelioma of the distal fibula: A clinical and radiological challenge

A 42-year-old man with a past history of lipomas, presented with right ankle pain radiating to the hip and limited range of motion of the ankle. An initial XR was performed revealing an expansile lytic lesion in the right distal fibula. Next, an MRI was performed to confirm this expansile lytic lesion. Initial presumptive differential diagnoses included chondromyxoid fibroma, osteoblastoma, intraosseous ganglion cyst and Brodie’s abscess. However, upon bone biopsy the pathology report revealed that the lesion was smooth muscle actin (SMA) positive and an ultimate diagnosis of intraosseous spindle myoepithelioma (ISM) was made. Curettage was then performed on the initial lesion to excise the tumor. The patient since has had multiple recurrences of this lesion. The diagnosis of ISM is rare and can present with many challenges in diagnosis radiologically and clinically as this tumor can mimic many common diagnoses. Due to the paucity of literature on this topic, documentation of this case will help enhance the understanding of this rare lesion, its behavior, and possible genetic associations.

Quantitative bone SPECT/CT applications for primary bone neoplasms.

To evaluate the clinical utility of quantitative values obtained with bone single photon emission computed tomography/computed tomography (SPECT/CT) for primary bone neoplasms. Bone SPECT/CT scans of 23 patients with 19 benign bone neoplasms (5 osteoid osteomas, 4 bone giant cell tumor, 4 osteofibrous dysplasia, 3 intraosseous ganglion, 2 aneurysmal bone cyst, 1 intraosseous hemangioma) and 5 malignant bone neoplasms (2 osteosarcoma, 1 periosteal osteosarcoma, 1 malignancy in bone giant cell tumor, 1 Ewing sarcoma) were retrospectively analyzed with maximum standardized uptake value (SUVmax), peak SUV (SUVpeak), mean SUV (SUVmean), metabolic bone volume (MBV), and total bone uptake (TBU) of primary lesions. Mean SUVmax of 19 benign and 5 malignant primary bone neoplasms were 6.89±3.26 (range 3.9-15.13) and 10.31±3.19 (5.0-13.45) respectively, with statistically significant difference (P=0.048). Mean SUVpeak of those were 5.87±2.83 (range 3.5-13.63) and 9.18±3.05 (4.09-12.03) respectively, with statistically significant difference (P=0.032). Mean SUVmean of those were 4.43±2.11 (range 2.59-9.37) and 7.13±2.90 (3.3-10.42) respectively, with statistically significant difference (P=0.027). Mean MBV of those were 22.0±30.0 (range 2.47-110.61) and 27.8±39.94 (8.59-99.24) respectively, with no statistically significant difference (P=0.72). Mean TBU of those were 80.64±94.57 (range 10.50-373.57) and 166.60±203.97 (28.68-528.13) respectively, with no statistically significant difference (P=0.17). Quantitative values obtained with bone SPECT/CT may serve as osteoblastic biomarkers for primary bone neoplasm.

Osteoblastoma of the Capitate Bone: Case Report.

Carpal bone tumors must be investigated in clinical cases of chronic wrist pain with no previous trauma. Intraosseous ganglion, enchondroma, osteoid osteoma, and, less commonly, osteoblastoma are potential causes of osteolytic lesions affecting the carpal bones. In most cases, the clinical presentation alone is not enough to differentiate such lesions. Knowledge of certain characteristics, including the radiological and histopathological aspects of each of these tumors, is critical in order to make the differential diagnosis. We present a rare case of osteoblastoma of the capitate bone and review the literature on the subject.

Rotator cuff tear with an intraosseous ganglion in the superior facet of the greater tuberosity: A report of two cases

Rotator cuff tear with an intraosseous ganglion in the superior facet of the greater tuberosity: A report of two cases

Outcomes of Surgical Management of Intraosseous Ganglia of the Carpal Bones: A Case Series.

