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Reinterpretation of their original published image however shows evidence of a joint
connection; indeed, the “proximal tail” of the cystic intraneural mass noted but not
explained by the authors, clearly extends and connects to a small joint in the wrist
(Figure 1), possibly the capitohamate joint or the 3rd carpometacarpal joint. Without access
to other images and different planes, it is impossible for us to comment further or
confidently on the exact joint of origin.
Figure 1Reinterpretation of the published MRI by Han et al.
Sagittal T2-weighted MR image of the wrist showing the joint origin of the intraneural
ganglion cyst (asterisk) from the region of the distal carpal row (arrows) with the
typical elongated tail extending from the joint to the larger portion of the cyst.
Joint fluid is present at the 3rd CMC joint (arrowhead). There is no fat suppression
present and the visible imaging parameters indicate significant partial volume effect
due to large (4 mm) interslice gap and suboptimal resolution.
Intraneural ganglion cysts of the peripheral nerve in the upper extremity are uncommon and usually originate within the epineurium of the peripheral nerve. The current report discusses a 57-year-old woman with a neuropathic nodular mass on the thenar area of the left hand. Magnetic resonance images showed a lobulated, homogeneous mass of high signal intensity on T2-weighted images and low signal intensity with peripheral enhancement on T1-weighted images. Excisional biopsy and histopathologic examination confirmed an intraneural ganglion cyst of the digital nerve of the thumb.
