Synovial cysts of the lumbar spine: Diagnosis, surgical management, and pathogenesis

IntroductionSynovial cysts are cystic dilatations of the synovial sheaths; they are bordered not only by the connectival tissue structures of these sheaths but also by the mono-or pluri-stratified cuboid synovial epithelium. Anatomical continuity with the synovial sheaths of the joint cavities from which the cyst probably originates may not always be observed.While synovial cysts are quite a frequent occurrence in joints and tendon sheaths [3,10,23], especially in the joints of the hands and wrists [45], they are very rare in the spine [13,18,25,40,47,62]. In the lumbar spine 220 cases have been described [1,2,16,21,28,34,38,40,43,45,48,51,[54][55][56]60].The incidence of synovial cysts with a cervical location was evaluated, with reference to veterinary literature too [15], and was found to be an occurrence specific to humans, of which, to our knowledge, only 22 cases have been reported to date.We describe another case of cervical synovial cyst and discuss the pathological, etiopathogenetic, and clinical aspects of this rare pathology. Case reportA 58-year-old man was referred to us with a progressive spastic paraparesis, which had started 8 months earlier. About 2 months prior to admission, he had begun to suffer from genital-sphincteric ailments such as urinary retention and difficult erection.Examination revealed a severe motor deficit in the lower limbs (he was able to raise his legs while lying in bed for a few seconds only), as well as an increased response to knee and ankle jerks. There was superficial and deep hypoesthesia below C8 and apallesthesia below the iliac crests. There was also urinary retention, which required catheterization. AbstractThe 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.

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“…In the lumbar spine 220 cases have been described [1,2,16,21,28,34,38,40,43,45,48,51,[54][55][56]60].…”

Section: Introductionmentioning

confidence: 99%

Cervical synovial cysts: case report and review of the literature

Lunardi

Acqui

Ricci

et al. 1999

European Spine Journal

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“…Treatment of synovial cysts usually consists of surgical resection, percutaneous injection, [3] aspiration [1] and immobilisation using a brace [13,15]. Surgery is a safe and effective treatment for patients with lumbar synovial cysts and is the treatment of choice for such lesions [20]. However, a few reports have described a dramatic decrease in the size of synovial cyst and even complete disappearance during the operation, compared with its appearance on initial MR images [9,12,14].…”

Section: Yasuhisa Maezawa Hisatoshi Baba Kenzo Uchida Nobuaki Furusawmentioning

confidence: 99%

“…Based on the MRI features, [9,13,15,17,20], a synovial cyst is defined as a smooth, extradural, well-circumscribed, cystic mass arising adjacent to the facet joint. Synovial cysts without haemorrhage appear isointense, or slightly hyperintense, relative to the cerebrospinal fluid on T1-weighted images, due to the high protein content within the cyst.…”

Section: Yasuhisa Maezawa Hisatoshi Baba Kenzo Uchida Nobuaki Furusawmentioning

confidence: 99%

“…[9,13,15,17,20]. These cysts are usually associated with osteoarthritis of the adjacent facet joint, degenerative spondylosis and/or spondylolisthesis, particularly in middle aged or elderly patients.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of such cysts require surgical resection due to persistent radicular symptom and/or occasional pareses. [2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. We report an unusual young patient in whom a symptomatic intraspinal juxta-articular cyst showed spontaneous remission through cessation of sport activity and immobilisation of the lumbar spine.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous remission of a solitary intraspinal synovial cyst of the lumbar spine

Maezawa

Baba

Uchida

et al. 2000

European Spine Journal

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Sheep stromal‐epithelial cell interactions and ovarian tumor progression

Wang-Johanning

Huang

Liu

et al. 2007

Intl Journal of Cancer

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Previous studies suggest that underlying ovarian stromal cues may regulate the ovarian surface epithelium. However, little is known about the interaction between ovarian stromal cells (OSC) and ovarian surface epithelial cells (OSE) under normal physiologic and pathologic conditions, largely because of the lack of a suitable model. In the current study, the OSC obtained from a sheep were immortalized with SV-40 T/t antigen (designated IOSC) and telomerase reverse transcriptase (designated IOSCH), followed by transfection with the oncogenic allele of the human HRas oncogene (designated IOSChR 1 Approximately 22,420 new cases and 15,280 deaths will occur in 2007, and the overall 5-year survival rate is 45%. If diagnosed while still localized, the 5-year survival rate increases to 94%.2 Unfortunately, many ovarian tumors remain asymptomatic until an advanced stage, and only 19% of OCs are diagnosed while still confined to the ovary. 1 OC can arise from any cell type of the ovary, including germ cells, granulosa or stromal cells; however, 90% of all OCs are epithelial and derived from a single cell layer of relatively pluripotent cells covering the surface of the ovary.3 Although the tumors derive from epithelial cells, their stromal cell component actively interacts with the tumor epithelium to support tumor progression.4 Stromal cell-epithelial cell interactions are important for tumor development, growth, angiogenesis and metastasis of many cancers including OC. 5,6 Unfortunately, few in vivo models for studying the role of ovarian stroma in the development of OC have been established. Although models that employ carcinogens have been used to induce ovarian tumorigenesis, animals rarely develop ovarian tumors spontaneously.7 Transgenic mouse models expressing promoters that drive expression of oncogenes in the ovarian surface epithelium have been developed recently to model OC. 8 Transfection of oncogenic viruses that cause human cancers into normal cells produces cell lines capable of inducing cancer in animal models. These oncogenes include the large T antigen of simian virus 40, the adenovirus E1A and E1B proteins and the E6 and E7 proteins of certain human papillomaviruses. 9 All of these viral proteins can bind to and inactivate the pRB and p53 tumor suppressor proteins. [10][11][12] The coexpression of SV40 large T antigen and an oncogenic allele of the H-Ras gene in rodent fibroblasts results in transformation of the fibroblasts to cells capable of forming tumors. Conversely, similar attempts to transform normal human cells do not generally result in a transformed, tumorigenic cell phenotype 13 The gene encoding the catalytic subunit of human telomerase (hTERT) 14 combined with the SV40 early region 9 yielded immortalized human fibroblasts, kidney epithelial cells, and human mammary epithelial cells.15 Subsequently, these immortalized cells acquired a tumorigenic phenotype upon introduction of the H-Ras oncogene. 16Multiple reports have shown that stromal cells are capable of regulating epithelial cell gro...

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Synovial cysts of the lumbar spine: Diagnosis, surgical management, and pathogenesis

Cited by 108 publications

References 11 publications

Cervical synovial cysts: case report and review of the literature

Cervical synovial cysts: case report and review of the literature

Spontaneous remission of a solitary intraspinal synovial cyst of the lumbar spine

Sheep stromal‐epithelial cell interactions and ovarian tumor progression

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