Intraosseous ganglia are well-circumscribed and generally do not have an identifiable macroscopic penetration of the cortex. 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. Among the 17 cases, 6 (40%) were in weight-bearing long bones of the lower limb. In the current case series, an obvious continuity to the nearby joint was not observed in many cases. In the current retrospective medical record study, the clinical features of intraosseous ganglion in 17 patients treated at one institute were assessed. In some rare cases, the cyst can develop due to other reasons. Continuity to the nearby joint was not observed in all cases. There is less association between intraosseous ganglia and degenerative joint disease than previously reported. Ganglion: Symptoms. Volar carpal exposure carpal tunnel approach. The average age of patients with an intraosseous ganglion in the long bone was 51.4 years, which was not significantly different from that of patients with an intraosseous ganglion in a flat bone (47.3 years) or in a small bone (45.0 years). The overall average age of the current series of patients was 48.9 years, a result consistent with the reported age at diagnosis of intraosseous ganglia . Akio Sakamoto, Yoshinao Oda, Yukihide Iwamoto, "Intraosseous Ganglia: A Series of 17 Treated Cases", BioMed Research International, vol. Purpose . An intraosseous ganglion (plural: ganglia) is a benign subchondral radiolucent lesion without degenerative arthritis. Intraosseous ganglion cysts of the ankle are relatively uncommon. Histologically, arthritic cysts. i wouldn't recommend it though. The main complications are joint stiffness and vascular disturbances of the lunate bone. 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. Swelling that may appear over time or suddenly. Ganglion cysts that cause pain or affect the nerve should be removed through aspiration or surgery. Treatment For Ganglion Cyst In Shoulder. A thorough curettage helps ensure that the lesion will not recur, even if the final pathology returns one of the neoplastic lesions described below. 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.'' Intraosseous ganglion cysts are benign lesions located in the subchondral bone adjacent to the joint and are usually found in adults . The plain radiographs showed a lesion with marginal osteosclerosis. The cavity is conveniently packed with cancellous bone from the adjacent distal radius (Fig. Intraosseous ganglia can affect the carpal bones of the hand and must be considered in the differential diagnosis of wrist pain. This report describes a case of an intraosseous ganglion of the proximal humerus. Intraosseous ganglion cyst (IGC) is a benign, no neoplastic bone lesion with histological similarity to the soft tissue ganglion cyst.1, 2 Intraosseous ganglion contains mucoid viscous material with no epithelial or synovial lining. Although there is no conclusive evidence that bone grafting is required, the authors prefer to do so. Copyright © 2013 Akio Sakamoto et al. The diagnosis was confirmed based both on the gross intraoperative finding of intralesional gelatinous material and on histopathology. Moreover, the periosteum and cortex of bone represent substantial physical barriers to intraosseous extension of a soft-tissue lesion into the bone. Intraosseous ganglia within the carpal bones are relatively rare, with only a limited number of cases previously reported (1–3).They are benign, non-neoplastic bone lesions that have similar histological characteristics to those of soft tissue ganglion cysts (4,5).The most common clinical symptom is wrist pain. Surgical treatment of this pathologic condition yields good results and a low recurrence rate. 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 . Scand J Plast Reconstr Surg Hand Surg. 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. A P value of less than 0.05 was considered to indicate statistical significance. Most intraosseous ganglia are small, between 1 and 2 cm in maximum diameter; lesions over 5 cm are rare [4, 5]. We present a case of recurrent intraosseous ganglion in the ankle of a 41-year-old female who had recurrence after initial surgery. All authors participated in the design of the study. A ganglion cyst is diagnosed during physical examination if it is on the shoulder. Clinical data are summarized in Tables 1 and 2. 4) . However, the reported frequency of extraosseous extension is only 16%  and was 24% in the current series. Curettage was performed in all cases except one, which was treated using arthroplasty. They most often occur at the back of the wrist, followed by the front of the wrist. Synovial fluid intrusion is the currently favored pathological mechanism of soft-tissue ganglion . Sometimes, hip cysts may develop as a result of a spread of disease from somewhere else, but this is not common. Tham S, Ireland DC: Intraosseous ganglion cyst of the lunate: diagnosis and management. However, one hypothesis suggests that the passage of synovial fluid causes an intraosseous ganglion through a small defect of cartilage and subchondral bone . Giant cell tumor of bone and aneurysmal bone cyst are typically large