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Diagnosed with ganglion cyst on top of foot. Having pain, tenderness and soft mass. Suggestions?

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General & Family Physician
Practicing since : 2009
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Hello, last week my 11 year old daughter was diagnosed with a ganglion cyst on the top of her foot. 6 months ago she saw an orthopedic surgeon for pain on the top of the same foot. He took several xrays to rule out any masses or fractures - the xrays showed no abnormalities. After resting the foot (she plays soccer and took some time off) the pain disappeared but would occasionally show up if she had played soccer/run a lot during a short period of time. Last week she had some tenderness and a soft round mobile mass appeared almost overnight, which prompted the most recent visit to the ortho. After palpating the mass and asking her some questions he felt certain it was a ganglion cyst, but ordered an MRI to rule out anything else. The MRI did confirm the ganglion cyst (the radiologist specializes in bone and soft tissue MRIs), but I am still worried that he is mistaken and it is something sinister like a synovial sarcoma, which if I understand correctly has similar features as a ganglion cyst. I have to assume a trained eye would be able to tell the difference, but I am still concerned. Any input would be appreciated.
Posted Sun, 30 Jun 2013 in Bones, Muscles and Joints
Answered by Dr. Luchuo Engelbert Bain 1 hour later
hi and thanks for the query,

its important to get a few clarifications. Radiological investigations take into consideration clinical observations and parameters for interpretation. A cyst and presentation of a synovial sarcoma are actually difficult to be interchanged for each other, both on clinical and radiological grounds.

A synovial sarcoma has a clinical history of chronic and intense pain, signs of inflammation, sustained pain and is generally not very common in young children. What is common in children is Ewing s tumour is generally located at the level of the bone shaft and not at the extremities.

I do not think after the clinical evaluation by the orthopedic surgeon and the MRI results you really should worry. A biopsy might be indicated to rule out a synovial sarcoma only in case there is persistence of pain and deformation/skin changes at the level of this point.

No worries for now as I wish her the best of health.

best regards,

Bain LE, MD.
Above answer was peer-reviewed by
Follow-up: Diagnosed with ganglion cyst on top of foot. Having pain, tenderness and soft mass. Suggestions? 2 hours later
Thank you for your reply. A few more questions if you don't mind:
1.) what do you mean by deformation/skin changes?

2.) The cyst is just slightly tender if it is pressed on a certain way, but the orthopedic surgeon said it wasn't necessary to drain unless it became painful or if got quite a bit larger. Do you agree with that course of action? (He also said that these cysts often come back even after they have been drained and that they sometimes go down in size on their own).

Answered by Dr. Luchuo Engelbert Bain 8 minutes later
Hi and thanks for your questions.

with respect to your first concern, deformation or skin changes means the skin color changes, or becomes wrinkled or comes very adherent to the subcutaneous tissue on clinical examination.

Secondly, cysts as such, I totally agree with the orthopedists have very uneventful outcomes. you simply need to observe and in case of excessive growth, pain, infection or spontaneous rupture, that s when the doctor can intervene.

As the child grows, regression is often spontaneous. I think what s important now is just to be watchful and report any unusual findings, especially ones I mentioned to your doctor,

Thanks once again and best regards,

Bain LE, MD.
Above answer was peer-reviewed by
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