Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection:A case report and review of the literature

A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection(ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel(antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors' knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking antiplatelet medications.     

Hemorrhagic colloid cyst: case report and review of the literature

Colloid cysts are benign tumors situated in and connected to the roof of the third ventricle. The clinical presentation is diverse, varying from incidentally found cysts to acute death. This presentation is explained by an acute hydrocephalus due to an obstruction of the cerebrospinal fluid (CSF) flow at the level of the foramina of Monro. Why these lesions cause a sudden obstruction is not clear in most cases. Possible explanations of a sudden deterioration are shifts of the cysts after lumbar puncture or CSF flow obstruction after shunt dysfunction. We add an explanation for the acute deterioration of patients with colloid cysts (ie, hemorrhagic changes in the cysts). This complication has been published only 4 times before, all diagnosed at postmortem examination. A young patient is presented with a recently diagnosed and symptomatic colloid cyst who deteriorated the night before surgery because of intracystic hemorrhage. Despite emergent CSF diversion, our patient remained in a poor clinical condition. We review the literature about this topic and discuss the consequences for the neurosurgical practice.     

Symptomatic lumbar intraspinal synovial cyst: a case report

Synovial and ganglion cysts, also known as juxta-facet cysts, are intraspinal lesions that may mimic disc herniations and cause radicular symptoms. A 75-year-old male patient presented with a 6-month history of left leg pain and numbness in the foot that increased in severity within the past week. Physical examination showed motor deficit of the left extensor hallucis longus muscle (4/5) and hypoesthesia on the left L4-5 dermatomes. Magnetic resonance imaging revealed an intraspinal cyst originating from the L4-5 facet joint. Medial facetectomy and cyst excision were performed, which provided immediate relief of pain. He had no loss of strength of the extensor hallucis longus muscle and his neurologic examination was normal during the first postoperative year.     

Myelopathy induced by a thoracic intraspinal synovial cyst: case report and review of the literature

STUDY DESIGN: A follow-up study of a patient with myelopathy resulting from a thoracic intraspinal synovial cyst was conducted. OBJECTIVE: To present this unusual form of myelopathy, and to highlight this unique condition by a literature review. SUMMARY OF BACKGROUND DATA: Intraspinal synovial cysts are quite common in the lumbar spine, but much rarer in the thoracic spine, where they may produce myelopathy from spinal cord compression. The reported patient presented with a lumbar degenerative spondylolisthesis, but actually was symptomatic from a thoracic synovial cyst. METHODS: Clinical and radiographic details of a patient with a thoracic intraspinal synovial cyst are presented. A complete literature review also summarizes previously published material on this topic. RESULTS: The thoracic intraspinal synovial cyst was appropriately identified on a magnetic resonance image examination. The patient underwent successful thoracic spinal cord decompression with stabilization and fusion. The myelopathy resolved postoperatively. CONCLUSIONS: The possibility of a thoracic synovial cyst should be considered in the evaluation of pain associated with myelopathy.     

Ligamentum flavum cyst in the lumbar spine: a case report and review of the literature

Degenerative changes in the lumbar spine can be followed by cystic changes. Most reported intraspinal cysts are ganglion or synovial cysts. Ligamentum flavum pseudocyst, as a cystic lesion in the lumbar spine, is a rare and unusual cause of neurologic signs and symptoms and is usually seen in elderly persons (due to degenerative changes). They are preferentially located in the lower lumbar region, while cervical localization is rare. Complete removal of the cyst leads to excellent results and seems to preclude recurrence. We report the case of a right-sided ligamentum flavum cyst occurring at L3–L4 level in a 70-year-old woman, which was surgically removed with excellent postoperative results and complete resolution of symptoms. In addition, we discuss and review reports in the literature.     

Hemorrhagic lumbar juxta facet cyst. A case report

We report the case of a hemorrhagic lumbar juxta facet cyst (L2-L3), revealed by a chronic right lumbocruralgia, in a 77-year-old woman treated by anticoagulants for cardiac arrhythmia. Computerized tomography and magnetic resonance imaging suggested the diagnosis of benign tumor. During surgical removal of the whole lesion, a hemorrhagic synovial cyst was evoked. The operation dramatically relieved the symptoms. The diagnosis was confirmed by the histopathological analysis confronted with the clinical and the radiological findings. This uncommon observation allows the discussion of the pathogenic mechanism and of the differential diagnosis.     

Pericardial synovial sarcoma: a case report and review of the literature

Primary pericardial synovial sarcoma is a rare disease. We herein report a case of synovial sarcoma that originated in the epicardium. A 13-year-old male visited our hospital with a fever and chest pain. Copious pericardial effusion and a large intrapericardial tumor were detected. An open-chest tumor resection was performed. A solid nodular tumor was observed in the pericardial cavity. The tumor was a polypoid mass that was pedunculated and grew from the inner surface of the pericardium near the origin of the SVC and ascending aorta. Histologically, the tumor cells were uniformly spindle shaped, with an ovoid or oval nucleus, and formed solid, compact sheets and fascicles. A storiform pattern was also observed. Based on the histopathological and immunohistochemical findings, and the fluorescence in situ hybridization detection of rearrangement of the SYT gene, a monophasic synovial sarcoma was diagnosed. We discuss the diagnosis and treatment of this case and review the pertinent literature.     

