Digital mucoid cyst: the ganglion type

Digital mucous cysts of the finger without osteoarthritis: optimizing outcome of long needle trajectory aspiration and injection

Digital mucous cysts are common, benign and highly recurrent tumors of the distal interphalangeal joints of the fingers and often associated with osteoarthritis. Multiple treatment modalities have been described, but still no consensus is stated. In the absence of degenerative changes, we promote a novel non-surgical approach. The aim of this study was to examine all patients with digital mucous cysts without underlying osteoarthritis, undergoing this injection technique and to assess outcome and complications of this procedure. This was a single center study (2018-2019) of 17 patients who received a long needle trajectory aspiration and injection for treatment of digital mucous cysts. Exclusion criteria were prior surgical treatment, post-traumatic cyst formation and the presence of radiographic distal interphalangeal joint osteophytosis. A total of 15 patients were found eligible for inclusion. The patient reports were retrospectively analyzed with a follow-up of 6 months. The primary study outcome was resolution of the cyst; secondary outcomes were complications of the procedure. Twelve (80%) resolved completely and three (20%) had limited local recurrence at 6 months. No complications were reported. None of the patients with limited recurrence desired further treatment. We believe that this technique offers a non-invasive, low-cost treatment option for digital mucous cysts, particularly in the subset of patients with ample evidence of degenerative articular changes in the distal interphalangeal joint. The described technique can be performed in an office-based setting and avoids typical surgical as well as aspiration-associated complications.

Osteophyte-Sparing Treatment of Mucous Cysts: Case Analysis and Surgical Technique

The purpose of this study was to examine patient outcomes and the risk of recurrence of mucous cysts affecting the distal interphalangeal (DIP) joint in the absence of osteophytectomy using the described flap technique.

The outcome of minimally invasive surgery for digital mucous cyst: a 2-year follow-up of percutaneous capsulotomy

Background: Digital mucous cyst(DMC) is the most common tumor or cyst of the hand. Although many operative methods have been proposed to treat DMCs and lower the recurrence rate, many patients hesitate to have surgery. A minimally invasive treatment using percutaneous capsulotomy for the DMCs could be an alternative choice. However, the clinical results of using this method are still uncertain.Objectives: Here, we introduce the percutaneous capsulotomy method and assess the clinical outcomes and the associated complications of this method. Methods: A total of 42 digits were finally included. All patients accepted percutaneous capsulotomy under a digital ring block. Functional and radiographic assessments were made pre- and postoperatively, with a mean of 28.8 months (range, 24-33 months) of follow-up. Results: The mean duration of the appearance of DMCs before treatment was 11.6 months. Of the 19 digits with nail deformity, 14 showed an improved nail appearance. There were no skin complications. The average visual analogue scale (VAS) satisfaction score was 9.4, only two cases had experienced recurrence at the final follow up. Conclusions: This study reported that percutaneous capsulotomy could be an effective method for DMCs treatment. The recurrence rate was low and patient satisfaction was good. Nail deformities could be improved with treatment.

[Mucous pseudocysts-when and how to treat?]

The treatment of mucous pseudocysts must consider their tendency for recurrence. There are numerous established treatment options available. The decision on the optimal therapy, however, depends on the clinical presentation and symptoms as well as on possible side effects. This review presents surgical as well as nonsurgical treatment options for digital mucous pseudocysts and an algorithm is suggested. For recurrent and symptomatic lesions with pain or deformation of the nail plate, surgical excision of the pseudocyst and closure with a flap can be considered.

Effectiveness and Safety of Surgical Excision in the Treatment of Digital Mucoid Cysts

BACKGROUND

Digital mucoid cysts have a tendency for recurrence after operative intervention. Several procedures are in use.

OBJECTIVE

Retrospective evaluation for effectiveness, safety and patient satisfaction by using a questionnaire after treatment for digital mucoid cysts with targeted surgical excision and closure by flap-design.

MATERIALS AND METHODS

All patients treated with surgical excision for digital mucoid cysts at the Dermatology Department of the Ludwigshafen City Hospital between 2007 and 2011 were evaluated using a specially designed questionnaire.

RESULTS

We evaluated 31 patients. The patient group consisted of 65% women, the median age was 61 years. Seventy-eight percent of patients with nail involvement had a marked improvement or complete resolution of this complaint after surgery. A few complications (e.g., redness, pain or hematoma) were observed after treatment, but no patients required oral antibiotics. Patient evaluation of cosmetic outcome revealed high satisfaction with the procedure, nevertheless recurrence of the digital mucoid cysts was observed in 22.5% of all cases.