and can be differentiated from intraosseous ganglion on radiographs by a lack of marginal osteosclerosis and thinning of the adjacent cortex due to expansion. However, neither side predominated in the flat bone and small bone lesions. Intraosseous ganglion cysts are rare causes of wrist pain. Symptomatic cyst usually present with diffuse dorsal wrist pain or ulnar sided wrist pain and mimic Kienbock disease. An intraosseous ganglion is considered to be a lesion that is distinct from a degenerative subchondral cyst . In some cases the lesion arises adjacent to an area of repeated osseous microtrauma. Intraosseous ganglia of the proximal humerus are rare and their etiology is unknown. Kligman M, Roffman M: Bilateral intraosseous ganglia of the scaphoid and lunate bones. The lesions were located in 9 long bones (5 tibiae, 2 humeri, 1 ulna, and 1 femur); 4 flat bones (2 scapulae, 2 ilia); and 4 small bones (2 scaphoid, 1 metacarpal bone, and 1 talus). There was communication between an Intraosseous ganglion cysts are rare. The “lump” on the wrist or other parts of the body is typically bulging.It has an average diameter of a few millimetres to two centimetres.However, there are also ganglia that grow up to eight centimetres in size. 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. Intraosseous ganglion cysts may also form at this ligament’s bony attachments. MRI also allows evaluation for related adjacent ligament pathology or unrelated pain generators involving the ligamen-tous structures and cartilage surfaces. Akio Sakamoto drafted the paper and performed the treatments. The main cause of a bone cyst on hip is osteoarthritis, often referred to as wear and tear of the bones by a layman. Intraosseous ganglia appeared as well-circumscribed radiolucent lesions accompanied by marginal sclerosis (Figure 1). No recurrence was observed in any case after at least 3 years of followup. Natural Autoimmune Diseases Cure and Treatment. However, chondroblastomas tend to occur in younger patients. The average patient age overall was 48.9 years (range 22–72); 2 patients were younger than 30 years, and 2 were between 30 and 40 years old. Arabori M, Kitazawa H, Akisue T, Kuroda R, Fujioka H, Doita M, et al. Intraosseous ganglion cysts can be occasionally be symptomatic, but a symptomatic ganglion cyst is a diagnosis of exclusion. Tuzuner T: Penetrating type intraosseous ganglion cyst of the lunate bone. The average size of an intraosseous ganglion overall was 22.4 mm (range, 6–40 mm); in long bones was 23.7 mm; in flat bones was 31.3 mm; and in small bones was 10.8 mm. At the final follow-up, satisfactory results were obtained with no recurrence or complications. Patient age and lesion size were statistically analyzed using the Mann-Whitney U test. The authors make a generous window to completely evacuate the ganglion contents and, more importantly, the ganglion wall. Yoshinao Oda and Yukihide Iwamoto conceived of the study, participated in its design and coordination, and helped to draft the paper. 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. Intraosseous Ganglia: A Series of 17 Treated Cases, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka 812-8582, Japan, Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. The main presenting symptom is radial wrist pain that usually resolves after treatment. We evaluated the feasibility of surgically treating these lesions with an arthroscopically assisted technique. 2008 Jan-Feb. 32 (1):73-6. 2. The high prevalence of intraosseous ganglia in patients who have dorsal wrist ganglia supports this theory . 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! The patient was a 47-year-old woman with a painful left shoulder with a limited range of motion. The etiology is unknown, but association with degenerative joint disease has been considered. Sign up here as a reviewer to help fast-track new submissions. We here report a case of intraosseous ganglion of the scaphoid that was treated in our department. She was treated effectively by curettage and autogenous cancellous bone grafting. No statistically significant difference was found in the size of lesions by bone type. Each patient and their family members were informed that the data from their case would be submitted for publication, and their consent was obtained. IOGs are regularly seen on wrist radiographs obtained to evaluate wrist pain or other problems. Bone consolidation within 1 year after surgery occurred in all 16 cases that had been treated with curettage. Ach Orthop Trauma Surg 114:14-7,1994. In the current study, because almost all cases of an intraosseous ganglion were treated surgically, the clinical data regarding the anatomical site and ages appear to be accurate. Introduction. Intraosseous ganglia are benign cystic and often multiloculated lesions composed of fibrous tissue with extensive mucoid changes located in the subchondral bone adjacent to a joint. Ganglion cysts are round or oval and usually measure less than an inch (2.5 centimeters) in diameter. Most reports of intraosseous ganglion in the biomedical literature describe a single case or a series of a few cases. The etiology is unknown, but association with degenerative joint disease has been considered. Ganglion cysts most commonly develop along the tendons or joints of your wrists or hands. 