原发性肾滑膜肉瘤一例报告并文献复习

目的探讨原发性肾滑膜肉瘤的临床特点及诊治方法。 方法回顾性分析我院原发性肾滑膜肉瘤1例的临床资料,并对国内外相关文献进行回顾。 结果患者接受根治性左肾切除术,术后病理回报为原发性肾滑膜肉瘤。 结论原发性肾滑膜肉瘤非常罕见,无特异性临床特点及影像表现,诊断主要依靠病理及免疫组化,SYT-SSX融合基因有提示作用,主要治疗方案为手术,化疗对生存率的影响还需进一步研究。     

Hemorrhagic prepatellar bursitis: a rare case report and review of the literature

Bursitis is a common cause of lower extremity pain in patients presenting to primary care physicians. However hemorrhagic prepatellar bursitis is considered to be one of the rare differential diagnoses of swellings around the knee and its diagnosis both clinically and radiologically can be difficult. We present a rare case report of a 50-year-old female patient with complaints of swelling and pain over her right knee for past one year. An initial diagnosis of prepatellar bursitis was made and aspiration of the swelling was done which revealed blood. After further investigations a final diagnosis of hemorrhagic prepatellar bursitis was made which was treated with complete excision and the patient was completely relieved of her symptoms.     

Retroperitoneal bronchogenic cyst: a case report and review of the literature

This unusual clinical case adds itself to the limited list of existing reports of retroperitoneal bronchogenic cysts in the international literature. It emphasizes the difficulties encountered in making a preoperative diagnosis, since these lesions can be described as both solid and cystic masses. A 69-year-old man underwent surgery to remove an expanding mass diagnosed as originating in the adrenal gland and discovered during clinical investigation for other indications. The lesion was excised only after adrenalectomy whereupon its cystic nature was revealed. Retroperitoneal bronchogenic cysts, though rare, should be considered in the differential diagnosis of retroperitoneal expanding lesions, especially in the presence of cystic tumours of the left adrenal region. This is the first case of a retroperitoneal bronchogenic cyst reported in an adult in Italy.     

Midline lumbar ganglion/synovial cyst mimicking an epidural tumor: case report and review of pathogenesis

A case of a midline lumbar extradural ganglion/synovial cyst causing lumbar canal stenosis and mimicking an epidural tumor is presented. The lesion was demonstrated by a magnetic resonance imaging study, and relief of symptoms was achieved with decompressive laminectomy and total removal of the mass. The pathogenesis of lumbar ganglion/synovial cyst is reviewed.     

Cervical synovial cysts: case report and review of the literature

The authors describe the case of a 58-year-old man with a 6-month history of severe myelopathy. CT scan and MRI of the spine revealed a cystic formation, measuring about 1 cm in diameter, at C7-T1 at a right posterolateral site at the level of the articular facet. At operation the mass appeared to originate from the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. Once the mass had been removed, there was a significant amelioration of the patient’s symptoms. As previously suspected, histological aspect was synovial cyst. Cervical synovial cysts are extremely rare and, as far as we know, only 22 cases have so far been described in the literature. Diagnostic radiological investigations used were CT scan and MRI. At CT scan the most important diagnostic findings are a posterolateral juxtafacet location of the mass, egg-shell calcifications on the wall of the cyst, and air inside the cyst. At MRI the contents of the cyst are iso/hypointense on T1- and hyperintense on T2-weighted images. There may also be a hypointense rim on T2-weighted images, which enhances after i.v. administration of gadolinium. Surgical treatment consists of removal of the mass. Fixation of the vertebral segments involved is not always necessary. Received: 12 January 1998 Revised: 17 September 1998 Accepted: 19 October 1998     

Congenital sublingual teratoid cyst: a case report and literature review

Head and neck dermoid cysts comprise less than 10% of all dermoid cysts. The sublingual location is very rare. One hypothesis for their etiology is that they arise from entrapment of epithelial debris or rests during the midline fusion of the first 2 branchial arches. They are classified as epidermoid, dermoid, and teratoid cysts. Sublingual cysts are slow-growing lesions generally seen in the second and third decades of life. They are rare in childhood. The cysts may interfere with swallowing and breathing. Rarely, they may show malignant transformation. Surgical extirpation is the treatment of choice.     

肾原发性滑膜肉瘤1例报告及文献复习

目的提高对肾原发性滑膜肉瘤的诊治水平。方法回顾性分析1例晚期肾原发性滑膜肉瘤的诊治经过,并报告采用索拉非尼治疗其肺转移灶的经验。结果本例临床和影像学表现无特异性,患肾切除术后常规病理检查误诊为肾母细胞瘤,经免疫组化检查及联合病理会诊,确诊为肾原发性滑膜肉瘤(梭形细胞型)。采用依托泊苷、异环磷酰胺、顺铂化疗联合索拉非尼靶向药物治疗其肺部转移灶,获得部分缓解,但索拉非尼单药治疗及免疫治疗效果不佳。疾病控制期为6个月,生存期11个月。结论肾原发性滑膜肉瘤诊断困难,对肿瘤标本进行免疫组化或分子学分析方可确诊。一旦发生转移,预后不佳,联合采用以高剂量异环磷酰胺为基础的化疗和索拉非尼靶向药物治疗可能获得一定疗效。