Weekly Case

Title : Case 682

Age / Sex : 70 / F


Chief complaint : Urinary obstruction and intermittent urinary incontinence.

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 
장민영, Min-Yung Chang, 국민건강보험공단 일산병원, National Health Insurance Service Ilsan hospital


 


Diagnosis:

Subpubic cartilaginous cyst = suprapubic cartilaginous cyst = retropubic cartilaginous cyst



Discussion


Findings:


 Round cystic mass which had a broad interface with the symphysis


 Neurogenic bladder


 


Differential Diagnosis:


 None


 


Discussion:



  • pubic symphysis : a nonsynovial amphiarthrodial joint that is situated at the confluence of the two pubic bones. The joint is composed of a thick fibrocartilaginous disk sandwiched between thin layers of hyaline cartilage. The pubic symphysis is reinforced by four strong ligaments; inferior pubic (or subpubic or arcuate) ligament, superior, anterior, and posterior pubic ligaments. 

  • Subcartilaginous cyst

  • rare cystic lesions arising from the symphysis pubis thought to be degenerative in origin.

  • epidemiology : multiparous and post-menopausal women.

  • Asymptomatic or urinary voiding symptoms, pelvic pain…

  • pathology : they consist of a dense fibrocartilaginous capsule internally covered by a thin layer of degenerate fibrocartilage. The lumen is filled with acellular debris and further degenerate fibrocartilage with mucin deposits

  • cystic, ganglionlike mucinous degeneration of the arcuate ligament tissue with cartilaginous metaplasia?


 


References:


 



  1. Alguacil-Garcia A, Littman CD. Subpubic Cartilaginous Cyst: Report of Two Cases. The American Journal of Surgical Pathology 1996; 20

  2. Kim CE, Beasley HS. MRI Diagnosis of Subpubic Cartilaginous Cyst. American Journal of Roentgenology 2004; 182:144-146

  3. Price G, McNicholas T, Buckingham S, Chang S. Subpubic cartilaginous cyst: an unusual cause of urinary tract infection. JRSM Open 2018; 9:2054270417739779






Correct Answer
Total applicants 28 Correct answers 20
Name Institution
윤유성 순천향대 부천병원, 전문의
여현정 전문의
이현규 전문의
임윤진 단국대학교병원, 전공의
김동언 서울아산병원, 전문의
이진영 전문의
조영민 전문의
조신영 전문의
전인환 전문의
변성환 전문의
이규정 국군대전병원, 전문의
권기언 서울아산병원, 전문의
이승보 서울아산병원, 전문의
김현진 서울성모병원, 전공의
강건우 전문의
김성진 365병원, 전문의
문경일 전남대학교병원, 전공의
최형인 군의관, 전문의
심상우 서울아산병원, 전문의
이혜란 전문의


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