Giant intraosseous ganglion of the fibula: multimodality imaging
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CASE REPORT
Giant intraosseous ganglion of the fibula: multimodality imaging Najoi Chatt 1 & Aline François 2 & Souad Acid 1 & Bruno Vande Berg 1 & Thomas Kirchgesner 1 Received: 8 March 2020 / Revised: 18 May 2020 / Accepted: 25 May 2020 # ISS 2020
Abstract Intraosseous ganglia around the knee are most commonly located in the proximal tibia and limited to the epiphyseal-metaphyseal region. We report the case of a giant intraosseous ganglion of the fibula. MRI demonstrated the fluid avascular content of the lesion. CT arthrography of the knee demonstrated partial opacification of the lesion through a cortical bone defect. The lesion was treated with curettage and bone grafting. Anatomopathological examination confirmed the medical imaging diagnosis of intraosseous ganglion. This case highlights the value of joint opacification with CT arthrography to demonstrate the communication between the articular cavity and the ganglion. Keywords Knee . Bone . Intraosseous . Ganglion . Cyst . MRI . CT arthrography
Introduction Ganglia or ganglion cysts are benign cystic lesions within the peri-articular soft tissues or within the juxta-articular bone [1]. Histologically, they contain a myxoid substance with fibroblasts and collagen located at the periphery of the lesion [2]. Pathologists use the term “ganglion” rather than “ganglion cyst” because of the absence of epithelial lining. However, we used the term ganglion cyst in the current report to emphasize the cystic aspect of these lesions at medical imaging. In the knee, intraosseous ganglion cysts are usually located in the proximal tibia, small, and limited to the epiphysealmetaphyseal region [3–5]. We report the case of a 59-yearold woman referred to our center for an extensive bone tumor of the proximal fibula found at knee MRI. Multimodality imaging including contrast-enhanced MRI and CT knee arthrography was consistent with an intraosseous ganglion cyst. Anatomopathological examination confirmed the diagnosis.
* Najoi Chatt [email protected] 1
Department of Radiology, Cliniques universitaires Saint-Luc – Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
2
Department of Anatomical pathology, Cliniques universitaires Saint-Luc, Brussels, Belgium
This case report highlights the possible diagnostic value of medical imaging in the management of atypical intraosseous ganglion cysts and emphasizes the value of joint opacification with CT arthrography to demonstrate the communication between the articular cavity and the cyst.
Case report A 59-year-old woman without relevant medical history was referred to our oncological orthopedic surgeon for a bone tumor of the right fibula. Indeed, MRI of the right knee performed in another medical center because of chronic lateral knee pain had demonstrated a lesion of the proximal fibula as well as a tear of the lateral meniscus (Fig. 1). Radiographs of the right lower limb showed a lytic bone lesion of the fibula extending from the proxim
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