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Diagnostics (Basel, Switzerland) Oct 2023Leiomyomas are the most common solid benign uterine neoplasms; they are usually asymptomatic and are identified incidentally. Yet, responsive to stimulation by...
Leiomyomas are the most common solid benign uterine neoplasms; they are usually asymptomatic and are identified incidentally. Yet, responsive to stimulation by estrogens, leiomyomas may expand, potentially outgrowing their blood supply to undergo hemorrhage, fibrosis, calcification, and atrophy. These pathologic mechanisms commonly lead to leiomyomas degeneration, i.e., red, hyaline, cystic, or myxoid. Magnetic resonance (MR) imaging is the most accurate imaging technique for the characterization of leiomyomas. In cases of degeneration, variable features on T2-weighted and contrast-enhanced images can be found. With no recent radiologic pathologic correlation literature available on this matter, herewith, we provide computed tomography (CT)/MR imaging along with histopathological specimens of two young women who were diagnosed with hyaline or hyaline and cyst degeneration of uterine leiomyomas at our university hospital. We report on the imaging features of uterine leiomyomas using CT and MR imaging and discuss the available literature on imaging signs that may be suggestive of hyaline or cyst degeneration using either of the imaging examination methods.
PubMed: 37892050
DOI: 10.3390/diagnostics13203230 -
The American Journal of Case Reports Mar 2023BACKGROUND This article presents a rare case of an intra-tendinous ganglion cyst of the peroneus tertius. Ganglion cysts are benign lesions frequently seen in hand... (Review)
Review
BACKGROUND This article presents a rare case of an intra-tendinous ganglion cyst of the peroneus tertius. Ganglion cysts are benign lesions frequently seen in hand pathologies, but they are rarely seen in the foot and ankle. This article discusses the present case and similar previously reported cases in the English literature. CASE REPORT We present a case of a 58-year-old man with a 3-year history of right foot pain caused by a mass located at the dorso-lateral aspect of the midfoot. Preoperative MRI demonstrated a ganglion cyst arising from the peroneus tertius tendon sheath. The lesion was successfully decompressed in the office; however, it recurred 7 months later. As it was symptomatic, we elected to proceed with surgical resection. During dissection, it became apparent that the cyst was arising from an intrasubstance tear of the peroneus tertius tendon, and a branch of the superficial peroneal nerve was noted to be adherent to the pseudo-capsule. Following excision of the lesion and its expansile pseudo-capsule, the tear was repaired with tubularization of the tendon and external neurolysis of the nerve was performed. At 6 months after surgery, there was no recurrence of the lesion, and the patient was pain free and had regained normal physical function. CONCLUSIONS Intra-tendinous ganglion cysts are rare, especially in the foot and ankle. This makes it challenging for an accurate preoperative diagnosis. When a tendon is arising from a tendon sheath, we recommend exploration of the underlying tendon for an associated tear.
Topics: Male; Humans; Middle Aged; Ganglion Cysts; Tendons; Leg; Lower Extremity; Hand
PubMed: 36860121
DOI: 10.12659/AJCR.938498 -
Saudi Medical Journal Aug 2016To identify incidence and utility of histopathology in wrist ganglions.
OBJECTIVES
To identify incidence and utility of histopathology in wrist ganglions.
METHODS
A retrospective study of 112 patients operated for wrist swellings between January 2009 and March 2014 at Aga Khan University Hospital, Karachi, Pakistan, was conducted. Medical records were reviewed for demographics, history, location and associated symptoms, provisional diagnosis and operative details. Histopathology reports were reviewed to confirm the final diagnosis.
RESULTS
One hundred and twelve patients were included in the study (34 males and 78 females) with a mean age of 28 ± 12 years. Ninety-five percent of ganglia were dorsally located and 85% were solitary in nature. Histopathology reports confirmed 107 as ganglion cysts, whereas 3 had giant cell tumor of tendon sheath and 2 were reported to be tuberculous tenosynovitis.
