PMC6195920_01
Ultrasound image of the knee showing multiple loculated cystic lesions involving the subcutaneous planes and the popliteal fossa with diffuse internal echoes and septations. No internal vascularity is seen.
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An ultrasound of the knee joint showed multiple loculated cystic lesions involving the subcutaneous planes and the popliteal fossa with diffuse internal echoes (Figure 1).
Coronal T
2 MRI of bilateral knees showing multiloculated cystic lesions with intra- and extra-articular components.
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It was suggested that she undergo an MRI of the knee for further evaluation, which showed multiloculated cystic lesions that were hypointense on T 1 weighted and hyperintense on T 2 weighted sequences around the knee joint with intra- and extra-articular components (Figures 2 and 3), and subcutaneous extension insinuating between the tendons, muscles and popliteal vessels (Figure 4).
Coronal T
1 MRI of bilateral knees showing multiloculated hypointense (cystic) lesions with intra- and extra-articular components.
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It was suggested that she undergo an MRI of the knee for further evaluation, which showed multiloculated cystic lesions that were hypointense on T 1 weighted and hyperintense on T 2 weighted sequences around the knee joint with intra- and extra-articular components (Figures 2 and 3), and subcutaneous extension insinuating between the tendons, muscles and popliteal vessels (Figure 4).
Axial T
2 MRI of bilateral knees showing hyperintense lesions insinuating between the tendons and muscles, and also demonstrating an intra-articular component.
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It was suggested that she undergo an MRI of the knee for further evaluation, which showed multiloculated cystic lesions that were hypointense on T 1 weighted and hyperintense on T 2 weighted sequences around the knee joint with intra- and extra-articular components (Figures 2 and 3), and subcutaneous extension insinuating between the tendons, muscles and popliteal vessels (Figure 4).
Sagittal short tau inversion-recovery MRI of the knee showing involvement of Hoffa's fat pad and the femoral intraosseous component.
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A similar small lesion was seen at the non-weight-bearing surface of the lateral condyle of the femur, suggestive of an intraosseous lesion (Figure 5). Hoffa's fat pad was involved (Figure 5).
Short tau inversion-recovery MRI showing a cystic lesion involving the lateral aspect of the wrist (along the abductor pollicis longus and the extensor pollicis brevis).
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Similar cystic lesions were found around the right knee joint, right wrist, abductor pollicis longus, extensor pollicis brevis (Figure 6) and overlying the ring finger, in the flexor tendon at the proximal phalanx of ring finger (Figure 7).
Coronal short tau inversion-recovery MRI of the right hand showing a hyperintense cystic lesion along the flexor tendon at the proximal phalanx of the ring finger.
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Similar cystic lesions were found around the right knee joint, right wrist, abductor pollicis longus, extensor pollicis brevis (Figure 6) and overlying the ring finger, in the flexor tendon at the proximal phalanx of ring finger (Figure 7).
Coronal short tau inversion-recovery MRI of the right hand showing a hyperintense cystic lesion within the capitate and the lunate.
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Intraosseous involvement of the capitate and lunate were noted (Figure 8).
Haematoxylin and eosin-stained slides (a, 10x;b, 40x) showing a cystic lesion lined by a single layer of synoviocytes. The cyst wall is thick and made of dense fibrocollagenous stroma with sparse lymphocytic infiltration. The lumen shows myxoid material, confirming a ganglion cyst.
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Also, biopsy of the lesion confirmed the diagnosis of a ganglion cyst (as described in Figure 9a,b).