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Cytomorphological Study of Articular and Periarticular Cystic Lesions Dr.Sneha Saini, Dr.Madhu Sinha , Dr

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Cytomorphological Study of Articular and Periarticular Cystic Lesions Dr.Sneha Saini, Dr.Madhu Sinha , Dr International J. of Healthcare and Biomedical Research, Volume: 06, Issue: 04, July 2018, 23- 36 Original article: Cytomorphological study of articular and periarticular cystic lesions Dr.Sneha Saini, Dr.Madhu Sinha , Dr. Natasha S. Gulati , Dr. Abhijit Das, Dr. Man Mohan Mehndiratta 1. Dr.Sneha Saini- Senior Resident, Janakpuri Superspeciality Hospital (JSSH) 2. Dr.Madhu Sinha- Specialist(Pathology), Janakpuri Superspeciality Hospital (JSSH) 3. Dr. Natasha S. Gulati- Specialist(Cytology), Janakpuri Superspeciality Hospital (JSSH) 4. Dr. Abhijit Das- Assistant Professor, Janakpuri Superspeciality Hospital (JSSH) 5. Dr. Man Mohan Mehndiratta, Director, Janakpuri Superspeciality Hospital (JSSH) Corresponding Author: Dr.Sneha Saini , Senior Resident, Janakpuri Superspeciality Hospital (JSSH) ABSTRACT: AIMS AND OBJECTIVES:- To study cytomorphology of articular and periarticular cystic lesions and to assess the efficacy of fine needle aspiration cytology (FNAC) in diagnosis and management of articular and periarticular cystic lesions. MATERIAL AND METHODS:- Our study was a retrospective study done over a period of 2 years from Jan 2015 to Jan 2017 in Cytology section of Pathology department of our hospital. Sixteen cases including ganglion cysts, synovial cysts and popliteal cysts from different articular and periarticular sites were studied. RESULTS:- In our study out of 16 cases, there were 10 (62.5%) cases of ganglion cysts, 3 (18.7%) cases of synovial cysts and 3 (18.7%) cases of popliteal cysts. The male to female ratio (M: F) for these lesions was 1:1.6 and were predominantly found in third decade (21-30 years). CONCLUSION:- FNAC offers a great diagnostic utility in articular and periarticular cystic lesions being an OPD procedure having low cost. It is minimally invasive and helpful in rapid diagnosis. Sometimes FNAC also has therapeutic implications in such lesions. Keywords:-Articular, periarticular, ganglion cyst, synovial cyst, popliteal cyst. INTRODUCTION: Cysts and cyst-like lesions are common finding in articular and periarticular spaces. Most of these lesions can be diagnosed successfully with fine needle aspiration cytology (FNAC) which can help in proper management. Fine-needle aspiration cytology represents an excellent alternative to traditional cytologic (exfoliative cytology) or histologic methods for diagnosis of joint pathology. The advantages over open biopsy and other surgical procedures have made FNAC an increasingly popular procedure. (1) It is important to incorporate radiographic and clinical data when interpreting FNAC materials from such articular and peri-articular lesions. FNAC offers a great deal of diagnostic utility not only in early diagnosis but also in their treatment with minimal invasive means. Sometimes it also has therapeutic implications for such cystic lesions around joints. There are various cystic lesions around joints such as ganglion cysts (GC), synovial cysts (SC), bursal cyst , cystic inflammatory lesions, hematoma around joints or cystic tumours. Articular and periarticular cystic lesions can present with symptoms like pain, swelling, weakness, joint movement restrictions and compression of surrounding structures like blood vessels, nerves etc. Ganglion cysts are degenerative lesions, most often of the fibrous joint tissue or synovium. They occur commonly in the wrist, foot, or knee and present as firm, circumscribed masses of soft tissue. FNAC of ganglia has become more popular as a 23 ISSN: 2319-7072 International J. of Healthcare and Biomedical Research, Volume: 06, Issue: 04, July 2018, 23- 36 preoperative diagnostic or, in some instances, a therapeutic procedure.(2,3,4,5,6) They may affect any age group; however they are more common in the twenties to forties.(7) The aspirated material from ganglion cysts is thick, colourless & jelly- like. Microscopically, smears from the aspirated material show a small number of single cells with abundant cytoplasm and small oval nuclei over a background of abundant myxoid material which shows a peculiar drying artifact.