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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What do these MRI findings indicate?

Answered by
Dr.
Dr. Prashant Sharma

Oncologist, Surgical

Practicing since :2003

Answered : 177 Questions

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Posted on Wed, 12 Oct 2016 in Cancer
Question: A couple weeks ago I injured my hand / wrist playing soccer. My orthopedic hand specialist ordered an MRI. Yesterday I met with him to get the results. The bone injury doesn't seem to be that serious (cast 4-6 weeks to heal it)... but my Dr. informed me that the Radiologist found a "cystic-appearing intramuscular lesion" and that this "probably reflects a ganglion cyst in an atypical location" but that "follow MR imaging with and without contrast would be helpful to exclude a pseudocystic solid neoplastic mass."

My wife and I are about to have twins after 5 years of fertility treatments, pregnancy losses, etc. I am a 34 year old male. I scheduled this follow up MRI but won't have that and the results for a couple weeks.

I am extremely worried about this. I have several questions that I'm hoping you can help me with. Attached is the MRI report so you can see all of the details.
1) I am concerned that this would be an "atypical location" for a ganglion cyst. In your opinion how likely / unlikely is it for this to be an intramuscular cyst?
2) Are the facts that this is T1 hypointense, no XXXXXXX solid, and hemorrhagic complex components a good thing? I'm assuming no XXXXXXX solids are definitely good but is T1 hypointense in line with a ganglion cyst?
3) If this is not a cyst and it is something else, how likely would it be cancer versus a benign tumor?

Thanks!
doctor
Answered by Dr. Prashant Sharma 3 hours later
Brief Answer:
I think it's benign.

Detailed Answer:
Dear Sir,
I can understand your feelings and your worry.
Please don't be worried without a diagnosis. Still we don't know it is a cancer, and even if it is a cancer it is stage 1 and is curable.
Yes, you are right, no XXXXXXX solid component is a good thing. Usually these well-defined cysts are benign. Intramuscular cysts are rare.
For confirmation of malignancy, we have to do FNAC ie fine needle aspiration cytology from the cyst.
with my experience I can say that this should be benign. if u don't want to go for the contrast study, please go for an FNAC to clear the doubt.
please don't panic. your family needs your support.
you will be all right soon and will be living happily with your children.
please feel free to ask further.

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Prashant Sharma 45 minutes later
Thanks you so much for your help. I do have some follow up questions:

1) What from the MRI report makes you say that it wouldbe stage 1? Thats great to hear but I'd like to know why you believe that to be the case if it is malignant.

2) I am already scheduled for the MRI with and without contrast. Will that be a waste of my time meaning that I will have to do a FNAC regardless of the new MRI findings? Or is there a good chance that this new MRI will be able to confirm it is a cyst meaning no need to biopsy?

3) Is hypointense on T1 a good thing? Does that align with it being a cyst?

4) In your opinion if this is benign is it likely a cyst or would it more likely be some other type of benign tumor like a myxoid since it is intramuscular?

Thanks!
doctor
Answered by Dr. Prashant Sharma 14 hours later
Brief Answer:
Tests bring us near to diagnosis

Detailed Answer:
dear Sir, hello again.
you should go for the contrast study. by this we can better characterize the lesion.
with the given history I think it is an inflammatory collection of fluid inside muscle as a result of trauma.
this lesion is elongated along the muscle. ganglions are rounded well-defined lesions and of course benign.
to me the chances of it being cancer are very less, but if so it is stage one because it is a small tumor, well contained inside single muscle and no evidence of near or distant spread.
please don't confuse with hypointensity. there r many other things we have to see in an MRI.
if we r almost confirm that it is benign, we may avoid FNAC. otherwise to confirm cancer one should undergo FNAC or biopsy.
hope I have answered your questions.
my good wishes are with you. you will be well soon and going to the foot ball ground.
Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
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Follow up: Dr. Prashant Sharma 4 hours later
Thanks so much! I do have another question... you mentioned "with the given history I think it is an inflammatory collection of fluid inside muscle as a result of trauma."

Two things regarding this... my soccer injury was just 1.5 weeks before this MRI, could a ganglion cyst of this size form that quickly and appear like this in that short amount of time?

Also, now that I've been told about this mass I've been thinking hard to figure out if I've ever noticed anything unusual with the palm of my left hand. I used to lift weights regularly and seem to remember (at least a year ago, quite possibly even longer than that) doing bench presses and feeling some pain in my left palm and having to rotate my grip some to ease the pain when doing bench presses...

If this pain was caused by this mass and that was at least a year ago, does that support it being a cyst? What I'm wondering is if the pain was caused by a cancerous mass and that was over a year ago, would it be expected that this mass would look differently after a year plus on MRI? Would it likely be causing more outward issues by now?

Besides this recent injury I don't remember another injury to this hand that would've caused the trauma causing the cyst but I can't say for sure. Just wondering if 1) a cyst like this could quickly form in 1.5 weeks after an injury and 2) more than likely b/c of the bench press pain over a year ago it has been there for some time now and wondering if that supports it being a cyst or gives more suspicion to malignancy.

Thanks!
doctor
Answered by Dr. Prashant Sharma 3 days later
Brief Answer:
start treatment from an expert doctor

Detailed Answer:
Dear sir,

Sorry for the delay. I was so busy that i didn't get time to see internet.
Yes sir, the inflammatory collection may occur in 1.5 week.
Ganglion takes some more time to occur usually and very slow in increasing size.
Yes, your previous history of pain may be significant. this may be a previously growing lesion. this supports it being ganglion. difficult to comment upon now.
basically a clinical examination of ur palm is needed to figure out the things properly.

sir, a cancerous mass is painless in early stages. if it is an year long, it should not be cancer because cancer has a progressive growth and much faster than this seems.
yes it might be causing more outward issues by now if it is a cancer.
don't wonder, inflammatory cysts may occur in 1.5 weeks.
please do't panic sir, show this to a sports physician or a surgeon and start the treatment. you will be alright soon.
do't try to prove the negative things when they are not there.
be happy, tension free. my best wishes are with you.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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