Bilateral intraosseous ganglia of the lunate: A case report A rare case of bilateral intraosseous ganglia of the lunate is reported. The patient had had 7 months of pain in both wrists and a cystic lesion in both lunates. Curettage and bone grafting resulted in complete relief of pain. (J HAND SURG 1992;17A:I084-S.)
Rafael Lorente, MD, Manuel Moreno, MD, and Manuel Quiles, MD, Cordoba, Spain
Intraosseous ganglions are rare. I We recently treated a patient with bilateral lunate intraosseous ganglions. We have been able to locate reports of only eight such unilateral lesions-" and two of patients with bilateral lesions. 1,7 From the Hand Section, Orthopaedic Service, Hospital Reina Sofia, University of Cordoba, Cordoba, Spain. Received for publication May 3, 1990; accepted in revised form Jan. 20, 1992. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Rafael Lorente, MD, The Hand Section, Orthopaedic Service, Hospital Reina Sofia, Universidad de Cordoba, AvenidaMenendez Pidal sin, 14004 Cordoba, Spain. 3/1136516
Case report A 24-year-old woman had 7 months of bilateral slight wrist pain with normal activity. Physical examination showed pain only at the extremes of wrist extension and some dorsal wrist tenderness. X-ray films (Fig. I) showed well-demarcated lytic lesions with sclerotic rims on the radial margin of each lunate. Laboratory findings were normal. At operation through a dorsal approach, the lesions did not communicate with the adjacentjoints. Each lunate shell was perforated, and a yellow, gelatinous material was curetted out. It appeared similar to material seen in soft tissue ganglions. Each cavity was packed with cancellous bone from the adjacent radius. The wrists were immobilized for 4 weeks in short arm casts. Two years after surgery the patient was free of symptoms, and there was almost complete obliteration of the lesions (Fig. 2). The histologic appearance of the lesions (Fig. 3) is similar to that of soft tissue ganglions.
Fig. 1. Preoperative x-ray film showing a well-defined radiolucent lesions of the lunates. 1084
THE JOURNAL OF HAND SURGERY
Vol. 17A, No.6 November 1992
Bilateral intraosseous ganglia of lunate
1085
Fig. 2. X-ray film 2 years after surgery.
Fig. 3. Photomicrograph of cyst wall.
Discussion According to Schajowicz et aI., I the pathogenesis of this lesion is obscure. It may occur de novo in the bone, or the bone may be penetrated by an adjacent soft tissue ganglion. The lesions in our case were probably of the former type. Differential diagnosis includes enchondroma, giant cell tumor, chondroblastoma, simple bone cyst, posttraumatic cyst, fibrous development defect, Kienbock's disease, and osteoarthritis. Multiple cystic lesions may be seen in pigmented villonodular synovitis, gout, and rheumatoid arthritis. REFERENCES 1. Schajowicz F, Sainz Me, Siullitel JA. Juxta-articular bone
2. 3. 4. 5. 6. 7.
cysts (intraosseous ganglia). J Bone Joint Surg 1979;61B:107-16. Crane AR, Scarano J1. Synovial cyst (ganglia) of bone. J Bone Joint Surg 1967;49A:355-6I. Feldman F, Johnston A. Intraosseous ganglion. Am J Roentgenol 1973;118:328-43. Mogan JV, Newberg AH, Davis PH. Intraosseous ganglion of the lunate. J HAND SURG 1981;6:61-3. lwahara T, Hirayama T, Takemitu Y. Intraosseous ganglion of the lunate. Hand 1983;15:297-8. Maruno H, Fujita N, Sonoda Y, Fujita H. Intraosseous ganglion of lunate. Rinsho Seikei Geka 1982;17:158-61. Pellegrino EA, Olsen JR. Bilateral carpal lunate ganglia. Clin Orthop 1972;87:225-7.
Rafael Lorente, MD, Manuel Moreno, MD, and Manuel Quiles, MD, Cordoba, Spain
Intraosseous ganglions are rare. I We recently treated a patient with bilateral lunate intraosseous ganglions. We have been able to locate reports of only eight such unilateral lesions-" and two of patients with bilateral lesions. 1,7 From the Hand Section, Orthopaedic Service, Hospital Reina Sofia, University of Cordoba, Cordoba, Spain. Received for publication May 3, 1990; accepted in revised form Jan. 20, 1992. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Rafael Lorente, MD, The Hand Section, Orthopaedic Service, Hospital Reina Sofia, Universidad de Cordoba, AvenidaMenendez Pidal sin, 14004 Cordoba, Spain. 3/1136516
Case report A 24-year-old woman had 7 months of bilateral slight wrist pain with normal activity. Physical examination showed pain only at the extremes of wrist extension and some dorsal wrist tenderness. X-ray films (Fig. I) showed well-demarcated lytic lesions with sclerotic rims on the radial margin of each lunate. Laboratory findings were normal. At operation through a dorsal approach, the lesions did not communicate with the adjacentjoints. Each lunate shell was perforated, and a yellow, gelatinous material was curetted out. It appeared similar to material seen in soft tissue ganglions. Each cavity was packed with cancellous bone from the adjacent radius. The wrists were immobilized for 4 weeks in short arm casts. Two years after surgery the patient was free of symptoms, and there was almost complete obliteration of the lesions (Fig. 2). The histologic appearance of the lesions (Fig. 3) is similar to that of soft tissue ganglions.
Fig. 1. Preoperative x-ray film showing a well-defined radiolucent lesions of the lunates. 1084
THE JOURNAL OF HAND SURGERY
Vol. 17A, No.6 November 1992
Bilateral intraosseous ganglia of lunate
1085
Fig. 2. X-ray film 2 years after surgery.
Fig. 3. Photomicrograph of cyst wall.
Discussion According to Schajowicz et aI., I the pathogenesis of this lesion is obscure. It may occur de novo in the bone, or the bone may be penetrated by an adjacent soft tissue ganglion. The lesions in our case were probably of the former type. Differential diagnosis includes enchondroma, giant cell tumor, chondroblastoma, simple bone cyst, posttraumatic cyst, fibrous development defect, Kienbock's disease, and osteoarthritis. Multiple cystic lesions may be seen in pigmented villonodular synovitis, gout, and rheumatoid arthritis. REFERENCES 1. Schajowicz F, Sainz Me, Siullitel JA. Juxta-articular bone
2. 3. 4. 5. 6. 7.
cysts (intraosseous ganglia). J Bone Joint Surg 1979;61B:107-16. Crane AR, Scarano J1. Synovial cyst (ganglia) of bone. J Bone Joint Surg 1967;49A:355-6I. Feldman F, Johnston A. Intraosseous ganglion. Am J Roentgenol 1973;118:328-43. Mogan JV, Newberg AH, Davis PH. Intraosseous ganglion of the lunate. J HAND SURG 1981;6:61-3. lwahara T, Hirayama T, Takemitu Y. Intraosseous ganglion of the lunate. Hand 1983;15:297-8. Maruno H, Fujita N, Sonoda Y, Fujita H. Intraosseous ganglion of lunate. Rinsho Seikei Geka 1982;17:158-61. Pellegrino EA, Olsen JR. Bilateral carpal lunate ganglia. Clin Orthop 1972;87:225-7.
