Histopathological Findings of Hemorrhagic Ganglion Cyst Causing Acute Radicular Pain: A Case Report

Abstract

Although juxtafacet cysts of the lumbar spine are being reported with increasing frequency, hemorrhage from a ganglion cyst is rare, and the pathophysiologic mechanism of the hemorrhage from the cyst is still unclear. A 75-year-old male presented with sudden radicular leg pain caused by hemorrhage from the ganglion cyst. Computed tomography revealed bony erosion of vertebral body and multiple punched-out lesions on facets. Magnetic resonance imaging showed the neural structure was compressed by a sharply delineating mass. Capsule and old hematoma with elastic consistency that extended to the epidural space were removed through a paramedian transforaminal approach, which led to the resolution of the patient's symptoms. Histopathologically, chronic inflammation with neovascularization and myxoid degeneration were present in the capsule. Alcian blue staining demonstrated the mixture of mucin and hematoma. The probable pathogenesis of hemorrhage from the cyst was discussed from the unique histopathological findings of surgical specimen.

Successful treatment of lumbar ligamentum flavum hematoma using a spinal full-endoscopic system

“…Myxoid degeneration is not a rare degenerative change of ligamentum flavum (4,17), and similar hemorrhagic ganglion cysts without a synovial layer have been reported previously (11,18). In contrast, the presence of myxoid degeneration may be a coincidental finding in elderly LFH patients because both LFH and ganglion cysts usually occur in elderly patients (2,18,19). Similarly, we also observed other degenerative changes of ligamentum flavum (hyalinization, calcification, and fibrous cartilage) in the same pathological specimens; thus, myxoid degeneration of the surrounding hematoma should be considered to be one of the alterations due to aging of the ligamentum flavum (4).…”

“…1, 2, and 5), LFH might have a greater association with a ganglion cyst rather than a synovial cyst. Myxoid degeneration is not a rare degenerative change of ligamentum flavum (4,17), and similar hemorrhagic ganglion cysts without a synovial layer have been reported previously (11,18). In contrast, the presence of myxoid degeneration may be a coincidental finding in elderly LFH patients because both LFH and ganglion cysts usually occur in elderly patients (2,18,19).…”

The Cause of Foot-Drop in a Patient with Ganglion Cyst in Lumbar Region: A Case Report

“…They are generally asymptomatic. On the other hand it may cause sciatica or lower extremity weakness symptoms when it compromise the surrounding thecal sac or nerve roots on the spine [2]. We report a case with ganglion cyst which is the cause of the foot-drop with radiological and pathological findings..…”

“…Trauma and segmental instability may also play a major role in formation of the ganglion cyst [5]. The ganglion cysts are more common in the lumbar region than the cervical and thoracal regions [2]. They are often located on the dorsal portion of the facet being usually asymptomatic.…”

“…But surgical treatment is recommended if it gives rise to motor deficit or intractable pain [4,2]. To our knowledge, this is the first report, being the cause of foot-drop in a patient with ganglion cyst without any bleeding in the spine.…”