Semimembranosus Tendonunda İntratendinöz Ganglion Kisti

Ganglion kistleri, sinovyal bir kapsülü bulunmayan, internal septalar içerebilen, hyaluronik asit ve diğer mukopolisakkaradilerden zengin sıvı içeren sık görülen tümör benzeri lezyonlardır. Vücudun herhangi bir yerinde görülebilirler. En sık el bilek, el, diz, ayak bilek ve ayakta izlenirler. Etyolojisi net olarak açığa çıkarılmamış olsa da kronik irritasyon, kronik tekrarlayıcı zedelenme ve kronik iskeminin rol oynadığı düşünülmektedir. Semptomatik olduklarında ağrı ve lokal yumuşak doku şişliği bulguları verirler. Ganglionlar geleneksel olarak orjin aldıkları dokuya göre klasifiye edilirler: İntraartiküler, ekstraartiküler, intraössesöz, periosteal gibi. Ganglion kistleri sık görülen bir patoloji olmasına rağmen intratendinöz ganglion kisti nadir görülür. Klinik olarak teşhis etmek zordur. Tanı ultrasonografi (USG) ya da MRG (Manyetik Rezonans Görüntüleme) tetkikleri ile konur. MRG'de tendon, ligaman, tendon kılıfı, menisküs ya da eklem kapsülünden orjin alan düzgün konturlu, lobule, basit ya da komplike sıvı sinyali veren, kontrast verilmesini takiben periferal rim şeklinde kontrastlanma paterni gösteren kitle olarak izlenir. Ultrasonografide ve renkli Doppler ultrason incelemesinde vaskülarizasyon göstermeyen, lobule konturlu, internal septa içerebilen hipoekoik ya da anekoik kitle olarak izlenir. Biz bu yayında diz ekleminde semimembranosus tendonunda yerleşim gösteren intratendinöz ganglion kistini, ultrasonMRG bulgularını ve ayırıcı tanısında yer alabilecek patolojileri vaka olarak sunduk. Bilgilerimize göre literatürde tanımlanan, semimembranosus tendonunun kendisinden orjin alan ganglion kisti hakındaki 3. vaka sunumudur. Diz eklemi ağrısının nadir nedenlerinden biri olarak, uygun radyolojik veriler ışığında ayırıcı tanıda göz önünde bulundurulması gereklidir.

Intratendinous Ganglion Cyst of The Semimembranosus Tendon

Ganglion cysts are commonly seen tumor-like lesions that do not have synovial capsules and can have internal septae as well as fluid rich with hyaluronic acid and other mucopolysacharides. They can be seen anywhere in the body. Although their etiology remains unclear, it is thought that chronic irritation, chronic repetitive injury and chronic ischemia are factors involved. When symptomatic, they cause pain and local soft tissue swelling. Ganglia are traditionally classified by the tissue from which they originate, such as intraarticular, extraarticular, intraosseous, periosteal etc. Although ganglion cysts are a commonly seen pathology, intratendinous ganglion cysts are rarely observed and hard to clinically diagnose. Diagnosis is made by ultrasonography (USG) or by MRI (Magnetic Resonance Imaging) work ups. On MRI, they appear as well demarcated and lobulated masses originating from tendons, ligaments, tendon sheaths, meniscuses or joint capsules, giving out simple or complicated fluid signals, and they appear with a peripheral rim pattern when contrast agents are applied. On ultrasonography and doppler ultrasonography, they appear as hypoechoic or anechoich masses of no vascularization, with a lobulated outline and possibly an internal septaIn this publication, the intratendinous ganglion cyst on the semimembranous tendon of the knee joint as well as the related ultrasound-MRI findings and the pathologies which can be on its differential diagnosis are presented as a case study. To the knowledge of the author of this paper, this is the third published case study about ganglion cysts originating from the semimembranous tendon itself. It is necessary to consider these cysts in differential diagnosis in light of adequate radiologic data, as a rare cause of knee joint pain.

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