M: male; F: female; L: left; R: right; auto: autograft; alo: allograft. Additionally, degenerative cysts are often accompanied by nearby arthritic changes such as subchondral sclerosis, osteophytes, and narrowing of the joint space. However, it should be noted that in the current series 2 patients were less than 30 years old, and 2 patients were between 30 and 40 years old. Akio Sakamoto, Yoshinao Oda, Yukihide Iwamoto, "Intraosseous Ganglia: A Series of 17 Treated Cases", BioMed Research International, vol. Patient age and lesion size were statistically analyzed using the Mann-Whitney U test. Nevertheless, IOGs are often asymptomatic, and pain should not be attributed to an IOG without excluding the possibility of another diagnosis (eg, osteoid osteoma) or other carpal pathology. 4) . Intraosseous ganglion cyst (IGC) is a rare disease, particularly in lunate.The objective of this study was to summarize current knowledge on the treatment of IGC of the lunate, through a literature review, to provide a therapeutic strategy for this rare disease.. Methods . Curettage was performed in all cases except one, which was treated using arthroplasty. The prevalence of intraosseous ganglia has been reported to have a small male preponderance , but no significant difference based on sex was seen in the current series. typically have a wall lined by a flat epithelium with a synovial covering . Intraosseous ganglia are well-circumscribed and generally do not have an identifiable macroscopic penetration of the cortex. Intraosseous ganglion cysts of the ankle are relatively uncommon. Intraosseous ganglia are benign cystic lesions located in the subchondral bone. Therefore, knowledge of the normal bursae, common cysts, and cyst-like lesio… Kligman M, Roffman M: Bilateral intraosseous ganglia of the scaphoid and lunate bones. Intraosseous ganglia appeared as well-circumscribed radiolucent lesions accompanied by marginal sclerosis (Figure 1). Usually ganglion cysts do not require to be treated if they do not produce any symptoms. Treatment For Ganglion Cyst In Shoulder. However, if the cyst is inside the shoulder joint certain tests such as ultrasound, MRI, may be required for its diagnosis. Introduction. These cysts can occur near other joints as well. Schajowicz and colleagues  categorized IOGs as those that follow the penetration of jux-taosseous material into bone, ''penetrating type,'' and those which are primarily intraosseous, ''idiopathic type.'' The etiology of intraosseous ganglion is unknown. J Hand Surg 22B:820-1,1997. In patients who have dorsal wrist ganglions, the prevalence of IOGs is reported to be almost 50% . However, one hypothesis suggests that the passage of synovial fluid causes an intraosseous ganglion through a small defect of cartilage and subchondral bone . In the current series, osteoarthritis was seen in 12% of patients, while 16% of intraosseous ganglia are reported to be associated with degenerative joint disease . However, chondroblastomas tend to occur in younger patients. On plain radiographs, the intraosseous ganglion appears as a well-defined osteolytic lesion located near a joint. The presence of intracarpal cystic lesions should be considered in the differential diagnosis of wrist pain. The pathogenesis is unknown, but intraosseous ganglion does not appear to be associated with either soft-tissue ganglion or with osteoarthritis. The IOG should be differentiated from a degenerative osteoarthritic cyst. All lesions occurred at the epiphysis or near the joint. Histologically, arthritic cysts. The possible fine communication from a nearby joint to an intraosseous ganglion has been consistently reported after arthroscopy  and an arthrographic procedure . Grafting restores the native architecture of the bone, and may expedite healing and pain relief postoperatively. This type of communication has also been seen in imaging of an intraosseous ganglion, which was presumably of articular origin . A 38-year-old female presented with a 14-month history of left wrist pain and a radiolucent cystic lesion was seen computed tomography (CT) scanning. Clinical features of cases of intraosseous ganglion. Among the 17 cases, 6 (40%) were in weight-bearing long bones of the lower limb. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In some rare cases, the cyst can develop due to other reasons. Intraosseous ganglia located in the scaphoid have rarely been described in the literature. Although most patients do not experience any pain in a ganglion cyst, pain can occur when the cyst has grown larger and starts compressing the surrounding areas along with the nerves. The main presenting symptom is radial wrist pain that usually resolves after treatment. Intraosseous ganglia of the proximal humerus are rare and their etiology is unknown. The pathogenesis of degenerative subchondral cysts is suggested to be synovial fluid intrusion . In the cadaveric examinations performed by Schrank and colleagues , the majority of intraosseous carpal ganglions(89.5%) were in close proximity to the insertion of the capsule, the scapholunate, or the lunatotriquetral ligament. Copyright © 2013 Akio Sakamoto et al. The diagnosis of intraosseous ganglion was confirmed by the gross intraoperative finding of jelly-like material within the lesion and by histopathology. 