Unusual presentation of an usual condition—cystic ganglionosis

Abstract

Cystic ganglionosis is an unusual benign condition, which presents as multiple ganglion cysts involving multiple joints. The case we report here is probably the first case of an adult reported in the literature. The only other case of multiple ganglion cysts reported in the literature is that of an 11-year-old child with ganglion cysts in multiple joints. A 57-year-old female presented with an approximately 4-year history of pain and swelling below the left knee and in the right hand. An MRI of the left knee showed multiloculated cystic-intensity lesions around the knee joint with intra-/extra-articular and intraosseous components. Similar lesions were noted around the right knee joint, right wrist and ring finger. With all the above findings and in view of multiple joint involvement, the possibility of cystic ganglionosis or multiple giant ganglion cysts was considered and confirmed by biopsy of one of the knee lesions. It is because of this rarity and the unusual presentation involving multiple joints that we have reported this case. The importance of the diagnosis is that unnecessary surgical intervention and hospitalization can be avoided, provided the patient’s symptoms are not severe.

Primary Cutaneous Aspergillosis Presenting as a Multiloculated Cyst in the Hand

“…Although imaging findings of primary cutaneous as- pergillosis of the hand has never been described, a multilobulated cystic lesion with diffuse enhancement of cystic walls and surrounding soft tissue on MR imaging gave the impression of infected multiple ganglion cysts in our case (10). In addition, rheumatoid nodule occurring in 20% -30% of cases diagnosed with rheumatoid arthritis could be typically seen over the bony prominence or extensor surface of the upper extremity with possible combined infection (11).…”

“…In addition, rheumatoid nodule occurring in 20% -30% of cases diagnosed with rheumatoid arthritis could be typically seen over the bony prominence or extensor surface of the upper extremity with possible combined infection (11). However, this patient presented no communication between the lesion and the joint capsule which could be often observed in cases of ganglion cysts or rheumatoid nodules (10,11). Besides, rheumatoid nodule could be seen as low signal intensity on both T1 and T2 weighted images.…”

Cystic Ganglionosis in a 3-year-old Mimicking Juvenile Idiopathic Arthritis

“…We found only 4 other case reports of cystic ganglionosis, 3 of which were on children. 5,6,7 Management is usually conservative unless a lesion is symptomatic. This case highlights that cystic ganglionosis can mimic joint effusions in small joints such as the TMJs, leading to concern for JIA, which was also a diagnostic consideration in another report of cystic ganglionosis.…”