CONCLUSION

Surgical excision in treatment of digital mucoid cysts was shown to be effective and safe. However, possible advantages and disadvantages of this treatment option should be discussed with the patients before a decision on the kind of therapy is reached.

Dermatoscopic pattern of digital mucous cyst: report of three cases

Digital mucous cysts are benign ganglion cysts of the digits typically located on the dorsal aspect of the interphalangeal joint and distal phalanx of the digits. Usually the clinical diagnosis is straightforward, though sometimes it may mimic other lesions and diagnosis becomes a challenge. We present a series of three digital mucous cysts with a repeatable dermoscopic pattern consisted of linear branched and serpentine vessels when no compression is applied and translucent aspect with white bright areas and loss of vascular pattern when compression is applied.

[Myxoid pseudocyst: when and how to treat?]

Myxoid pseudocysts (MPCs) are the most frequent pseudotumors of the digit and dermatologists are frequently referred. It is now believed that MPCs occur as a result of a leakage of synovial fluid through a breach in the joint capsule of the distal interphalangeal joint promoted by osteoarthritis. Many treatments have been proposed from simple repeated punctures, injections of steroids or sclerosants, cryosurgery, laser evaporation, infrared coagulation to surgical excision. Surgical procedures depend on the location of MPCs in the nail apparatus. In this review, we will discuss the best approaches to the treatment of MPCs whereas no guidelines are available for their management.

Digital Mucous Cysts

Background:

Digital mucous cyst (DMC) is a common benign condition, but consensus has not been reached regarding its pathogenesis and treatment.

Objective:

This review provides a concise overview of DMCs.

Methods:

The review presents the literature pertaining to the etiology, pathogenesis, classification, clinical features, epidemiology, differential diagnoses, diagnosis, and management of DMCs.

Results:

DMCs have a predilection for middle-aged patients, a good prognosis, and a high recurrence rate. DMCs may occur in one of three locations on the distal digit. They arise owing to a metaplastic or degenerative process. Preexisting osteoarthritis is common and may be an etiologic factor in patients with DMCs. A number of conservative and surgical treatments are available depending on the structures and locations involved.

Conclusion:

Studies with greater sample size and longer follow-up would enrich current knowledge of the benefits, recurrences, and complications for each treatment modality.

A case of herpetiform appearance of digital mucous cysts

A digital mucous cyst (DMC) is clinically characterized by a round to oval, translucent, smooth nodule localized to the dorsal aspect of the distal digits near the distal interphalangeal joint. It usually presents as a solitary lesion, and multiple lesions are uncommon. An 88-year-old man presented with herpetiform translucent papules on the right thumb. We first diagnosed the lesion as molluscum contagiosum or herpetic whitlow. Histopathology showed a cystic space containing mucinous material and numerous fibroblasts surrounded by mucinous stroma in the upper dermis. The lining of the cyst wall was not apparent and mucinous material was stained with Alcian blue, indicating a diagnosis of DMC.

Nail changes and association of osteoarthritis in digital myxoid cyst

BACKGROUND

Digital myxoid cyst is relatively common on the digits. Nail changes and osteoarthritis are usually associated with this pathogenesis.

OBJECTIVE

The objective was to clarify this relationship and its significance by analyzing the clinical, radiologic, and pathologic data.

METHODS AND MATERIALS

Fifty-one patients with digital myxoid cysts were diagnosed and analyzed during a 5-year period.

RESULTS

Thirty-eight (74.5%) of 51 patients showed radiologic evidence of primary interphalangeal joint osteoarthritis in the affected digits. Among the 39 cysts removed surgically and examined pathologically, 28 were myxomatous and 11 were ganglion. Different clinical manifestations of nail change, including longitudinal grooves (20 cases), concave canaliform dystrophy (9 cases), "washboard" transverse lines (5 cases), and longitudinal grooves with beaded ridges (1 case) were found.

CONCLUSION

Osteoarthritis of the adjacent terminal joint is an important factor involved in forming digital myxoid cysts. Of the two cyst types, ganglion cysts are related to osteoarthritis more often than myxomatous cysts. Nail changes, secondary to matrix damage, are reliable clinical signs of underlying cyst formation. Understanding the pathogenesis of the digital myxoid cyst in relation to osteoarthritis and nail deformity helps inform the care of these patients.