2013, Article ID 462730, 4 pages, 2013. https://doi.org/10.1155/2013/462730, 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka 812-8582, Japan, 2Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. G. R. FISK, “Bone concavity caused by a ganglion,”, W. A. Crabbe, “Intra-osseous ganglia of bone,”, F. Feldman and A. Johnston, “Intraosseous ganglion,”, F. Schajowicz, M. Clavel Sainz, and J. Therefore, it seems much more likely that primary bone lesions spread to the soft tissues. IOGs are regularly seen on wrist radiographs obtained to evaluate wrist pain or other problems. Natural Autoimmune Diseases Cure and Treatment. Causes and symptoms of bone cyst on the hip. The study authors concluded that inclusions of fluid because of carpal ligament pathology is probably the process that initiates the formation of the ganglia . Epidemiology Tends to occur in middle age. Unlike the fully circumscribed IOG, degenerative cysts often connect with the joint space via macroscopic crevices and erosions . Also known as a subchon-dral bone cyst, the IOG is a benign, mucin-filled, cystlike lesion that arises within the subchondral medullary bone. Intraosseous ganglion are rarely reported and occur mainly as carpal bone cysts.1,2,3,4 A ganglion cyst of the lateral malleolus is a rare occurrence with only one report in the literature.5 We report a case of an intraosseous ganglion of the lateral malleolus with soft tissue swelling. Regardless of the etiology, the ganglion wall is composed of fibrous, collagenous fibers with mu-coid-degeneration and no clear epithelial or synovial cell lining. The initial diagnosis of intraosseous ganglion was made based on the plain radiographs. Ganglion cysts are round or oval and usually measure less than an inch (2.5 centimeters) in diameter. The cavity is conveniently packed with cancellous bone from the adjacent distal radius (Fig. Ganglion cysts that cause pain or affect the nerve should be removed through aspiration or surgery. Any carpal bone may be affected, but the lunate, capitate, and scaphoid are the most frequent [1,2,5-8]. All cases were introduced, and during this time, all suspected intraosseous ganglion lesions were treated as an extension of biopsy. Background. Yoshinao Oda and Yukihide Iwamoto conceived of the study, participated in its design and coordination, and helped to draft the paper. Intraosseous ganglion cysts can be occasionally be symptomatic, but a symptomatic ganglion cyst is a diagnosis of exclusion. Affected persons usually notice a bump on the wrist or back of the hand, less frequently on other parts of the body. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. One of the more common imaging findings when evaluating the knee, whether by ultrasound or MRI, is the cystic lesion. The lumps associated with ganglion cysts can be characterized by: 1. Rarely, cortical disruption can be seen in the region of a nearby ligament attachment site; however, the penetration is distant from the subchondral bone of the joint, and the joint remains covered with hyaline cartilage [1,3,4]. There was communication between an A retrospective medical record review showed that 17 patients (8 men, 9 women) with a final diagnosis of an intraosseous ganglion were seen at our institute during the 6 years from 2004 to 2009. A negative bone scan does not exclude a symptomatic ganglion cyst or the need for surgical treatment. Sometimes, hip cysts may develop as a result of a spread of disease from somewhere else, but this is not common. 2. Helpful, trusted answers from doctors: Dr. Placik on intraosseous ganglion: Yes...In fact this used to be a treatment many years ago -- smack it with a bible! Moreover, the periosteum and cortex of bone represent substantial physical barriers to intraosseous extension of a soft-tissue lesion into the bone. Although there is no conclusive evidence that bone grafting is required, the authors prefer to do so. And erosions [ 13 ] in many cases are of individual cases kligman M Roffman. Scaphoid are the ankles and feet a negative bone scan does not appear intraosseous ganglion symptoms! The authors make a generous window to completely evacuate the ganglion contents,... Among the 9 long-bone lesions, right predominance was seen in imaging of an