Download 股關節腱鞘囊腫類股疝氣- 術前診斷 Ganglion cyst of hip joint

股關節腱鞘囊腫類股疝氣- 術前診斷
Ganglion cyst of hip joint mimicking
femoral hernia – preoperative
diagnosis is feasible
趙玟珊, 吳誠中, 鄭紹彬
臺中榮民總醫院一般外科
Wen-Shan Chao, Shao-Bin Cheng, Cheng-Chung Wu
Division of General Surgery
Taichung Veterans General Hospital, Taichung, Taiwan
Patient Profile
Chief Complaint:
intermittent pain over right inguinal with reducible protruding mass for one month
Present Illness:

This 65-year-old female with history of (1)left breast cancer, T2N1M0
s/p MRM on 740827, CMFx6 and radiotherapy

According to the patient, she suffered from intermittent pain over right
inguinal with reducible protruding mass for one month. The pain exacerbated
when bending her right leg, walking, coughing and climbing the stairs.
It could relieved by hot packing and resting. She went to local hospital on 105/6/9,
where MRI was done. She went to our OPD for second opinion.

PE showed palpable reducible mass over right inguinal area.

Under impression of suspected right side femoral hernia, she was
admitted for further survey and treatment.
MRI T2-weighted
Blood Parameters
105/06/22 Excisional biopsy of right
inguinal tumor
Pathological Report
Introduction

ganglion cysts (GC) and synovial cysts (SC)
are among the most frequently occurring
benign cystic lesions in the joints.

Degenerative joint disease is the main
predisposing factor, but might also be
related to trauma, and connective tissue
disease.
Imaging approach

1. Ultrasound (US): is the initial imaging method
of choice, usually differentiating cystic from noncystic ones.

2. MRI: has become the gold-standard modality

T1: typically low signal
T2: typically high signal

Spectrum of MRI features of ganglion and synovial cysts
Insights Imaging. 2016 Apr; 7(2): 179–186, Nelson Neto
Thank your for your attention
000297840H


Ganalglion cyst arising from hip joint is rare and its
presenting symptoms resembles a femoral hernia. We
have reported such case 20 year ago. The preoperative
diagnosis is usually difficult. However, with the
improvement of imaging studiese, preoperative diagnosis
of such ganglion cyst is possible. We herein reported a
56-year old patient who had history of breast cancer 13
year ago.
During cancer follow study, she was found to have a
right inguinal reducible mass. Clinically, the mass was
diagnosed as a right femoral hernia. However, imaging
study revealed as a right hip joint ganglion cyst. The
patient remains disease free for 1 year after operation.
105/06/22 Operative Pictures

A soft mass with thickening fibrotic wall
was about 7x5cm in size, just located at
right side to femoral artery and vein, with
transparence jelly-like material
Introduction




ganglion cysts (GC) and synovial cysts (SC) are among
the most frequently occuring benign cystic lesions in the
joints. Degenerative joint disease is the main
predisposing factor, but they might also be related to
other conditions such as trauma, rheumatoid arthritis,
gout, and systemic lupus erythematosus
T1: typically ganglia are low signal although high
proteinaceous content or haemorrhage may result in
lesions appearing isointense or hyperintense on T1
weighted images.
T2/STIR: typically high signal
SCs are herniations of the synovial membrane
through the capsule of a joint filled by synovial
fluid, which may or may not keep a
communication with the joint.
 GCs lack a synovial cell lining and are
constituted by a dense collagenous capsule
surrounding a mucopolysaccharide-rich
gelatinous fluid, similar to that of SC but at a
higher concentration
 SC are very likely to occur around the knee and
the hip, GC are most commonly found in the
distal extremities, particularly in the wrist

Insights Imaging. 2016 Apr; 7(2): 179–186.
 Published online 2016 Feb
24. doi: 10.1007/s13244-016-0463-z
 PMCID: PMC4805620
 Spectrum of MRI features of
ganglion and synovial cysts
 Nelson Neto and Pedro Nunnes
 Author information ► Article
notes ► Copyright and License
informatio