CONCLUSION
Although most of the time the clinical diagnosis conforms to the final diagnosis, the possibility of an alternate diagnosis cannot be ignored (4% in this study). We suggest routine histopathological analysis so that such diagnoses are not missed.
Topics: Adult; Diagnosis, Differential; Female; Ganglion Cysts; Humans; Male; Middle Aged; Retrospective Studies; Wrist
PubMed: 27464871
DOI: 10.15537/smj.2016.8.15749 -
The Journal of Hand Surgery Mar 2019This study aimed to determine whether Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function and Pain Interference scores varied at... (Comparative Study)
Comparative Study
PURPOSE
This study aimed to determine whether Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function and Pain Interference scores varied at presentation for specialty care by nontrauma hand condition. The secondary aim was to compare PROMIS scores with a reference standard, the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH), regarding the magnitude and direction of score differentials among diagnoses.
METHODS
PROMIS Physical Function and Pain Interference scores were analyzed from 1,471 consecutive new adult patient clinic visits at a tertiary orthopedic hand clinic presenting with 1 of 5 nontrauma hand conditions. A 5-point difference on PROMIS assessments was presumed to be clinically relevant. A random sample of 30 QuickDASH scores from each diagnostic group was evaluated for score differentials among groups. We also measured the correlation between PROMIS and QuickDASH scores.
RESULTS
Patients with carpal tunnel syndrome and thumb basal joint arthritis reported worse physical function and more pain interference, whereas those with Dupuytren contractures and ganglion cysts reported less pain and better function. For both domains, patients with trigger fingers averaged PROMIS scores among the other groups. Similar differences were observed in QuickDASH scores because patients with carpal tunnel syndrome and thumb arthritis reported clinically worse upper-extremity function than did patients with ganglion cysts and Dupuytren contracture. A strong correlation was seen between QuickDASH scores with both PROMIS Physical Function scores and Pain Interference scores.
CONCLUSIONS
The PROMIS system is sufficiently able to capture differences in self-reported function and pain interference among patients with different hand conditions. Moreover, PROMIS Physical Function demonstrates construct validity when evaluated against a reference of the QuickDASH across nontrauma hand conditions.
CLINICAL RELEVANCE
The use of PROMIS is expanding, but because PROMIS is not disease-specific, assessment of its construct validity is necessary for hand conditions.
Topics: Age Factors; Carpal Tunnel Syndrome; Cross-Sectional Studies; Disability Evaluation; Dupuytren Contracture; Female; Ganglion Cysts; Hand; Humans; Male; Middle Aged; Osteoarthritis; Patient Reported Outcome Measures; Racial Groups; Trigger Finger Disorder
PubMed: 30577995
DOI: 10.1016/j.jhsa.2018.10.029 -
Cureus Aug 2021Background The common benign surgical lesions of skin and subcutaneous tissues like lipoma and sebaceous cysts are diagnosed clinically and treated by surgical excision...
Background The common benign surgical lesions of skin and subcutaneous tissues like lipoma and sebaceous cysts are diagnosed clinically and treated by surgical excision under local anesthesia. The occurrence of malignancy in these lesions is extremely low, and routine histopathological examination (HPE) adds to increased costs and workload on pathologists. This study was undertaken to estimate the clinical concordance and the frequency of malignancy in these lesions. Methods A total of 1,815 HPE reports of clinically benign skin and subcutaneous lesions excised under local anesthesia from January 2014 to December 2018 were studied. Results Lipoma (31.3%) and sebaceous cyst (29.9%) were the common clinical diagnosis in our study. The clinical accuracy in the diagnosis of lipoma was 88.6%, and for sebaceous cyst, it was 72.7%. There were six reports of malignancy in our study from the clinically diagnosed benign skin and subcutaneous lesions (0.33%). None of the cases of lipoma and the sebaceous cyst had a malignancy in the final histopathology report. The frequency of malignancy in the rest of the lesions is 0.85% (six out of 699 cases); (p-value: 0.003). Discussion In the absence of red flag signs, lesions like lipoma, sebaceous cyst, corn, and callus can be discarded without an HPE. We advocate routine HPE of other solid lesions, cystic lesions with solid areas, and pigmented or ulcerated lesions, as the clinical concordance is low and there is a significant occurrence of malignancy in these lesions.
