Ganglion cyst

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Ganglion cyst
Diagnosis in short

Ganglion cyst. H&E stain.

LM empty space(s) - usually multiple; fibrotic wall without an epithelial lining +/- myxoid change +/- spindled fibroblasts
LM DDx synovial cyst, juxta-articular myxoma, (other) myxomas, digital mucous cyst, myxoid lesions
Site soft tissue close to joints - esp. in hand

Prevalence common
Prognosis benign
Treatment surgical excision or conservative management

Ganglion cyst is a small benign ditzel classically found on the wrist.

General

  • Very common.
    • Most common tumour of the hand.[1]
  • Classically on the wrist.[2]
  • May be painful.[3]
  • Many (~60%) regress if left alone.[4]

Gross

  • Mass at a joint - classically in the hand.

DDx - clinical:

Image

Microscopic

Features:[1][3]

  • Empty space(s); usually multiple.
  • Fibrotic wall.
  • No epithelial lining.†
  • +/-Myxoid change - very common.
    • May have some spindled fibroblasts.

Note:

  • † The entity is really a pseudocyst.[1]

DDx:

Images

www:

Stains

  • Alcian blue +ve (mucin).[6]

Images

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Soft Tissue (Submitted as "Ganglion from Left Wrist"), Excision:
- Ganglion cyst.

Block letters

SOFT TISSUE ("GANGLION CYST"), LEFT WRIST, EXCISION:
- GANGLION CYST.

Micro

The sections show fibroadipose tissue with cyst-like spaces surrounded by fibrous tissue. There are no villous projections into the cyst-like spaces. Focal myxoid areas are present with rare bland spindle cells. There is no nuclear atypia and no mitotic activity is appreciated. Dense connective tissue consistent with tendon is present focally.

Alternate

The sections show cyst-like spaces surrounded by fibrous tissue. There are no villous projections into the cyst-like spaces. Focal myxoid areas are present with rare bland spindle cells. There is no nuclear atypia and no mitotic activity is appreciated. Dense connective tissue consistent with tendon is present focally. Benign glands are present.

See also

References

  1. 1.0 1.1 1.2 URL: http://emedicine.medscape.com/article/1243454-overview. Accessed on: 8 February 2012.
  2. Hasham, S.; Burke, FD. (May 2007). "Diagnosis and treatment of swellings in the hand.". Postgrad Med J 83 (979): 296-300. doi:10.1136/pgmj.2005.043992. PMID 17488856.
  3. 3.0 3.1 3.2 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 322. ISBN 978-0443066542.
  4. Suen, M.; Fung, B.; Lung, CP. (2013). "Treatment of ganglion cysts.". ISRN Orthop 2013: 940615. doi:10.1155/2013/940615. PMID 24967120.
  5. Cuono, CB.; Watson, HK. (Jan 1979). "The carpal boss: surgical treatment and etiological considerations.". Plast Reconstr Surg 63 (1): 88-93. PMID 432327.
  6. 6.0 6.1 Park, JH.; Im, SB.; Kim, HK.; Hwang, SC.; Shin, DS.; Shin, WH.; Kim, BT. (Dec 2013). "Histopathological findings of hemorrhagic ganglion cyst causing acute radicular pain: a case report.". Korean J Spine 10 (4): 242-5. doi:10.14245/kjs.2013.10.4.242. PMC 4040643. PMID 24891856. //www.ncbi.nlm.nih.gov/pmc/articles/PMC4040643/.