Letter to the Editor
An Uncommon Presentation: 66 Year-Old Woman with a Tumor-Like Medial Meniscal Cyst - a Case Report
Giovannini Cesar Figueiredo, Evânia Claudino Queiroga de Figueiredo, Ericsson Albuquerque Marques
State University of Paraíba, Orthopedic Clinics - Campina Grande/PB, Brazil
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Fr, flexor retinaculum; HE, hypothenar eminence; Ma, median artery; Mn, median nerve; RA, radial artery; TE, thenar eminence; UA, ulnar artery; 1 & 2, common palmar digital arteries originating from the ulnar artery; 3, common palmar digital arteries originating from the superficial palmar arch; 4, arteria radialis indicis; 5, proper palmar digital artery to the radial side of the index finger. Note that the black arrows indicate the superficial palmar arch.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Soubhagya R. Nayak, Ashwin Krishnamurthy, Lakshmi Ramanathan, Latha V. Prabhu" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Soubhagya R." "apellidos" => "Nayak" ] 1 => array:2 [ "nombre" => "Ashwin" "apellidos" => "Krishnamurthy" ] 2 => array:2 [ "nombre" => "Lakshmi" "apellidos" => "Ramanathan" ] 3 => array:2 [ "nombre" => "Latha V." "apellidos" => "Prabhu" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222028071?idApp=UINPBA00004N" "url" => "/18075932/0000006300000003/v1_202212060912/S1807593222028071/v1_202212060912/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "An Uncommon Presentation: 66 Year-Old Woman with a Tumor-Like Medial Meniscal Cyst - a Case Report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "411" "paginaFinal" => "413" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Giovannini Cesar Figueiredo, Evânia Claudino Queiroga de Figueiredo, Ericsson Albuquerque Marques" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Giovannini Cesar" "apellidos" => "Figueiredo" "email" => array:1 [ 0 => "giocesar@uol.com.br" ] ] 1 => array:2 [ "nombre" => "Evânia Claudino Queiroga" "apellidos" => "de Figueiredo" ] 2 => array:2 [ "nombre" => "Ericsson Albuquerque" "apellidos" => "Marques" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "State University of Paraíba, Orthopedic Clinics - Campina Grande/PB, Brazil" "identificador" => "af1" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig6" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 599 "Ancho" => 993 "Tamanyo" => 172093 ] ] "descripcion" => array:1 [ "en" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Resected cyst with medial meniscus</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Meniscal cysts are well-defined and documented lesions that were first reported by Nicaise in 1883 (according to Kurian, 2003)<a class="elsevierStyleCrossRef" href="#bib1">1</a> and are located adjacent to the peripheral margin of the meniscus. They are almost always associated with a meniscal tear.<a class="elsevierStyleCrossRef" href="#bib2">2</a> Even though Barrie<a class="elsevierStyleCrossRef" href="#bib3">3</a> reported meniscal cysts in up to 7% of patients undergoing meniscectomy, others have stated that the true prevalence is probably about 1% of patients who undergo meniscectomy<a class="elsevierStyleCrossRef" href="#bib4">4</a>. In addition, while some authors have advocated that lateral meniscal cysts are three to ten times more common than medial cysts<a class="elsevierStyleCrossRef" href="#bib5">5</a>, others have stated that medial cysts are more frequent<span class="elsevierStyleSup">6;7</span>. Meniscal cysts are most often seen in young adults and occur more frequently in men than women.