Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

QUIZ
Year
: 2006  |  Volume : 16  |  Issue : 3  |  Page : 397--398

Radiological quiz - musculoskeletal


NU Bahri, HP Parekh, PV Padhara, HH Zalawadia, II Pathan, VA Karmur 
 Department of Radiodiagnosis, M.P.Shah Medical College, Jamnagar, Gujarat, India

Correspondence Address:
P V Padhara
C/O. Dr. Himanshu Zalawadia, DQKailashDQ, 35-B, Janata Society, Kamdar Main Road, Jamnagar. Gujarat-361006
India




How to cite this article:
Bahri N U, Parekh H P, Padhara P V, Zalawadia H H, Pathan I I, Karmur V A. Radiological quiz - musculoskeletal.Indian J Radiol Imaging 2006;16:397-398


How to cite this URL:
Bahri N U, Parekh H P, Padhara P V, Zalawadia H H, Pathan I I, Karmur V A. Radiological quiz - musculoskeletal. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Feb 28 ];16:397-398
Available from: http://www.ijri.org/text.asp?2006/16/3/397/29028


Full Text

A 58 years old man presented with dull aching pain, intermittent in nature in radial aspect of Rt. wrist

since 18 years and aggravated by movement occasionally. On clinical examination, slight limitation of movement is noted, no swelling. Radiographs of Rt. wrist Dorsovolar view [Figure 1] and Oblique view [Figure 2] were obtained and showed osteolytic lesion. What is your diagnosis?

 Radiological Diagnosis



 View Answer

 Intraosseous Ganglion Cyst



Radiograph shows a well defined, oval shaped, osteolytic lesion with surrounding sclerosis in the proximal pole of scaphoid in Rt. wrist. There is no matrix mineralization and cortical continuity appears normal. Curettage is done and showed mucoid degeneration on histology.

Intraosseous ganglion cyst is a benign cystic and often multiloculated lesion made up of fibrous tissue with extensive mucoid changes located in the subchondral bone adjacent to a joint. There are two fundamental types of intraosseous ganglia, one type apparently arises from penetration of juxtraosseous ganglion into the underlying bone and the other is primarily intraosseous [1].

Many theories regarding intraosseous ganglion cyst is suggested .The most popular ones are

(a) The intraosseous ganglia arise as a result of combination of intramedullary metaplasia and connective tissue followed by mucoid degeneration

(b) There is an intrusion of ganglion-like connective tissue of the local soft parts into the bone. [2]

It is frequently encountered in adults between 20 and 60 years of age and appears clinically silent; however chronic pain which sometimes increases with physical activity may be evident if particularly located in wrist. [3],[4]

Lesion predominantly occurs in articular ends of long bones particularly medial malleolus of tibia, femoral head, proximal tibia, and carpal bone especially lunate and scaphoid. [3]

Radiaograph is usually diagnostic and shows single well defined, round to oval shaped, lytic lesion, sharply circumscribed by thin shell of sclerotic bone it usually measures from few millimeter (in the carpal bone) to three cm in the diameter. Calcification within the lesion is never noted. Occasionally there is thinning of the cortex. [2]

Bone scintigraphy shows increased accumulation of bone seeking agent. [3]

With MR imaging a lesion of low signal intensity on T1-weighted spin echo MR images and high signal intensity on T2-weighted spin echo MR images is evident. [1],[3]

The differential diagnosis includes Giant cell tumor and Chondroblastoma that leads to epiphyseal and subchondral radiolucent foci, the sclerotic margin about the ganglion cyst and the absence of calcification allows differentiation ; Subchondral cyst of osteoarthritis, the relatively normal appearing of the adjacent articulation is differentiating feature; Pigmented villonodular synovitis is usually differentiated by the presence of lesion on both sides of the joint and large intracapsular lobulated dense soft tissue mass.[2],[3]

Curettage or excision of the lesion usually is curative although recurrent lesions develop in some cases. [3]

References

1Thomas HM, Anthony MR, Gregory GD. Intraosseous ganglion cyst of the wrist. Radiology 1995; 195:517-520.
2Wilner D. Intraosseous ganglion (Ganglionic cystic defect of bone). In: Wilner D. Radiology of bone tumors and allied disorders 1sted. Philadelphia: W.B.Saunders, 1982: 1127-1143.
3Resnick D, Kyriakos M, Greenway G. Tumors and tumors-like lesions of bone: Imaging and pathology of specific lesions. In: Resnick D. Diagnosis of bone and joint disorders, 3rded. Philadelphia: W.B.Saunders, 1995: 3878-3882.
4Greenspan A, Benign tumors and tumor-like lesions IV: Miscellaneous lesions. In: Adam Greenspan, Orthopedic Radiology, A Practical Approach, third edition,643-644.