Intraosseous ganglia of the carpal bones are uncommon with sparse publications to guide treatment. The purpose of this study was to review a single-institution experience to determine the outcomes of patients with surgically treated intraosseous carpal ganglia. Skeletally mature patients with intraosseous carpal ganglia between 1995 and 2016 treated operatively were identified. Demographic information, clinical data, and radiographic studies were evaluated. Thirty-three ganglia in 31 patients were identified. Intraosseous ganglia were located in the lunate (23), scaphoid (9), and trapezoid (1). Patients who presented with pathologic fracture or collapse had larger intraosseus ganglia than those presenting with pain alone. Surgery significantly improved pain. Patients treated with debridement with autograft bone graft had a higher consolidation rate compared with allograft bone but no difference in pain. Patients with large or symptomatic lesions can be treated successfully with curettage and debridement, which leads to relief of pain. The use of bone grafting remains controversial.

Intraosseous Ganglion Cyst of the Sternoclavicular Joint

Summary:We report the case of a 63-year-old man who presented with a mass on the right clavicle near the sternoclavicular joint. He had received prior puncturing treatment, but relapsed each time. Magnetic resonance imaging revealed that the mass was a ganglion cyst, which appeared to be connected to the right clavicle. Excisional biopsy revealed that the cyst was an intraosseous ganglion cyst, and the cavity was connected to the sternoclavicular joint. The cavity was filled with an artificial bone graft after curettage to prevent fracture. Histological examination showed that the cyst wall had no lining cells and consisted of fibrous connective tissue. To the best our knowledge, this case is the first report of an intraosseous ganglion cyst of the sternoclavicular joint.

Distal Chevron Osteotomy without Fixation for Correction of Hallux Valgus: A Ten Year Retrospective Study

Introduction: More than eighty surgical methods have been proposed to correct Hallux Valgus Deformity. This study evaluates the efficacy of Distal Chevron Osteotomy by means of assessing pre-operative and post-operative radiographic parameters and clinical results. Methods: The authors performed a ten-year retrospective study, on patients treated with Chevron Osteotomy alone without internal fixation, by the senior author, at the Toronto Western Hospital, between the years 2000-2009. The association of Hallux Valgus with demographics, other pre-operative foot pathology, etiology, intra-op pathology, complications (late and early) and radiographic parameters (pre-operative and post-operative IMA and HVA’s) were studied. Results: Two hundred and eight-five Chevron osteotomies were performed, on one hundred and seventy-eight patients with Hallux Valgus. In the study group 89% were female, the average age was 44 years ± 14 (range 16 to 77), 60% were bilateral. Radiographic measurements of the Hallux Valgus angle (HVA) and Intermetatarsal angle (IMA) demonstrated a statistically significant difference in pre-operative and post-operative measurements (p <0.05) t-test. The mean correction in the HVA for the left foot was 14.94 degrees compared with 14.98 degrees for the right foot. A mean correction of 1.99 degrees in the IMA for the left foot and 2.05 degrees for the right foot was obtained. The recurrence rate for Hallux Valgus was 0.70% (2 feet). In 12.36% of the study group, unexpected intra-operative findings such as EHL tendon contracture, bursae, intra-osseous ganglion cysts, and osteoporosis or capital osteophytes resulted in adding to, or modifying, the standard operative procedure. Conclusion: Despite minor and largely reversible post-operative complications, this study demonstrates that with distal Chevron osteotomy excellent radiographic and cosmetic correction of the deformity was achieved with a high level (99.30%) of patient satisfaction. Patients should be advised pre-operatively about their risk for developing Keloids 5.61%, transfer metatarsalgia 4.56% and recurrence 0.70% when treated by Chevron osteotomy.

Intraosseous ganglion diagnosed on cytology: A familiar entity in an exotic location

An intraosseous ganglion is a rare lesion which can be confused clinically and radiologically with bony neoplasms. This lesion can be accurately diagnosed on FNAC when biopsy may not be very useful.