Intraosseous ganglion
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AnIntraosseous ganglion cysts, intraosseous ganglionganglia (plural: or gangliajuxta-articular bone cysts) is a are benign tumour-like non-neoplastic lesions occurring in the subchondral radiolucent lesion without regions of bone in the absence of degenerative or inflammatory arthritis1,2.
Epidemiology
TendsIntraosseous ganglion cysts tend to occur in middle age with a peak incidence in the 4th and 5th decade of life 1-4 and seem to be slightly more common in men 1,3.
Diagnosis
The diagnosis of intraosseous ganglia is made by a combination of clinical and typical imaging characteristics. If they are excised the diagnosis can be confirmed histologically.
Clinical presentation
Patients may have mildmight present with localised pain, swelling and/or tenderness 1-4 or might be asymptomatic 1.
Complications
A potential complication of an intraosseous ganglion cyst is a pathological fracture2.
Pathology
They are uni-/multilocular cysts within bone adjacent to joints containing mucoid viscous gelatinous material and are surrounded by a fibrous lining, containing gelatinous material. Different from subchondral cysts they do not have an epithelial or synovial lining2. Most intraosseous ganglia are small up to 1-2 cm and larger lesions > 5cm are rare 2.
OriginAetiology
- mucoid degeneration of intraosseous connective tissue
perhapsdue totrauma/ischemiaaltered mechanical stress -
occasional penetration of
juxtaosseousjuxta-osseous soft-tissue ganglion(=synovial herniation) intointo the underlying bone(occasionally)
Possible theories on the pathogenesis are 1-3:
However, the exact aetiology is unknown 1,2.
Location
Common locations are1-4:
-
epiphyses and metaphyses of long bones
(medial malleolus(tibia,femoral headfemur,proximal tibiahumerus,carpal bonesulna) -
subarticularcarpal or tarsal bones -
flat
bone (acetabulumbones (acetabulum, scapula)
Radiographic features
Intraosseous ganglia are cystic well-defined lesions located close to joints, they have similar imaging features as subchondral cysts except that there are no degenerative changes of the joint. They might show signs of cortical expansion 1.
Plain radiograph
TypicallyA solitary well-demarcated solitary-defined lytic lesion, in a subchondral region with a sclerotic margin1-4.
CT
On CT intraosseous ganglia appear as solitary lucent bone lesions near joints. NoA communication withto the joint canmight be demonstratedpresent 3.
MRI
Intraosseous ganglia appear as solitary, unilocular or multilocular
25-
lesions usually with a sclerotic rim
is present.Signal characteristics
- T1: low signal
- T2: usually high signal
Bone scanNuclear medicineBone scans demonstrate increased radiotracer uptake (in 10%).
Treatment and prognosis
The management will depend on the size and clinical presentation. Small asymptomatic intraosseous ganglion cysts will not need any treatment, whereas symptomatic intraosseous ganglion cysts are probably treated by surgical excision with curettage and subsequent bone grafting 2,3. Recurrences have been reported 1.
History and etymology
An intraosseous ganglion was described by Geoffrey R Fisk in 1949 6.
Differential diagnosis
Imaging differentials include the following 1-4:
-
post-traumatic/degenerativesubchondral cyst - unicameral bone cyst
- chondromyxoid fibroma
- Brodie abscess
- giant cell tumour of bone
- chondroblastoma
- chondrosarcoma7
See also
-<p>An <strong>intraosseous ganglion</strong> (plural: <strong>ganglia</strong>) is a benign subchondral radiolucent lesion without degenerative arthritis. </p><h4>Epidemiology </h4><p>Tends to occur in middle age.</p><h4>Clinical presentation</h4><p>Patients may have mild localised pain.</p><h4>Pathology</h4><p>They are uni-/multilocular cysts surrounded by a fibrous lining, containing gelatinous material.