Digital mucoid cyst: the ganglion type

Abstract

A 43‐year‐old woman presented with a soft, smooth, cystic, slightly erythematous, dome‐shaped nodule, 6 × 8 mm in diameter, located on the dorsum of the middle finger of the right hand, between the proximal fold and the distal interphalangeal joint, lateral to the midline ( ). The nail of the affected finger showed longitudinal grooving and mild distal transverse overcurvature. The lesion had been present for 3 months and was tender upon pressure. 1 Digital mucoid cyst, lateral to the midline of the third finger, causing nail deformity Clinical examination revealed early signs of osteoarthritis and Heberden’s nodes on the distal interphalangeal joints of both hands. Previous treatment included the intake of nonsteroidal anti‐inflammatory drugs (NSAIDs) indicated by a rheumatologist. An X‐ray of the right hand showed decreased joint spaces between the second and third phalanges of the middle finger. Diagnosis of a digital mucoid cyst (with nail deformity secondary to the former) was made. Surgical excision was performed. During surgery, a pedicle connecting the cyst to the joint capsule was clearly observed and two satellite lesions were also found ( ). The cyst and its satellite lesion, including the communicating tract, were totally removed. 2 (A) direct link of the cyst to the distal interphalangeal joint during surgery is clearly observed The histopathologic study showed large cystic spaces containing mucin (colloidal iron stain) which were lined in some areas by synovial membrane ( ). The histopathologic report was compatible with a digital mucoid cyst of the ganglion type. 3 Large cystic spaces containing mucin lined, in some areas, by synovial membrane (×100, original magnification) Six months after excision, no recurrence has been detected, and the nail plate deformities have improved.

A Case of Herpetiform Appearance of Digital Mucous Cysts

“…The first is the myxomatous type, which is analogous to focal mucinosis, and shows a large cystic space containing mucin surrounded by collagen fibers with no lining of the cyst wall. It results from an overproduction of hyaluronic acid by the fibroblasts, and it is not anatomically connected with the adjacent DIP joint 2,5 . Histologically, there are ill-defined areas of mucinous material in its early stages.…”

“…It is clinically characterized by a round to oval, translucent, smooth nodule localized to the dorsum of the finger near the distal interphalangeal (DIP) joint 2 . It usually presents as a solitary lesion, and rarely, as multiple lesions.…”

Excision of Periungual Myxoid Cyst Using Proximal Nail Fold Flap

“…[5] These cysts appear clinically as soft, smooth, clear or flesh-colored nodules that develop on the dorsal digits between the distal interphalangeal joint and the proximal nail fold. [5][6][7][8] These periungual swellings are usually solitary and are often seen lateral to the midline. [8] These slowly growing cysts are asymptomatic initially but can become tender and painful in some patients, causing decreased range of movements at the adjoining joint and even cause deformity of the nail apparatus.…”

Digital mucous cyst –

“…Torbiel śluzowa jest łagodnym, przeziernym guzkiem zlokalizowanym na grzbietowej powierzchni palca ręki, rzadziej stopy, najczęściej pomiędzy stawem międzypaliczkowym dalszym a wałem paznokciowym [1][2][3]. Po raz pierwszy zmiana została opisana w 1883 roku przez Hyde [4,5].…”

“…Trudności diagnostyczne pojawiają się, gdy torbiel umiejscowiona jest podpaznokciowo [6]. W diagnostyce różnicowej należy uwzględ-nić ziarniniaka ropotwórczego, torbiel naskórkową, włókniaka twardego, guzki Heberdena, naczyniakomięśniaka gładkokomórkowego [1].…”