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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 17  |  Issue : 1  |  Page : 44-45

First report of a ganglion cyst of the short head of the biceps femoris: A rare presentation


1 Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India
2 Department of Medicine, INHS Kalyani, Visakhapatnam, Andhra Pradesh, India

Date of Submission27-Dec-2019
Date of Acceptance17-Jan-2020
Date of Web Publication17-Mar-2020

Correspondence Address:
Reddy Ravikanth
Department of Radiology, Holy Family Hospital, Thodupuzha - 685 605, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_82_19

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  Abstract 


This is the first report of a ganglion cyst arising from the short head of the biceps femoris tendon. Intratendinous ganglion cyst is a very rare lesion with an unknown etiology that originates within the tendon. We encountered a case of a 30-year-old female who complained of persistent pain for 2 months in the proximal anterolateral part of the leg. An intratendinous ganglion cyst in the semimembranosus tendon of the short head of the biceps femoris was diagnosed and located by ultrasound. Three months after surgical excision, there we encountered no recurrence. We describe this case with a review of the relevant literature.

Keywords: Intratendinous ganglion, short head of biceps femoris, ultrasound


How to cite this article:
Ravikanth R, Majumdar P. First report of a ganglion cyst of the short head of the biceps femoris: A rare presentation. Apollo Med 2020;17:44-5

How to cite this URL:
Ravikanth R, Majumdar P. First report of a ganglion cyst of the short head of the biceps femoris: A rare presentation. Apollo Med [serial online] 2020 [cited 2020 Mar 29];17:44-5. Available from: http://www.apollomedicine.org/text.asp?2020/17/1/44/280923




  Introduction Top


A ganglion cyst is a common tumor-like lesion arising from various soft tissues that are generated by mucoid degeneration of the joint capsule, tendon, or tendon sheath. It can occur in any part of the extremities, including the hand, wrist, and foot. However, an intratendinous ganglion cyst is an uncommon lesion that originates within the tendon substance itself and causes soft-tissue swelling. Intratendinous ganglion cysts are difficult to diagnose clinically before the surgery and to excise completely. Ultrasound and magnetic resonance imaging (MRI) can differentiate a ganglion cyst from other soft-tissue tumors and tumor-like lesions, and provide excellent information on the location of an intratendinous lesion. To the best of our knowledge, this is the first report of a ganglion cyst arising from the short head of the biceps femoris tendon itself.


  Case Report Top


A 30-year-old female patient with complaints of persistent pain for 2 months in the proximal anterolateral part of the right leg, distal to the knee joint with no sensory, motor, or functional impairment. Radiograph of the knee joint revealed no abnormality. Subsequently, the patient was referred for ultrasonography (USG) which revealed a well-circumscribed cystic anechoic lesion measuring 8 mm × 6 mm at the insertional site of the short head of the biceps femoris onto the fibular head [Figure 1]a. Histopathological examination confirmed the ganglion cyst demonstrating multiple cystic chambers with no specialized lining [Figure 1]b.
Figure 1: (a) Ultrasonography image demonstrating a well-circumscribed cystic anechoic lesion (star) suggesting the diagnosis of a ganglion cyst at the insertional site of the short head of the biceps femoris onto the fibular head. (b) HPE image demonstrating ganglion cyst with multiple cystic chambers with no specialized lining (H and E, ×4)

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  Discussion Top


Ganglion cysts are cystic lesions located adjacent to a tendon sheath or joint capsule. However, they may occur within tendons and muscles of the upper and lower extremities and also menisci of the knee joint.[1] Intratendinous ganglion cysts have a rare incidence, though majority commonly arise from the tendon sheaths.[2] Ganglion cysts are named according to the tendon sheath, joint, bone, or site of origin.[3] The first report of an intratendinous ganglion cyst located over the dorsum of the hand arising within the common extensor tendon to the middle finger was given by Lece´ne.[4] Intratendinous ganglion cysts of the lower extremity are very rare and have been reported in semimembranosus tendon, the quadriceps femoris tendon, the tendons of peroneus longus and peroneus tertius, and extensor digitorum longus tendon.[5]

Ganglia are myxoid lesions of unknown cause characterized by dense connective tissue rich in hyaluronic acid (mucopolysaccharides). Unlike synovial cysts which communicate with the joint space, ganglia lack cellular lining and have no communication. Based on imaging, however, it is difficult (or impossible) to distinguish ganglia from synovial cysts as both appear hypointense on T1-weighted images and hyperintense on T2-weighted images. However, ganglia may demonstrate rim enhancement. They classically lack solid internal enhancement, though small multi-septated ganglia can simulate this appearance. Moreover, long-standing ganglia can cause pressure erosions in the adjacent bone, mimicking an aggressive process. Noninvasive imaging modalities such as USG and MRI have a high sensitivity and specificity in diagnosing intratendinous ganglion cysts and also help delineate their relationship with the adjacent anatomical structures.

Ganglia around the knee can occur at any tendon insertion, but most commonly involve the popliteus and the heads of gastrocnemius.[6] Gastrocnemius ganglia are more common at the medial head and often multiseptated.[7] Ganglia can be painful if large; although, a major concern is mistaking one for a soft-tissue tumor. Popliteus tendon ganglia often arise near their insertion onto the lateral femoral condyle and are usually asymptomatic. They may be mistaken for parameniscal cysts, and large ganglia can be painful. Intra-articular ganglia can be associated with the cruciate ligaments. Increased T2 signal can be seen as a discrete focus of fluid or a more diffuse abnormality of “mucoid degeneration.”


  Conclusion Top


Intratendinous ganglion cysts are relatively uncommon lesions, and this case letter describes the USG diagnosis at a rare location arising from the short head of the biceps femoris. Further, the early diagnosis of the ganglion cyst using USG can help initiate early treatment strategies.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ikeda K, Tomita K, Matsumoto H. Intratendinous ganglion in the extensor tendon of a finger: A case report. J Orthop Surg (Hong Kong) 2001;9:63-5.  Back to cited text no. 1
    
2.
Steiner E, Steinbach LS, Schnarkowski P, Tirman PF, Genant HK. Ganglia and cysts around joints. Radiol Clin North Am 1996;34:395-425, xi-xii.  Back to cited text no. 2
    
3.
Rayan GM. Intratendinous ganglion. A case report. Orthop Rev 1989;18:449-51.  Back to cited text no. 3
    
4.
Lece´ne MP. Three cases of pseudocystic gelatinous degeneration of juxta-articular connective tissue and tendon tissue. Bull Mem Soc Nat Chir 1927;53:2.  Back to cited text no. 4
    
5.
Rozbruch SR, Chang V, Bohne WH, Deland JT. Ganglion cysts of the lower extremity: An analysis of 54 cases and review of the literature. Orthopedics 1998;21:141-8.  Back to cited text no. 5
    
6.
Beaman FD, Peterson JJ. MR imaging of cysts, ganglia, and bursae about the knee. Magn Reson Imaging Clin N Am 2007;15:39-52.  Back to cited text no. 6
    
7.
Nicholson LT, Freedman HL. Intramuscular dissection of a large ganglion cyst into the gastrocnemius muscle. Orthopedics 2012;35:e1122-4.  Back to cited text no. 7
    


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