<a class="elsevierStyleCrossRef" href="#bib8">8</a></p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">CASE REPORT</span><p id="para20" class="elsevierStylePara elsevierViewall">A 66-year-old woman had a history of mild pain in the left knee that had increased in severity over six months. There was no history of trauma. On examination, the patient had pain in the medial aspect of the joint line, with focal tissue swelling on the medial aspect of the knee. The swelling was large (<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>) and painful, but the knee did not lock or give way. On physical examination, a consistent and large, orange-sized mass could be seen and palped. Lachman’s, McMurray’s, and Apley’s tests were negative, and the range of motion was 0 - 110º. Magnetic resonance showed that the mass was multi-lobulated with thin septations and surrounded the medial collateral ligament (<a class="elsevierStyleCrossRef" href="#fig2">Figures 2</a>, <a class="elsevierStyleCrossRef" href="#fig3">3</a>, <a class="elsevierStyleCrossRef" href="#fig4">4</a>). Through a medial arthrotomy (<a class="elsevierStyleCrossRef" href="#fig5">Figure 5</a>), the cyst was excised intact with its correspondent meniscus (<a class="elsevierStyleCrossRef" href="#fig6">Figure 6</a>). The specimen measured 50 x 40 x 40 mm and contained clear gelatinous material. A split retinacular graft was performed to fulfil the capsule failure. Histological examination showed chronic inflammation without malignancy. The patient was ordered to wear a brace with partial weight bearing for two weeks. Rehabilitation occurred uneventfully. After a 2-year follow-up, the patient had full range of articular motion with no recurrence.</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><elsevierMultimedia ident="fig2"></elsevierMultimedia><elsevierMultimedia ident="fig3"></elsevierMultimedia><elsevierMultimedia ident="fig4"></elsevierMultimedia><elsevierMultimedia ident="fig5"></elsevierMultimedia><elsevierMultimedia ident="fig6"></elsevierMultimedia></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para30" class="elsevierStylePara elsevierViewall">The etiology of meniscal cysts is controversial. Many authors advocate that trauma, chronic infection, hemorrhage, and mucoid degeneration may lead to the development of these entities<a class="elsevierStyleCrossRef" href="#bib9">9</a>. Because the fluid found in meniscal cysts is similar to sinovial fluid, the prevailing view is that cysts form from joint fluid that is forced through a peripherally extended meniscal tear and accumulates outside the joint capsule<a class="elsevierStyleCrossRef" href="#bib10">10</a>. Pain is most likely related to the associated meniscal tears, but discomfort may also be due to stretching of the knee capsule and other parameniscal soft tissues<a class="elsevierStyleCrossRef" href="#bib11">11</a>. The mass may be multiloculate and demonstrate thin internal septations, and its consistency may vary from soft and fluctuant to firm or bone-hard. MRI is preferred for evaluating meniscal cysts<a class="elsevierStyleCrossRef" href="#bib6">6</a>,<a class="elsevierStyleCrossRef" href="#bib12">12</a> because it shows structures such as the menisci, cartilage and ligaments and is the most effective modality to evaluate soft-tissue masses. The differential diagnosis for soft-tissue masses of the knee should include sinovial cyst formation, bursal fluid collections, ganglion cysts, severe degenerative changes with osteophytic spurring and soft-tissue masses such as pigmented villonodular sinovitis, lipoma, hemangioma and sarcomas<a class="elsevierStyleCrossRef" href="#bib9">9</a>. Meniscal cysts tend to recur after aspiration or simple resection<a class="elsevierStyleCrossRef" href="#bib6">6</a>. Therefore, open or arthroscopic intra-articular surgery to treat the underlying meniscal tear is necessary for successful therapy<a class="elsevierStyleCrossRefs" href="#bib13">13–15</a>. In conclusion, distinguishing meniscal cysts from other cystic lesions is important because meniscal cysts more often require surgery. In our case, the uncommon combination of mass size and location associated with the gender and age of the host led us to report it.