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LETTER TO THE EDITOR
Year : 2016  |  Volume : 12  |  Issue : 1  |  Page : 426-428

Intraosseous ganglion cyst of scaphoid: A rare bone tumor


1 Department of Orthopedics, Pramukswami Medical College, M. S. Patel Cancer Centre, Karamsad, Anand, Gujarat, India
2 Department of Orthopedic Surgery, Pramukswami Medical College, Karamsad, Anand, Gujarat, India

Date of Web Publication13-Apr-2016

Correspondence Address:
Abhijeet Ashok Salunke
Department of Orthopedics, Pramukswami Medical College, M. S. Patel Cancer Centre, Karamsad - 388 325, Anand, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.172591

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How to cite this article:
Salunke AA, Kanani H, Singh S, Sheth H. Intraosseous ganglion cyst of scaphoid: A rare bone tumor. J Can Res Ther 2016;12:426-8

How to cite this URL:
Salunke AA, Kanani H, Singh S, Sheth H. Intraosseous ganglion cyst of scaphoid: A rare bone tumor. J Can Res Ther [serial online] 2016 [cited 2019 Dec 8];12:426-8. Available from: http://www.cancerjournal.net/text.asp?2016/12/1/426/172591



Sir,

We read with interest the article by Vijayan et al. who have demonstrated a case of benign chondroblastoma of scaphoid treated with curettage, bone grafting, and K-wire fixation.[1]

Surely, the authors would acknowledge that ganglion cyst is found in small bones of hand should also be considered as differential diagnosis of the radial-sided wrist pain.

We present a case of a 30-year-old right-handed dominant male with a right wrist pain for 6 months. The radiograph of right wrist joint revealed a well-defined nonexpansile osteolytic lesion with thinning of cortex in scaphoid [Figure 1]. Magnetic resonance imaging revealed an area of low-signal intensity area in the scaphoid waist on T1-weighted images and high-signal intensity on short-TI inversion recovery images [Figure 2]. The patient underwent curettage of scaphoid lesion through volar approach to scaphoid bone and void was filled with autogenous iliac corticocancellous bone graft. Histopathological examination showed mucoid viscous material without epithelial or synovial lining and was suggestive of ganglion cyst [Figure 3]. There were no signs suggestive of local recurrence, and the patient is working well and doing all activities of daily living comfortably and is having 2 years follow-up.
Figure 1: Plain radiograph of the wrist joint shows a well-defined lytic lesion of scaphoid (white arrow)

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Figure 2: Magnetic resonance imaging of the wrist with short-TI inversion recovery image shows a high-signal intensity area in the scaphoid waist (white arrow)

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Figure 3: Histopathological examination of the intraosseous ganglion cyst shows mucoid viscous material without epithelial lining

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Intraosseous ganglion is a benign cystic lesion often located in the subchondral bone adjacent to a joint and contains fibrous tissue with mucoid changes. The intraosseous ganglion is rarely seen in lunate and scaphoid, as carpal bones are unusual site of involvement. Intraosseous ganglion peak incidence in the second to fourth decade of life and is having female preponderance. The etiopathogenesis of intraosseous ganglion cyst is myxomatous degeneration of connective tissue leading to cyst formation.[2],[3] Patients with intraosseous ganglion present with no history traumatic event before wrist pain and repeated overuse of hand is an important predisposing factor. The clinical findings are mild to moderate pain during movement of the affected wrist joint, and tenderness can be elicited.

Radiograph of the wrist shows a well-defined osteolytic unilocular nonexpansile cystic lesion with surrounding sclerotic zone.[3],[4] Magnetic resonance imaging findings are T1-weighted images with well-defined area of low-signal intensity, and fat suppression images show areas of high-signal intensity.[3],[4] The histopathology examination of intraosseous ganglion cyst shows myxomatous degeneration of connective tissue, fibrous wall, and mucoid tissue.

According to Uriburu and Levy, increasing size of the lesion and progressive growth are possible indications for surgical management of intraosseous ganglion cyst.[2] Conservative management is beneficial when no cortical erosion or change in size of the cyst is found during follow-up. The treatment of intraosseous ganglion cyst is observation or curettage and filling of void with bone graft or bone cement depending on the size of the lesion.[2],[3],[4],[5] Complications due to intraosseous ganglion cyst are fracture and repeated erosion leading to rupture of tendon mainly flexor tendon of a finger.[2],[5]

In conclusion, intraosseous ganglion cyst is a rare bone tumor, and diagnosis of intraosseous ganglion is based on the imaging features, clinical presentation, and index of suspicion if necessary.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Vijayan S, Bhat AK, Hameed SA, Kumar B. Chondroblastoma of the scaphoid: A case report. J Cancer Res Ther 2015;11:669.  Back to cited text no. 1
    
2.
Uriburu IJ, Levy VD. Intraosseous ganglia of the scaphoid and lunate bones: report of 15 cases in 13 patients. J Hand Surg Am 1999;24:508-15.  Back to cited text no. 2
    
3.
Williams HJ, Davies AM, Allen G, Evans N, Mangham DC. Imaging features of intraosseous ganglia: A report of 45 cases. Eur Radiol 2004;14:1761-9.  Back to cited text no. 3
    
4.
Castellanos J, Bertrán C, Pérez R, Roca J. Pathologic fracture of the scaphoid caused by intraosseous ganglion followed by regression after the healing of the fracture. J Trauma 2001;51:141-3.  Back to cited text no. 4
    
5.
Fealy MJ, Lineaweaver W. Intraosseous ganglion cyst of the scaphoid. Ann Plast Surg 1995;34:215-7.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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