(8) Synovial cysts are juxta-articular fluid- filled collections that are lined by synovial cells which cytologically as well as histologically distinguish them from other juxta-articular fluid collections, most importantly from ganglion cyst. It represents a focal extension of joint fluid due to herniation of synovial tissue into the surrounding soft tissue that can communicate with joint cavity. (9) Synovial cysts around knee joint are of two types on the basis of location i.e. popliteal (Baker’s cyst) and proximal tibiofibular cysts. (10) Other articular or periarticular cystic lesions include both benign and malignant lesions like meniscal cysts, bursitis, hematoma, abscess and synovial sarcoma etc. MATERIAL & METHODS: Our study was a two years retrospective study from Jan 2015 to Jan 2017 done in Cytology section of Pathology department of our hospital. After taking proper consent and clinical details of patients, FNAC was performed from the lesion sites mentioned on requisition forms and OPD slips. Skin overlying the lesions was cleaned by betadine and alcohol swab using a proper antiseptic method and aspiration was done using a 22-23 gauge needle attached to a 10 ml syringe with holder. The aspirated material was collected on to clean glass slides. The smears which were air-dried were stained with MGG (May Grunwald Giemsa) stain and those wet fixed were stained with Papanicolaou stain. Sometimes FNAC proved to be therapeutic due to partial or complete reduction in size of swelling. Cell block was also prepared from aspirated material of one case and stained with Haematoxylin and Eosin (H&E). Inclusion criteria:-All the cystic lesions around various joints. Exclusion criteria:-Non cystic lesions, clinically and radiologically malignant lesions. RESULTS AND DISCUSSION: A cyst adjacent to or in articular spaces is a frequent presentation. These lesions can be articular or periarticular which can present with symptoms like pain, swelling, weakness, joint movement restrictions and compression of surrounding structures (Fig no.1). FNAC offers a great deal of diagnostic utility not only in early diagnosis but also in their treatment with minimal invasive means. During retrospective study of two years from Jan 2015 to Jan 2017, total 16 cases of cystic lesions in joint spaces were studied. In our study, there were 10(62.5%) cases of ganglion cysts, 3(18.7%) cases of synovial cysts and 3(18.7%) cases of popliteal cysts. Most common lesion was ganglion cyst and found common in wrist joints (table no 1& fig no.2). Ganglion cysts are benign soft tissue tumors most commonly encountered in the wrist, but can occur in any joint. Sixty to seventy percent of ganglion cysts are found in the dorsal aspect of the wrist and communicate with the joint via a pedicle. (11) 24 ISSN: 2319-7072 International J. of Healthcare and Biomedical Research, Volume: 06, Issue: 04, July 2018, 23- 36 Fig no:-1 showing distribution of various type of bursal cysts and ganglion cyst of articular or periarticular region. In our study, age of presentation varied from 10 years to 63 years. These cystic lesions were more common in the age group of 21-30 years (table no.2). It is comparable with a study done by Meena S et al and Vijay PM et al. (7, 8) Table no.1 :-Data of 16 cases of articular and periarticular cysts. S. No. Age/Sex Site of FNAC FNAC Impression Duration of Consistency of swelling fluid 1 30/M Swelling right wrist Ganglion cyst 1 year Thick,gelatinous 2 25/F Swelling left wrist Ganglion cyst 2 months Thick,gelatinous 3 35/F Swelling right wrist Ganglion cyst 5 months Clear,thin 4 63/M Swelling medial side of left knee Ganglion cyst 2 years Clear,thin 5 56/F Swelling medial side of left knee Synovial cyst 1 year Thick,gelatinous 6 29/F Swelling medial side of right knee Synovial cyst 1 year Thick,gelatinous 5 months 7 22/F Swelling lateral side of right wrist Ganglion cyst 4 months Thick,gelatinous 8 36/F Swelling lateral side of left wrist Ganglion cyst 3 months Thick,gelatinous 9 28/M Swelling lateral side of right wrist Ganglion cyst 1 year Blood tinged, thick gelatinous 10 10/F Swelling lateral side of right wrist Ganglion cyst 1 year Thick,gelatinous 2 months 11 24/M Swelling over right wrist Ganglion cyst 4 months Thick,gelatinous 25 ISSN: 2319-7072 International J. of Healthcare and Biomedical Research, Volume: 06, Issue: 04, July 2018, 23- 36 12 39/F Swelling over right elbow Ganglion cyst 8 months Thick,gelatinous 13 44/F Swelling over right elbow Ganglion cyst 3 years Thick,gelatinous 14 20/M Swelling over back of knee Baker’s cyst 1year Blood tinged, thick gelatinous 15 56/F Swelling in popliteal fossa Baker’s cyst 6 months Thick,gelatinous 16 17/M Swelling in popliteal fossa Baker’s cyst I year Thick,gelatinous 3 months Fig no.2 :- Case distribution in our study. 12 10(62.5%) CASE DISTRIBUTION 10 8 6 N U 4 M 3(18.7%) B 3(18.7%) E 2 R 0 Gangion cyst Synovial cyst Popliteal cysts TYPE OF CYST 26 ISSN: 2319-7072 International J. of Healthcare and Biomedical Research, Volume: 06, Issue: 04, July 2018, 23- 36 Table no.2 :- Age-wise incidence of articular and periarticular cysts. Age range (years) No. of cases 0-10 1 11-20 2 21-30 6 31-40 3 41-50 1 51-60 2 61-70 1 Total 16 In our study, cystic lesions were more common in females with 10 out of 16 cases (62.5%). The M: F ratio was 1:1.6 in our study which was comparable with study done by Meena S et al and Vijay PM et al (7,8). In a study done by Meena et al, incidence in males was 25/100,000 and in females 43/100,000. (7) Ganglion cysts on aspiration revealed thick, colorless, jelly like aspirate.
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