Ganglion cyst - Foot and Ankle

Summary
Description

The origin of ganglion cysts is unclear but they are commonly associated with degenerative conditions of soft tissue or bone. They may occur adjacent to joints, tendons, fascial planes, and within bone.

Brief description of the xray
When these lesions occur near a joint, there is often osteoarthritis seen on the xray.
Brief desc of tx
Once confirmed, the cyst may be treated with aspiration and injection with cortisone, which should lead to resolution in about half the cases.
Tumor Name
ganglion cyst - foot and ankle
Tumor Type
Tumors of the Foot and Ankle
Benign or Malignant
Benign
Body region
ankle and foot, leg
Most Common Bones
multiple bones
Complete Information on this Tumor
Introduction and Definition

The origin of ganglion cysts is unclear but they are commonly associated with degenerative conditions of soft tissue or bone. They may occur adjacent to joints, tendons, fascial planes, and within bone.

Symptoms and Presentation

Most ganglion cysts can be definitively diagnosed based on a careful history and physical examination. By history the lesion has a tendency to both increase and decrease in size over time. On exam, ganglion cyst typically has superficial location, and may be adjacent to a joint. When these lesions occur near a joint, there is often osteoarthritis seen on the xray. The mass is soft when the nearby joint is relaxed, and becomes firm when the nearby joint or muscle is tensed. A pen light or a small laser pointer will transilluminate the cyst.

X-Ray Appearance and Advanced Imaging Findings
When these lesions occur near a joint, there is often osteoarthritis seen on the xray. An MRI should be obtained to further delineate the mass. Ganglion cyst has a characteristic MRI appearance. The lesion is well-defined, lobular and homogeneous, with low signal intensity on T1 sequences and high signal intensity on T2 sequences typical of water or fluid.
Preferred Biopsy Technique for this Tumor
If the initial assessment yields the expected results, one attempt at aspiration with a large bore needle should be performed. Aspiration of the characteristic clear viscous material from the mass confirms the diagnosis. If the characteristic fluid is not obtained, no further attempts should be made.
Treatment Options for this Tumor
Once confirmed, the cyst may be treated with aspiration and injection with cortisone, which should lead to resolution in about half the cases. Surgical removal is indicated for persistent, large or troublesome cysts. The mass should explored and the origin of the cyst and the stalk identified, if possible. A portion of the joint capsule and the stalk should be excised in continuity with the mass. Loupe magnification and tourniquet hemostasis will assist in visualization of the stalk and may decrease the risk of recurrence.
Outcomes of Treatment and Prognosis
Approximately 10% of these cysts recur following surgery.