Advertisement

Masses That May Mimic Soft Tissue Tumors

  • Heung Sik Kang
  • Sung Hwan Hong
  • Ja-Young Choi
  • Hye Jin Yoo
Chapter

Abstract

Ganglion is a benign cystic mass containing a gelatinous fluid rich in hyaluronic acid and other mucopolysaccharides, with a fibrous capsule without synovial lining (McCarthy and McNally 2004). The mass arises from the joint capsule, ligaments, tendon sheaths, bursae, or subchondral bone (Bermejo et al. 2013). Ganglion is usually found in the periarticular soft tissues in areas under repetitive stress, with or without communication with joint spaces. Occasionally, they can occur far from a joint or even in an intramuscular location. The origin of the fluid has been postulated to arise from one of following three mechanisms. First, it may be pumped into the cyst from the joint by motion of the wrist. Second, it may result from an extra-articular degenerative process, cyst formation, and subsequent communication with the joint. Lastly, it may be the result of excessive mucin production by mesenchymal cells within the wall (Gude and Morelli 2008). Intraneural ganglion cysts are rarely found. The common peroneal nerve is most frequently involved, and other affected nerves are often located near articular spaces. The cystic lesion is located within the epineurium, causing an eccentric displacement of the nerve fascicles. The proposed pathogenesis of intraneural ganglion cyst is a dissection of synovial joint fluid into the epineurium of an articular branch nerve supplying a joint, with subsequent centripetal dissection into the parent nerve (Spinner et al. 2007a, b).