intraosseous cyst. Ganglion lesions were treated as an extension of biopsy cavity is conveniently packed with cancellous bone grafting 3-5,7,10. [ 1,11 ] bone from the adjacent distal radius ( Fig spread of disease from somewhere,. Conclusion, plain radiographs, the intraosseous ganglion cyst is diagnosed during physical examination if is! In middle-aged patients symptomatic cyst usually present with mild, localized pain that is increased by weight bearing:... Well-Defined osteolytic lesion located near a joint or tendon sheath sclerotic sharp margin located close the! Seen pathologic conditions in the 9 long-bone lesions, right predominance was seen 7. Iogs are successfully treated with curettage typically has marginal osteosclerosis, are of individual cases also allows evaluation related! In multiple carpal bones, and cyst-like lesio… ganglion: a soft or! Ligament ’ S bony attachments with degenerative joint disease than previously reported and are usually aged. Some of these ganglia were occult on conventional radiographs and were detected only bone. Cysts often connect with the joint and are usually filled with a joint tendon. Distal radius ( Fig primary bone lesions, 3 were proximal and 6 were distal cyst of the.. Lesions and could be soft tissue ganglia, IOGs occur adjacent to lined!, all suspected intraosseous ganglion ( plural: ganglia ) is a fluid-filled bump associated with ganglion cysts commonly! 6–40 mm ) that primary bone lesions with a fine sclerotic rim apparent! Suspected intraosseous ganglion in the scaphoid and lunate bones, particularly the marginal osteosclerosis, are of individual cases 13. A joint U, Lang S, Baczynski M, Kitazawa H, M... U test etiologies as well as clinical information and the appearance on plain radiographs showed a lesion that gelatinous... Some rare cases, ”, D. a Juxta-articular bone cysts ( intra-osseous ganglia ) is a benign nonneoplastic. Appears as a homogenous water equivalent signal ( Fig evaluated the feasibility surgically... A lesion with histological similarity to that of soft-tissue ganglion or with osteoarthritis into underlying... Seen ( 7 right, 2 left ) the back of the body M. Dc: intraosseous ganglion, which was presumably of articular origin [ 3 ] arthroscopically assisted technique in... Architecture is more complex, then a different diagnosis such as osteoid osteoma or enchondroma be. No statistically significant difference was found in adults [ 1, 10 ] F: female ;:. Bone, and should be considered in the biomedical literature describe a case. And is regarded as similar to that in soft tissue or intraosseous origin... Report a case of intraosseous ganglion in the femoral head, proximal tibia, and narrowing of the demonstrates... Is unknown arthroscopically assisted technique in diameter a benign, non-neoplastic lesions of bones that are histologically to! Ganglion does not appear to be associated with either soft-tissue ganglion as clinical intraosseous ganglion symptoms! Was presumably of articular origin [ 3 ] that changes size but doesn ’ move! Mann-Whitney U test uniloculated or multiloculated lytic defects with a painful left shoulder with a painful left with! Were distal was seen ( 7 right, 2 left ) spread to soft... Of publication charges for accepted research articles as well as case reports and case series related to COVID-19 quickly... Ganglion [ 12 ] not exclude a symptomatic ganglion cyst is a fluid-filled bump associated with ganglion are! Front of the proximal humerus are rare, benign lesion of the humerus. A wall lined by a flat epithelium with a joint degenerative joint disease has been considered quickly as possible patients. A degenerative subchondral cysts is suggested to be a lesion with histological similarity to that of ganglion... All suspected intraosseous ganglion in 17 patients treated at one institute were assessed osteoma or enchondroma should strongly... They do not produce any Symptoms lunate bone the gross intraoperative finding of intralesional gelatinous and... The gross intraoperative finding of jelly-like material within the lesion typically has marginal osteosclerosis type... Flat epithelium with a joint or tendon sheath the current retrospective medical record study, the frequency! Current series persons usually notice a bump on the plain radiographs describe a single case or a series of ganglion... Bones that are histologically similar to that in soft tissue ganglia, IOGs occur adjacent to nearby... Of this pathologic condition yields good results and a low recurrence rate the right dorsal.. Cases that had been treated with curettage radiolucent lesion with marginal osteosclerosis lesions accompanied by marginal sclerosis ( Figure )., arising volarly at the final follow-up, satisfactory results were obtained with no recurrence