PubMed: 34540422
DOI: 10.7759/cureus.17194 -
Journal of Nippon Medical School =... Nov 2021Ganglion cysts are common benign lesions in the hand and wrist. However, intratendinous ganglion cysts are uncommon. We present a case of intratendinous ganglion cyst in... (Review)
Review
Ganglion cysts are common benign lesions in the hand and wrist. However, intratendinous ganglion cysts are uncommon. We present a case of intratendinous ganglion cyst in the extensor pollicis longus (EPL) tendon of the right hand of a 73-year-old woman. The subcutaneous mass moved in concert with the EPL tendon in her right thumb. Magnetic resonance imaging showed a space-occupying lesion in the EPL tendon. Biochemical and hemato-immunological examinations ruled out diabetes, rheumatoid arthritis, and other connective tissue diseases. She reported motion pain during thumb extension, for which she desired surgery. An intratendinous cyst was identified intraoperatively within the tendon substance of the EPL, in which a part of the cyst was herniated into a slit in the tendon substance, just distal to the extensor retinaculum, without notable proliferative synovial tissue. The EPL tendon was opened longitudinally, and a cystic lesion was enucleated. Pathological examination showed that the cyst wall consisted of fibrous tissue with degeneration and no epithelial lining. Postoperative recovery was uneventful. Six months after surgery, the patient had no residual pain and no cyst recurrence. The rarity of intratendinous ganglion cysts makes diagnosis and treatment challenging. Because intratendinous ganglion cysts and associated synovitis frequently weaken the structure of affected tendons, prompt diagnosis and surgical excision are necessary.
Topics: Aged; Female; Ganglion Cysts; Hand; Humans; Magnetic Resonance Imaging; Pain; Tendons; Thumb; Treatment Outcome
PubMed: 32999177
DOI: 10.1272/jnms.JNMS.2021_88-416 -
Eplasty 2023Intraneural ganglia are a rare cause of common peroneal nerve palsy. Although several treatment modalities exist, surgical intervention is recommended, especially in the... (Review)
Review
BACKGROUND
Intraneural ganglia are a rare cause of common peroneal nerve palsy. Although several treatment modalities exist, surgical intervention is recommended, especially in the setting of neurological dysfunction. We present a case series and systematic review on the clinical outcomes following surgical excision of common peroneal nerve intraneural ganglia.
METHODS
We performed a retrospective chart review of all patients who had undergone surgery for common peroneal nerve intraneural ganglia at Queen Elizabeth Hospital in Birmingham, UK, from 2012 to 2022. Demographic and pre- and postoperative findings were collected. A comprehensive literature search of MEDLINE and EMBASE databases was also performed to identify similar studies. Data were subsequently extracted from included studies and qualitatively analyzed.
RESULTS
Five patients at our center underwent procedures to excise intraneural ganglia. There was a male preponderance. Pain, foot drop, and local swelling were the common presenting features. Postoperatively, all patients who completed follow-up demonstrated improved motor function with no documented cyst recurrence. The systematic review identified 6 studies involving 128 patients with intraneural ganglia treated with surgery. Similar findings were reported, with objective and subjective measures of foot and ankle function and symptoms improving after surgical intervention. The recurrence rate varied from 0% to 25%, although most recurrences were extraneural.
CONCLUSIONS
Excision of intraneural ganglia is associated with symptomatic relief and functional improvement. Recurrence rates are relatively low and are rarely intraneural.
