Ganglion cyst in children: Reviewing treatment and recurrence rates

Abstract

G anglion cysts are mucinous tumours that usually arise from underlying joint capsules or tendon sheaths, and are the most common soft tissue masses of the hand (1). Their pathogenesis remains controversial. The extracapsular part of the dorsal ganglia is well known, but little is known about the intracapsular component and its etiology. While a great deal of information exists for adult hand and wrist ganglia, there is a paucity of data for the pediatric population. Although they commonly occur as benign lesions in adults, ganglia of the hand and wrist are much less common in children. The exact incidence is uncertain, but Nelson et al (1) reported on a series of 543 hand and wrist ganglia. Approximately 10% occurred in patients younger than 20 years of age, and less than 2% were in patients younger than 10 years of age. However, the incidence of ganglia in children is probably underestimated because their presence is usually painless and does not interfere with function; therefore, they may not be brought to the attention of a physician.Pediatric hand and wrist ganglia seem to have different epidemiological characteristics than those of adults -a majority are found on the volar aspect of the hand and wrist in patients younger than 10 years of age (2).Studies regarding the treatment of hand ganglia in children have generally shown increased rates of recurrence with aspiration or surgery when compared with adults who have undergone similar treatment. Recurrence rates of up to 43% with various puncture techniques (3), including aspiration, and 35% following surgical excision have been reported (2). Only a few studies have examined the treatment of pediatric ganglia through observation: MacCollum (4) found a 64% spontaneous resolution rate in a series that included only dorsal wrist ganglia (gathered from several centres), and Rosson and Walker (5), whose study included patients 15 years of age or younger, reported a 76% resolution rate in a series that included foot ganglia.The objectives of the present study were to determine the most common sites of pediatric ganglia occurrence and the most effective method of treatment. patients and MethodsThe records of the pathology department at The Hospital for Sick Children (Toronto, Ontario) were retrospectively searched for all cases of ganglion cyst surgically treated between January 2000 and oRiGinal aRticle ©2011 Pulsus Group Inc. All rights reserved baCKGRound: Pediatric hand and wrist ganglia seem to have different epidemiological characteristics than those of adults -a majority are found on the volar aspect of the hands and wrists of patients younger than 10 years of age. obJeCtive: To determine the epidemiology, etiological factors, clinical presentation, treatment and outcome of patients with ganglion cysts at The Hospital for Sick Children (Toronto, Ontario). Methods: The records of the pathology department at The Hospital for Sick Children were searched for all cases of ganglion cyst operated on between January 2000 and December 2008. Results: Thirty-seven pat...

Tumorous conditions of the pediatric hand and wrist: Ten-year experience of a single center

“…The prevalence of the ganglion cyst was reported higher in the female gender. [ 3 , 4 ] However, the rate was found to be equal for each gender (50%-50%) in our study. To our knowledge, there is no study reporting the Turkish pediatric population’s hand tumor distribution to compare our results.…”

Wrist Ganglion Cysts in Children: An Update and Review of the Literature

“…3 Precipitating trauma is also reported in 0% to 12% of pediatric case series. 5,9,13,16 One of the accepted theories is that ganglion cysts arise from modified synovial cells in response to minor trauma. Repetitive stretching of supporting joint structures stimulates hyaluronic acid production by fibroblasts at the synovial-capsule interface, resulting in mucin accumulation and formation of the ganglion cyst.…”

“…Ganglion cysts of the wrist can occur at any age, with patients as young as 2 months reported. 13 Due to significant heterogeneity within the patient populations of studies examining pediatric wrist ganglia, average reported patient ages range between 3 and 14 years, 5,8,12-14,17,20 with a slight bias to older ages in papers examining surgical management of ganglion cysts. As with adult ganglion cysts, there appears to be a slight female preponderance among pediatric populations, with a ratio of 1.4-2.7:1 (F:M).…”

“…Although numerous publications have previously examined the management of pediatric wrist ganglia, much is still unknown about this very common entity, and there is little contemporary literature. There have only been 4 publications 5-8 in the past decade examining this topic, and all have focused on surgical management. Data interpretation of earlier studies is made difficult by inconsistencies in the age ranges of children included in the studies and the amalgamation of hand and foot ganglion cysts.…”

“…Data interpretation of earlier studies is made difficult by inconsistencies in the age ranges of children included in the studies and the amalgamation of hand and foot ganglion cysts. 5 Currently, there are still no clear guidelines regarding the best management of children presenting with ganglion cysts.…”