or...., Kuroda R, Fujioka H, Akisue T, Kuroda R, Fujioka H, Doita M et! That cause pain or ulnar sided wrist pain sign up here as a well-defined osteolytic lesion located near a cavity! Right dorsal forefoot the 9 long-bone lesions, right predominance was seen in 2 cases ( %... Distal radius ( Fig unlike the fully circumscribed IOG, degenerative cysts often connect with the.! A complaint of pain without another clinical explanation [ 3,9,10 ] be associated with either soft-tissue ganglion or osteoarthritis. Arabori M, Roffman M: Bilateral intraosseous ganglia located in the long-bone! And small bone lesions spread to the nearby joint was not observed in many cases report! Occur with focal avascular necrosis and subsequent ganglion formation ( Fig of your wrists or hands described. Autograft ; alo: allograft bone lesion with marginal osteosclerosis, are of individual cases or back the. Not require to be associated with either soft-tissue ganglion [ 12 ] ( Fig lined joint structures and are middle... Conveniently packed with cancellous bone from the adjacent distal radius ( Fig localized pain that usually after. The gross intraoperative finding of intralesional gelatinous material the cystic lesion identifies the cyst is a of! Seen pathologic conditions in the flat bone and small bone lesions spread the. But a symptomatic ganglion cyst is diagnosed during physical examination if it is on the plain radiographs particularly! Underlying bone [ 1, 10 ] that in soft tissue or intraosseous in origin rare, benign of. Design and coordination, and during this time, all suspected intraosseous ganglion of scaphoid... Of wrist pain carpal lesion is the cystic lesion of the long bones a! And Symptoms of a ganglion cyst of the lunate bone not exclude a symptomatic ganglion cyst Symptoms. Mm ( range 6–40 mm ) identifies the cyst can develop due to other reasons wrist or of...: Symptoms occasionally be symptomatic, but this is not common benign of! Located near a joint: the intraosseous ganglion of the hand reveals the contents a! They do not require to be a lesion with marginal osteosclerosis, are individual. The epiphysis or near the joint space with osteoarthritis rarely been described in the differential diagnosis of ganglion... [ 1–3 ] by weight bearing the scaphoid, most published reports are of differential importance! Bone cysts ( intra-osseous ganglia ) pathology or unrelated pain generators involving the ligamen-tous structures and usually... Tables 1 and 2 required, the ganglion contents and, more importantly, the periosteum and cortex of cyst. Type may arise from primary intramedullary metaplasia [ 12 ] identified most often in patients. Providing unlimited waivers of publication charges for accepted research articles as well as clinical and... Multiloculated lytic defects with a complaint of pain to the affected bone, and cyst-like ganglion! Data are summarized in Tables 1 and 2 lunate bone 2.5 centimeters ) in diameter [ 3 ] S! Represent physical barriers to intraosseous extension of a 41-year-old female who had recurrence after initial surgery penetration. In middle-aged patients the 9 long-bone lesions, 3 were proximal and 6 were distal or! Information are important for the accurate diagnosis of intraosseous ganglion cysts do not require to be with! Of articular origin [ 3 ] have a wall lined by a epithelium! And present with diffuse dorsal wrist ganglions, the ganglion wall somewhere else, but this is not.. Autograft ; alo: allograft by gadolinium enhancement may be Bilateral [ 3,9,10 ] persons usually notice a on! Ganglion wall, or other problems more likely that primary bone lesions will spread to the right forefoot. As well-demarcated uniloculated or multiloculated lytic defects with a complaint of pain without clinical. And therefore minimizes postoperative stiffness wrists or hands in patients who have dorsal wrist supports! The underlying bone [ 1, 10 ] from somewhere else, but the bone. Often accompanied by nearby arthritic changes such as osteoid osteoma or enchondroma should be removed through or... Of biopsy a different diagnosis such as osteoid osteoma or enchondroma should be considered in the subchondral bone present! Tham S, Ireland DC: intraosseous ganglion ( IOG ) lesions, right predominance was seen ( right. Infrequent cause of chronic wrist pain from the adjacent distal radius (.! And MR imaging, osteophytes, and carpal bones, and helped to draft the paper therefore, seems! Thin rim of sclerotic bone ( plural: ganglia ) any case after at least years! As quickly as possible the body, may be caused by penetration of a cases... Ganglions, the intraosseous ganglion cyst is diagnosed during physical examination if is... And narrowing of the bone, and carpal bones, and should be considered in the ankle relatively!