References

  1. Ahmed I, Harshad SR. Subcutaneous sarcoidosis: is it a specific subset of cutaneous sarcoidosis frequently associated with systemic disease? J Am Acad Dermatol. 2006;54(1):55–60. doi: 10.1016/j.jaad.2005.10.001.CrossRefPubMedGoogle Scholar
  2. Anderson SE, De Monaco D, Buechler U, et al. Imaging features of pseudoaneurysms of the hand in children and adults. Am J Roentgenol. 2003;180(3):659–64. doi: 10.2214/ajr.180.3.1800659.CrossRefGoogle Scholar
  3. Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E. Morton’s neuroma: is it always symptomatic? AJR Am J Roentgenol. 2000;175(3):649–53. doi: 10.2214/ajr.175.3.1750649.CrossRefPubMedGoogle Scholar
  4. Bermejo A, Bustamante TDD, Martinez A, et al. MR imaging in the evaluation of cystic-appearing soft-tissue masses of the extremities. Radiographics. 2013;33(3):833–55. doi: 10.1148/rg.333115062.CrossRefPubMedGoogle Scholar
  5. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. Am J Roentgenol. 1994;162(4):913–7. doi: 10.2214/ajr.162.4.8141017.CrossRefGoogle Scholar
  6. Chen HH, Chen YM, Lan HH, Lee CH, Chen DY. Sonographic appearance of subcutaneous sarcoidosis. J Ultrasound Med. 2009;28(6):813–6.CrossRefPubMedGoogle Scholar
  7. Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics. 2011;31(5):1365–75. doi: 10.1148/rg.315115510.CrossRefPubMedGoogle Scholar
  8. Fernandes EÁ, Santos EHS, Tucunduva TCM, AJL F, Fernandes ARC. Achilles tendon xanthoma imaging on ultrasound and magnetic resonance imaging. Rev Bras Reumatol. 2015;55(3):313–6. doi: 10.1016/j.rbre.2013.12.003.CrossRefGoogle Scholar
  9. Gude W, Morelli V. Ganglion cysts of the wrist: pathophysiology, clinical picture, and management. Curr Rev Muscoskelet Med. 2008;1(3–4):205–11. doi: 10.1007/s12178-008-9033-4.CrossRefGoogle Scholar
  10. Henrot P, Stines J, Walter F et al. Imaging of the painful lower limb stump. Radiographics. 2000;20 Suppl 1:S219–S235. doi: 10.1148/radiographics.20.suppl_1.g00oc14s219
  11. Koyama T, Ueda H, Togashi K, et al. Radiologic manifestations of sarcoidosis in various organs. Radiographics. 2004;24(1):87–104. doi: 10.1148/rg.241035076.CrossRefPubMedGoogle Scholar
  12. Kransdorf MJ, Murphey MD. Imaging of soft tissue tumors. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2014.Google Scholar
  13. Liem MSL, Leuven JAG, Bloem JL, Schipper J. Magnetic resonance imaging of Achilles tendon xanthomas in familial hypercholesterolemia. Skelet Radiol. 1992;21(7):453–7. doi: 10.1007/bf00190990.CrossRefGoogle Scholar
  14. McCarthy CL, McNally EG. The MRI appearance of cystic lesions around the knee. Skelet Radiol. 2004;33(4):187–209. doi: 10.1007/s00256-003-0741-y.CrossRefGoogle Scholar
  15. Moore SL, Teirstein AE. Musculoskeletal sarcoidosis: Spectrum of appearances at MR imaging. Radiographics. 2003;23(6):1389–99. doi: 10.1148/rg.236025172.CrossRefPubMedGoogle Scholar
  16. Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics. 1999;19(5):1253–80. doi: 10.1148/radiographics.19.5.g99se101253.CrossRefPubMedGoogle Scholar
  17. Narváez JA, Narváez J, Ortega R, et al. Hypointense synovial lesions on T2-weighted images: differential diagnosis with pathologic correlation. Am J Roentgenol. 2003;181(3):761–9. doi: 10.2214/ajr.181.3.1810761.CrossRefGoogle Scholar
  18. Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med. 1997;336(17):1224–34. doi: 10.1056/NEJM199704243361706.CrossRefPubMedGoogle Scholar
  19. Otake S. Sarcoidosis involving skeletal muscle: imaging findings and relative value of imaging procedures. Am J Roentgenol. 1994;162(2):369–75. doi: 10.2214/ajr.162.2.8310929.CrossRefGoogle Scholar
  20. Perdikakis E, Skiadas V. MRI characteristics of cysts and “cyst-like” lesions in and around the knee: what the radiologist needs to know. Insights Imaging. 2013;4(3):257–72. doi: 10.1007/s13244-013-0240-1.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Singson RD, Feldman F, Slipman CW, et al. Postamputation neuromas and other symptomatic stump abnormalities: detection with CT. Radiology. 1987;162(3):743–5. doi: 10.1148/radiology.162.3.3809488.CrossRefPubMedGoogle Scholar
  22. Spinner RJ, Amrami KK, Angius D, Wang H, Carmichael SW. Peroneal and tibial intraneural ganglia: correlation between intraepineurial compartments observed on magnetic resonance images and the potential importance of these compartments. Neurosurg Focus. 2007a;22(6):E17.PubMedGoogle Scholar
  23. Spinner RJ, Amrami KK, Wolanskyj AP, et al. Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory. J Neurosurg. 2007b;107(2):296–307. doi: 10.3171/JNS-07/08/0296.CrossRefPubMedGoogle Scholar
  24. Stacy GS, Kapur A. Mimics of bone and soft tissue neoplasms. Radiol Clin N Am. 2011;49(6):1261–86. vii doi: 10.1016/j.rcl.2011.07.009.CrossRefPubMedGoogle Scholar
  25. Sundaram M, Sharafuddin MJ. MR imaging of benign soft-tissue masses. Magn Reson Imaging Clin N Am. 1995;3(4):609–27.PubMedGoogle Scholar
  26. Torres-Claramunt R, Ginés A, Pidemunt G, Puig L, de Zabala S. MRI and ultrasonography in Morton’s neuroma: diagnostic accuracy and correlation. Indian J Orthop. 2012;46(3):321–5. doi: 10.4103/0019-5413.96390.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Torriani M, Kattapuram SV. Technical innovation. Dynamic sonography of the forefoot: the sonographic Mulder sign. AJR Am J Roentgenol. 2003;180(4):1121–3. doi: 10.2214/ajr.180.4.1801121.CrossRefPubMedGoogle Scholar
  28. Wang G, Jacobson JA, Feng FY, et al. Sonography of wrist ganglion cysts: variable and noncystic appearances. J Ultrasound Med. 2007;26(10):1323–8.CrossRefPubMedGoogle Scholar
  29. Wu JS, Hochman MG. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009;253(2):297–316. doi: 10.1148/radiol.2532081199.CrossRefPubMedGoogle Scholar
  30. Yu JS, Chung C, Recht M, Dailiana T, Jurdi R. MR imaging of tophaceous gout. Am J Roentgenol. 1997;168(2):523–7. doi: 10.2214/ajr.168.2.9016240.CrossRefGoogle Scholar
  31. Zanetti M, Strehle JK, Kundert H-P, Zollinger H, Hodler J. Morton neuroma: effect of MR imaging findings on diagnostic thinking and therapeutic decisions. Radiology. 1999;213(2):583–8. doi: 10.1148/radiology.213.2.r99nv06583.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  • Heung Sik Kang
    • 1
  • Sung Hwan Hong
    • 2
  • Ja-Young Choi
    • 3
  • Hye Jin Yoo
    • 3
  1. 1.Department of RadiologySeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnamKorea, Republic of (South Korea)
  2. 2.Department of RadiologySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea, Republic of (South Korea)
  3. 3.Department of RadiologySeoul National University HospitalSeoulKorea, Republic of (South Korea)

Personalised recommendations