</p><h5>Origin</h5><ol>-<li>mucoid degeneration of intraosseous connective tissue perhaps due to trauma/ischemia</li>-<li>penetration of juxtaosseous soft-tissue ganglion (=synovial herniation) into underlying bone (occasionally)</li>-</ol><h5>Location</h5><p>Common locations are:</p><ul>-<li>epiphyses of long bones (medial malleolus, femoral head, proximal tibia, carpal bones) </li>-<li>subarticular flat bone (acetabulum)</li>-</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Typically well-demarcated solitary lytic lesion, with a sclerotic margin. No communication with joint can be demonstrated. </p><h5>MRI</h5><ul>-<li>solitary, unilocular or multilocular <sup>2</sup>- +<p><strong>Intraosseous ganglion cysts</strong>, <strong>intraosseous ganglia</strong> or <strong>juxta-articular bone cysts</strong> are benign tumour-like non-neoplastic lesions occurring in the subchondral regions of bone in the absence of <a href="/articles/osteoarthritis">degenerative</a> or <a href="/articles/inflammatory-arthritis">inflammatory arthritis</a> <sup>1,2</sup>.</p><h4>Epidemiology </h4><p>Intraosseous ganglion cysts tend to occur in middle age with a peak incidence in the 4<sup>th</sup> and 5<sup>th</sup> decade of life <sup>1-4</sup> and seem to be slightly more common in men <sup>1,3</sup>.</p><h4>Diagnosis</h4><p>The diagnosis of intraosseous ganglia is made by a combination of clinical and typical imaging characteristics. If they are excised the diagnosis can be confirmed histologically.</p><h4>Clinical presentation</h4><p>Patients might present with localised pain, swelling and/or tenderness <sup>1-4</sup> or might be asymptomatic <sup>1</sup>.</p><h5>Complications</h5><p>A potential complication of an intraosseous ganglion cyst is a <a href="/articles/pathological-fracture">pathological fracture</a> <sup>2</sup>.</p><h4>Pathology</h4><p>They are uni-/multilocular cysts within bone adjacent to joints containing mucoid viscous gelatinous material and are surrounded by a fibrous lining. Different from subchondral cysts they do not have an epithelial or <a href="/articles/synovium">synovial lining</a> <sup>2</sup>. Most intraosseous ganglia are small up to 1-2 cm and larger lesions > 5cm are rare <sup>2</sup>.</p><h5>Aetiology</h5><p>Possible theories on the pathogenesis are <sup>1-3</sup>:</p><ul>
- +<li>mucoid degeneration of intraosseous connective tissue due to altered mechanical stress</li>
- +<li>occasional penetration of juxta-osseous soft-tissue ganglion into the underlying bone</li>
- +</ul><p>However, the exact aetiology is unknown <sup>1,2</sup>.</p><h5>Location</h5><p>Common locations are <sup>1-4</sup>:</p><ul>
- +<li>
- +<a href="/articles/epiphysis">epiphyses</a> and <a href="/articles/metaphysis">metaphyses</a> of <a href="/articles/long-bones">long bones</a> (tibia, femur, humerus, ulna)</li>
- +<li>
- +<a href="/articles/carpal-bones">carpal</a> or <a href="/articles/tarsal-bones">tarsal bones</a>
-<li>usually sclerotic rim is present</li>-</ul><h5>Bone scan</h5><p>Bone scans demonstrate increased radiotracer uptake (in 10%).</p><h4>Differential diagnosis</h4><ul><li>post-traumatic/<a href="/articles/geode">degenerative cyst</a>-</li></ul><h4>See also</h4><ul><li><a href="/articles/ganglion-cyst">ganglion cysts</a></li></ul>- +<li>
- +<a href="/articles/flat-bones">flat bones</a> (<a href="/articles/acetabulum">acetabulum</a>, <a href="/articles/scapula">scapula</a>)</li>
- +</ul><h4>Radiographic features</h4><p>Intraosseous ganglia are cystic well-defined lesions located close to joints, they have similar imaging features as subchondral cysts except that there are no degenerative changes of the joint. They might show signs of cortical expansion <sup>1</sup>.</p><h5>Plain radiograph</h5><p>A solitary well-defined lytic lesion in a subchondral region with a sclerotic margin <sup>1-4</sup>.</p><h5>CT</h5><p>On CT intraosseous ganglia appear as <a href="/articles/osteolytic-bone-lesion">solitary lucent bone lesions</a> near joints. A communication to the joint might be present <sup>3</sup>.</p><h5>MRI</h5><p>Intraosseous ganglia appear as solitary, unilocular or multilocular <sup>5</sup> lesions usually with a sclerotic rim.</p><h6>Signal characteristics</h6><ul>
- +<li>
- +<strong>T1:</strong> low signal</li>
- +<li>
- +<strong>T2: </strong>usually high signal</li>