PubMed: 37465473
DOI: No ID Found -
Polymers Mar 2024Poly-L-lactic acid (PLLA) implants have been used for bone fixation for decades. However, upon insertion, they can cause a foreign body reaction (FBR) that may lead to... (Review)
Review
Poly-L-lactic acid (PLLA) implants have been used for bone fixation for decades. However, upon insertion, they can cause a foreign body reaction (FBR) that may lead to complications. On 15 December 2023, a systematic review was conducted to search for articles on the PubMed, MeSH term, and Scopus databases using the keywords 'PLLA' and 'foreign body reaction'. The articles were reviewed not only for the question of FBR, its severity, and the manifestation of symptoms but also for the type of implant and its location in the body, the species, and the number of individuals included. A total of 71 original articles were identified. Of these, two-thirds reported on in vivo trials, and one-third reported on clinical applications. The overall majority of the reactions were mild in more than half of the investigations. Symptoms of extreme and extensive FBR mainly include osteolysis, ganglion cysts, and swelling. The localization of PLLA implants in bone can often result in osteolysis due to local acidosis. This issue can be mitigated by adding hydroxyapatite. There should be no strong FBR when PLLA is fragmented to 0.5-4 µm by extracorporeal shock wave.
PubMed: 38543422
DOI: 10.3390/polym16060817 -
Journal of Wrist Surgery Aug 2023Synovial cysts (SCs) are the most frequent wrist tumors; the arthroscopic treatment presents good results when surgery is indicated for symptomatic or patients with...
Synovial cysts (SCs) are the most frequent wrist tumors; the arthroscopic treatment presents good results when surgery is indicated for symptomatic or patients with cosmetic concerns. The tumoral lesion should be arthroscopically decompressed or drained toward the inside of the joint through pedicle opening and resection of a small portion of the capsule. Hence, the cyst pedicle must be found for the success of this technique. Some tricks have already been described to facilitate SC location during arthroscopy. We describe an indirect technique that employs an 18-G needle to enhance SC pedicle location and drainage. The technique involves a puncture on the interval of the carpal extrinsic ligaments where the pedicle is suspected to be remain. When found, cyst is drained with a single-puncture motion of the need which promotes cyst content extravasation due to pressure toward the joint. This method has been employed in 16 patients, including 9 with dorsal cysts, and seven with volar cysts. All patients presented complete recovery and symptom improvement in up to 30 days, with total disappearance of the cyst. There were no relapses or severe complications within the 12-month follow-up. This is a safe, useful technique that facilitates location of intra-articular cyst pedicle, thus avoiding unnecessary damage in healthy tissues with no increased costs.
PubMed: 37564625
DOI: 10.1055/s-0042-1751015 -
Journal of Neurosurgery. Case Lessons Sep 2023Intraneural cysts involving the tibial nerve in the knee region (popliteal fossa) are rare. According to the articular (synovial) theory, which posits a joint origin for...
BACKGROUND
Intraneural cysts involving the tibial nerve in the knee region (popliteal fossa) are rare. According to the articular (synovial) theory, which posits a joint origin for this pathology, these cysts originate from either the superior tibiofibular joint (STFJ) or the tibiofemoral (knee) joint. As tibial intraneural cysts arising from the tibiofemoral joint remain poorly understood, the authors present 2 illustrative cases and a review of the world's literature on all tibial intraneural ganglion cysts in the knee region.
OBSERVATIONS
Fourteen cases of tibial intraneural ganglion cysts arising from the tibiofemoral joint were identified in the literature. Different articular branch patterns were demonstrated, which could be explained by the varied, rich articular branch innervation at the knee. Favorable outcomes were observed in cases in which the articular branch had been disconnected and the cyst drained and were comparable to the outcomes seen in tibial intraneural ganglion cysts with an STFJ origin.
LESSONS
Tibial intraneural cysts in the knee region can be subdivided by their joint of origin: the STFJ or the tibiofemoral joint. Those arising from the tibiofemoral joint originate from different areas of the joint and propagate in predictable patterns, with favorable outcomes following surgical intervention when the joint connection is identified and treated. The origin of tibial intraneural cysts from the tibiofemoral joint are more complex than those originating from the STFJ but seem to have similar propagation patterns and outcomes.
PubMed: 37728275
DOI: 10.3171/CASE23314