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October 2001
Case submitted by Stephen M. Schleicher,
MD
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CASE:
A 41-year-old woman requests treatment for a growth on her
finger. The lesion, which she first noted several months before,
has slowly increased in size. Although the growth is usually
asymptomatic, it has often been traumatized, because of its
location. The patient gives no history of arthritis or other
systemic disease.
Examination reveals a semitranslucent, flesh-colored papule
that is located on the distal phalangeal joint and measures
0.5 cm in diameter. Palpation does not elicit tenderness.
Puncture of the lesion with a no. 11 blade produces extravasation
of a jellylike fluid.
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The patient has a mucinous, or synovial, cyst.
Such lesions are found predominantly on the terminal digits
of the fingers, sometimes in association with osteoarthritis.
They present as bluish to flesh-colored nodules that generally
do not exceed 1.0 cm in diameter. Although asymptomatic, they
are prone to trauma. Pressure on the nail plate may lead to
distortion of the adjacent nail. The cysts are filled with the
viscous fluid mucin, which is thought to be extravasated from
the underlying joint space. Therapy is difficult, and the cysts
frequently recur even after surgical excision. |
Dr. Schleicher is director of the DermDx Centers for Dermatology
of Northeastern Pennsylvania and a clinical instructor of dermatology
at Graduate Hospital's City Line Campus in Philadelphia, Kings
College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
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