Purpose of study:. “Ganglia are a benign condition taking up the time of competent surgeons who might be more usefully engaged.” – McEvedy. Our aim was to perform a retrospective review comparing preoperative clinical presentation, intraoperative findings and histological diagnosis of all hand and wrist ganglia presenting to the Hand Unit at Chris Hani Baragwanath Hospital. Methods:. A retrospective review of hand and wrist ganglia treated at the Hand Unit at Chris Hani Baragwanath Hospital. Clinical and surgical notes and histology reports were reviewed. All ganglia were removed surgically as directed by clinical findings. Results:. A total of 75 hand and wrist masses were operated over a period of 6 months between January and June 2012. Of these 42 were clinically diagnosed as ganglia. All 42 “ganglia” were removed surgically and sent for histological evaluation. Of these, 40 were diagnosed intra-operatively as ganglia. In 2 cases the diagnoses were changed intra-operatively to synovitis and Giant Cell Tumor of tendon sheath. Histologically 5 out of 42 cases were found not to be ganglia; their diagnoses were as follows:. 1. Granulomatous synovitis. 2. Chronic inflammation (possible tuberculous). 3. Giant Cell Tumour of Tendon Sheath. (Correlates with intra-op diagnosis). 4. Nerve sheath tumour (Schwannoma). 5. Chronic bursitis. Conclusion:. Be wary of “the simple ganglion”. Other conditions may mimic a ganglion with potentially disastrous consequence if misdiagnosed. In our setting histological evaluation is compulsory. Always follow the patient up and confirm histological diagnosis

Giant cell tumours of tendon sheaths have been given multiple denominations due to the uncertain pathologic nature of this lesion. Various contributory factors have been accounted for a wide variation in their recurrence rates. Owing to their high recurrence rates ranging from 9% to 44%, these tumours continue to present with treatment dilemma. There is a lack of consensus regarding how to best manage the balance between extensive dissection and preservation of normal tissues for normal function and recovery versus the risk of recurrence. The authors studied 46 patients with histopathologically confirmed Giant cell tumours over a period of 9 years between 1997 and 2006. The average follow-up in this case series was 35 months. This study aims to analyse the distribution of giant cell tumours of tendon sheaths in hand and our experience with their resection in a District General Hospital with possible predictors associated with recurrence. The referral letters, radiographs, operative and histology records were reviewed. The data was carefully analysed including patients' age and sex at the time of presentation and surgery, presenting symptoms, any associated trauma and the anatomical location of the tumour. A telephonic questionnaire was conducted and the patients with any complications or recurrence were reviewed. Our recurrence rate of 8.6% (4 patients) is lower than previously reported in the literature when the patients did not receive post-operative radiotherapy. Recurrence was seen to be statistically higher in cases where the tumours were excised piecemeal as opposed to removed in one piece and in patients with osseous erosions which were confirmed radiologically and intra-operatively. No atypical mitosis was reported on histology. None of our patients received radiotherapy post-operatively. Other factors including age, size, degenerative joint disease and location within the digit were not confirmed as risk factors in our study. We recommend meticulous surgical technique by an experienced hand surgeon and warning patients of the risk of recurrence if any risk factors were identified