1. 股關節腱鞘囊腫類股疝氣- 術前診斷 Ganglion cyst of hip joint mimicking femoral hernia – preoperative diagnosis is feasible
趙玟珊, 吳誠中, 鄭紹彬
臺中榮民總醫院一般外科
Wen-Shan Chao, Shao-Bin Cheng, Cheng-Chung Wu Division of General Surgery Taichung Veterans General Hospital, Taichung, Taiwan

2. Patient Profile Chief Complaint: Present Illness:
intermittent pain over right inguinal with reducible protruding mass for one month
Present Illness:
This 65-year-old female with history of (1)left breast cancer, T2N1M0
s/p MRM on , CMFx6 and radiotherapy
According to the patient, she suffered from intermittent pain over right
inguinal with reducible protruding mass for one month. The pain exacerbated
when bending her right leg, walking, coughing and climbing the stairs.
It could relieved by hot packing and resting. She went to local hospital on 105/6/9,
where MRI was done. She went to our OPD for second opinion.
PE showed palpable reducible mass over right inguinal area.
Under impression of suspected right side femoral hernia, she was
admitted for further survey and treatment.

3. MRI T2-weighted

4. Blood Parameters

5. 105/06/22 Excisional biopsy of right inguinal tumor

6. Pathological Report

7. Introduction
ganglion cysts (GC) and synovial cysts (SC) are among the most frequently occurring benign cystic lesions in the joints.
Degenerative joint disease is the main predisposing factor, but might also be related to trauma, and connective tissue disease.

8. Imaging approach
1. Ultrasound (US): is the initial imaging method of choice, usually differentiating cystic from non- cystic ones.
2. MRI: has become the gold-standard modality
T1: typically low signal
T2: typically high signal
Spectrum of MRI features of ganglion and synovial cysts
Insights Imaging Apr; 7(2): 179–186, Nelson Neto  

9. Thank your for your attention

10. H
Ganalglion cyst arising from hip joint is rare and its presenting symptoms resembles a femoral hernia. We have reported such case 20 year ago. The preoperative diagnosis is usually difficult. However, with the improvement of imaging studiese, preoperative diagnosis of such ganglion cyst is possible. We herein reported a 56-year old patient who had history of breast cancer 13 year ago.
During cancer follow study, she was found to have a right inguinal reducible mass. Clinically, the mass was diagnosed as a right femoral hernia. However, imaging study revealed as a right hip joint ganglion cyst. The patient remains disease free for 1 year after operation.

11. 105/06/22 Operative Pictures
A soft mass with thickening fibrotic wall was about 7x5cm in size, just located at right side to femoral artery and vein, with transparence jelly-like material

12. Introduction
ganglion cysts (GC) and synovial cysts (SC) are among the most frequently occuring benign cystic lesions in the joints. Degenerative joint disease is the main predisposing factor, but they might also be related to other conditions such as trauma, rheumatoid arthritis, gout, and systemic lupus erythematosus
T1: typically ganglia are low signal although high proteinaceous content or haemorrhage may result in lesions appearing isointense or hyperintense on T1 weighted images.
T2/STIR: typically high signal

13. SCs are herniations of the synovial membrane through the capsule of a joint filled by synovial fluid, which may or may not keep a communication with the joint.
GCs lack a synovial cell lining and are constituted by a dense collagenous capsule surrounding a mucopolysaccharide-rich gelatinous fluid, similar to that of SC but at a higher concentration
SC are very likely to occur around the knee and the hip, GC are most commonly found in the distal extremities, particularly in the wrist 

14. Insights Imaging. 2016 Apr; 7(2): 179–186.
Published online 2016 Feb 24. doi:   /s z
PMCID: PMC
Spectrum of MRI features of ganglion and synovial cysts
Nelson Neto  and Pedro Nunnes
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