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. The differential diagnoses include tumors that arise in the epiphyseal to metaphyseal region, such as giant cell tumor of bone, aneurysmal bone cyst, and chondroblastoma [4, 5, 9]. The pathogenesis of the IOG is controversial. Intraosseous ganglion (IOG) cyst of the scaphoid is an infrequent cause of hand and wrist pain. Wrist arthroscopy is a surgical technique that reduces the intra-articular operative area and therefore minimizes postoperative stiffness. Ganglion Cyst Symptoms Symptoms of a ganglion cyst can include: A soft bump or mass that changes size but doesn’t move. The initial diagnosis of intraosseous ganglion was made based on the plain radiographs. On magnetic resonance imaging a cystic lesion of the proximal humerus was detected. The authors declare no conflict of interests. Nonoperative observation is an option for intraosseous ganglia . Darcy PF, Sorelli PG, Qureshi F, Orakwe S, Ogufere W. Carpal tunnel syndrome caused by an intraosseous ganglion of the capitate. Location. Intraosseous ganglion is a cystic lesion that contains gelatinous material and is regarded as similar to that of soft-tissue ganglion. Intraosseous ganglia are benign, non-neoplastic lesions of bones that are histologically similar to their soft tissue equivalents. All cases were introduced, and during this time, all suspected intraosseous ganglion lesions were treated as an extension of biopsy. typically have a wall lined by a flat epithelium with a synovial covering . Some of these ganglia were occult on conventional radiographs and were detected only at bone scanning and MR imaging. Shape and size. Intraosseous ganglia are identified most often in middle-aged patients. On plain radiographs, the intraosseous ganglion appears as a well-defined osteolytic lesion located near a joint. Several ganglions can also develop. Intraosseous ganglion contains mucoid viscous material with no epithelial or synovial lining . Intraosseous ganglia located in the scaphoid have rarely been described in the literature. In the 9 long-bone lesions, right predominance was seen (7 right, 2 left). Intraosseous ganglion is a benign, nonneoplastic bone lesion with histological similarity to that in soft tissue [1–3]. Lesions may occur in multiple carpal bones, and may be bilateral [3,9,10]. Affected persons usually notice a bump on the wrist or back of the hand, less frequently on other parts of the body. Epidemiology Tends to occur in middle age. They are also frequent incidental findings in the capitate, arising volarly at the attachment of the radioscaphocapitate ligament. In conclusion, plain radiographs as well as clinical information are important for the accurate diagnosis of intraosseous ganglion. Axial imaging of the IOG demonstrates key diagnostic features. Onset is often over months. Introduction Intraosseous ganglions are rare, benign lesion of bone that most frequently occur in the metaphyses of the long bones. Results. Report of four cases and review of the literature,”, U. Helwig, S. Lang, M. Baczynski, and R. Windhager, “The intraosseous ganglion. 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 . Intraosseous ganglia of the distal tibia are rare. Also known as a subchon-dral bone cyst, the IOG is a benign, mucin-filled, cystlike lesion that arises within the subchondral medullary bone. The periosteum and cortex of bone represent physical barriers. Among the 9 long bone lesions, 3 were proximal and 6 were distal. Of the 17 lesions, 9 were in long bones, 4 in flat bones, and 4 in small bones of the hand and feet. Intraosseous ganglion is a cystic lesion that contains gelatinous material, most often occurs in middle-aged patients, and is regarded as similar to soft-tissue ganglion. The average lesion size was 22.4 mm (range 6–40 mm). Clinical presentation Patients may have mild localized pain. 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. Perhaps the later type may arise from primary intramedullary metaplasia . Among the 17 patients, 2 (12%) had osteoarthritis, 3 (18%) had pathological fracture, and 4 (24%) had extraskeletal extension. A 70-year-old female presented with a complaint of pain to the right dorsal forefoot. 3. This type of communication has also been seen in imaging of an intraosseous ganglion, which was presumably of articular origin . They are mostly benign lesions; however, not all hypoechoic or T2 hyperintense lesions are cysts, and neoplastic lesions may be missed if close attention is not paid to the typical imaging findings. Helwig U, Lang S, Baczynski M, Windhager R: The intraosseous ganglion: a clinical pathological report on 42 cases. 2004. Materials and Methods. The surrounding bone is focally sclerotic and, by microscopic examination, has components of both necrotic and revascularized osseous elements [1,11]. A negative bone scan does not exclude a symptomatic ganglion cyst or the need for surgical treatment. 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