- +</ul><h5>Nuclear medicine</h5><p><a href="/articles/bone-scintigraphy-1">Bone scans</a> demonstrate increased radiotracer uptake (in 10%).</p><h4>Treatment and prognosis</h4><p>The management will depend on the size and clinical presentation. Small asymptomatic intraosseous ganglion cysts will not need any treatment, whereas symptomatic intraosseous ganglion cysts are probably treated by surgical excision with curettage and subsequent bone grafting <sup>2,3</sup>. Recurrences have been reported <sup>1</sup>.</p><h4>History and etymology</h4><p>An intraosseous ganglion was described by Geoffrey R Fisk in 1949 <sup>6</sup>.</p><h4>Differential diagnosis</h4><p>Imaging differentials include the following <sup>1-4</sup>:</p><ul>
- +<li><a href="/articles/geode">subchondral cyst</a></li>
- +<li><a href="/articles/unicameral-bone-cyst-1">unicameral bone cyst</a></li>
- +<li><a href="/articles/chondromyxoid-fibroma">chondromyxoid fibroma</a></li>
- +<li><a href="/articles/brodie-abscess-1">Brodie abscess</a></li>
- +<li><a href="/articles/giant-cell-tumour-of-bone">giant cell tumour of bone</a></li>
- +<li><a href="/articles/chondroblastoma">chondroblastoma</a></li>
- +<li>
- +<a href="/articles/chondrosarcoma">chondrosarcoma</a> <sup>7</sup>
- +</li>
- +</ul><h4>See also</h4><ul><li><a href="/articles/ganglion-cyst">ganglion cysts</a></li></ul>
References changed:
- 8. Wolfgang Dähnert. Radiology Review Manual. (2003) ISBN: 9780781738958 - <a href="http://books.google.com/books?vid=ISBN9780781738958">Google Books</a>
- 7. Seo E, Yoon Y, Cha J, Kim H. Intraosseous Ganglion Cyst Mimicking Chondrosarcoma on MRI: A Case Report. Eur J Med Res. 2022;27(1):8. <a href="https://doi.org/10.1186/s40001-022-00631-0">doi:10.1186/s40001-022-00631-0</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/35027087">Pubmed</a>
- 6. Fisk G. Bone Concavity Caused by a Ganglion. The Journal of Bone and Joint Surgery British Volume. 1949;31-B(2):220-1. <a href="https://doi.org/10.1302/0301-620x.31b2.220">doi:10.1302/0301-620x.31b2.220</a>
- 5. Perdikakis E & Skiadas V. MRI Characteristics of Cysts and "Cyst-Like" Lesions in and Around the Knee: What the Radiologist Needs to Know. Insights Imaging. 2013;4(3):257-72. <a href="https://doi.org/10.1007/s13244-013-0240-1">doi:10.1007/s13244-013-0240-1</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23479129">Pubmed</a>
- 4. Zarezadeh A, Nourbakhsh M, Shemshaki H, Etemadifar M, Mazoochian F. Intraosseous Ganglion Cyst of Olecranon. Int J Prev Med. 2012;3(8):581-4. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429806">PMC3429806</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22973489">Pubmed</a>
- 3. Sedeek S, Choudry Q, Garg S. Intraosseous Ganglion of the Distal Tibia: Clinical, Radiological, and Operative Management. Case Rep Orthop. 2015;2015:759257. <a href="https://doi.org/10.1155/2015/759257">doi:10.1155/2015/759257</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25664195">Pubmed</a>
- 2. Sakamoto A, Oda Y, Iwamoto Y. Intraosseous Ganglia: A Series of 17 Treated Cases. BioMed Research International. 2013;2013:1-4. <a href="https://doi.org/10.1155/2013/462730">doi:10.1155/2013/462730</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23841071">Pubmed</a>
- 1. Schajowicz F, Clavel Sainz M, Slullitel J. Juxta-Articular Bone Cysts (Intra-Osseous Ganglia): A Clinicopathological Study of Eighty-Eight Cases. J Bone Joint Surg Br. 1979;61(1):107-16. <a href="https://doi.org/10.1302/0301-620X.61B1.422629">doi:10.1302/0301-620X.61B1.422629</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/422629">Pubmed</a>
- 1. Dähnert W. Radiology review manual. Lippincott Williams & Wilkins. (2007) ISBN:0781738954. <a href="http://books.google.com/books?vid=ISBN0781738954">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/0781738954?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0781738954">Find it at Amazon</a><div class="ref_v2"></div>
- 2. Perdikakis E, Skiadas V. MRI characteristics of cysts and "cyst-like" lesions in and around the knee: what the radiologist needs to know. Insights Imaging. 2013;4 (3): 257-72. <a href="http://dx.doi.org/10.1007/s13244-013-0240-1">doi:10.1007/s13244-013-0240-1</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675245">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23479129">Pubmed citation</a><span class="auto"></span>
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