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 1 => array:2 [ "identificador" => "cesec20" "titulo" => "CASE REPORT" ] 2 => array:2 [ "identificador" => "cesec30" "titulo" => "DISCUSSION" ] 3 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 620 "Ancho" => 992 "Tamanyo" => 104904 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">External aspect of the cyst</p>" ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 744 "Ancho" => 993 "Tamanyo" => 72176 ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">T1 coronal view</p>" ] ] 2 => array:7 [ "identificador" => "fig3" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 915 "Ancho" => 992 "Tamanyo" => 62214 ] ] "descripcion" => array:1 [ "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">T2 coronal view</p>" ] ] 3 => array:7 [ "identificador" => "fig4" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 863 "Ancho" => 992 "Tamanyo" => 120587 ] ] "descripcion" => array:1 [ "en" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">T1 axial view</p>" ] ] 4 => array:7 [ "identificador" => "fig5" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 633 "Ancho" => 993 "Tamanyo" => 129779 ] ] "descripcion" => array:1 [ "en" => "<p id="spara50" class="elsevierStyleSimplePara elsevierViewall">Cyst resection using the open approach</p>" ] ] 5 => array:7 [ "identificador" => "fig6" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 599 "Ancho" => 993 "Tamanyo" => 172093 ] ] "descripcion" => array:1 [ "en" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Resected cyst with medial meniscus</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medial meniscal cyst of the knee. 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=> array:2 [ 0 => """ AD Tasker \n \t\t\t\t\t\t\t\t """ 1 => """ SJ Ostlere \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0009-9260(05)83219-2" "Revista" => array:6 [ "tituloSerie" => "Clin Radiol" "fecha" => "1995" "volumen" => "50" "paginaInicial" => "778" "paginaFinal" => "781" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7489629" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meniscal cysts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ B Lantz \n \t\t\t\t\t\t\t\t """ 1 => """ KH Singar \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Sports Med" "fecha" => "1990" "volumen" => "9" "paginaInicial" => "707" "paginaFinal" => "725" "link" => array:1 [ 0 => array:2 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=> "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arthroscopic treatment of 105 lateral meniscal cysts with 5-year average follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ C Hulet \n \t\t\t\t\t\t\t\t """ 1 => """ D Souquet \n \t\t\t\t\t\t\t\t """ 2 => """ P Alexandre \n \t\t\t\t\t\t\t\t """ 3 => """ B Locker \n \t\t\t\t\t\t\t\t """ 4 => """ J Beguin \n \t\t\t\t\t\t\t\t """ 5 => """ C Vielpeau \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arthro.2004.06.014" "Revista" => array:6 [ "tituloSerie" => "Arthroscopy" "fecha" => "2004" "volumen" => "20" "paginaInicial" => "831" "paginaFinal" => "836" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15483544" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 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array:2 [ "etal" => false "autores" => array:4 [ 0 => """ M El-Assal \n \t\t\t\t\t\t\t\t """ 1 => """ M Mostafa \n \t\t\t\t\t\t\t\t """ 2 => """ A Andel-Aal \n \t\t\t\t\t\t\t\t """ 3 => """ M El-Shafee \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00167-002-0321-z" "Revista" => array:6 [ "tituloSerie" => "Knee Surg Sports Traumatol Arthrosc" "fecha" => "2003" "volumen" => "11" "paginaInicial" => "30" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12548448" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006300000003/v1_202212060912/S1807593222028083/v1_202212060912/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006300000003/v1_202212060912/S1807593222028083/v1_202212060912/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 54 | 26 | 80 |
| 2024 September | 87 | 37 | 124 |
| 2024 August | 68 | 38 | 106 |
| 2024 July | 58 | 20 | 78 |
| 2024 June | 49 | 20 | 69 |
| 2024 May | 75 | 16 | 91 |
| 2024 April | 70 | 10 | 80 |
| 2024 March | 64 | 26 | 90 |
| 2024 February | 62 | 15 | 77 |
| 2024 January | 97 | 17 | 114 |
| 2023 December | 91 | 18 | 109 |
| 2023 November | 97 | 23 | 120 |
| 2023 October | 99 | 31 | 130 |
| 2023 September | 79 | 15 | 94 |
| 2023 August | 62 | 2 | 64 |
| 2023 July | 30 | 10 | 40 |
| 2023 June | 63 | 2 | 65 |
| 2023 May | 62 | 3 | 65 |
| 2023 April | 39 | 2 | 41 |
| 2023 March | 37 | 0 | 37 |
| 2023 February | 18 | 1 | 19 |
| 2023 January | 22 | 2 | 24 |
| 2022 December | 36 | 4 | 40 |
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