A 78-year-old woman comes to the office due to an enlarging growth on the right wrist for the past year. The growth does not bother the patient. Examination findings are shown in the exhibit. The lesion is round, rubbery, mobile, and nontender; it transilluminates on penlight examination. There is no overlying skin change. Grip strength and sensation in the hand are intact. Which of the following is the most appropriate initial management for this patient's condition?

Question

A 78-year-old woman comes to the office due to an enlarging growth on the right wrist for the past year.  The growth does not bother the patient.  Examination findings are shown in the exhibit.  The lesion is round, rubbery, mobile, and nontender; it transilluminates on penlight examination.  There is no overlying skin change.  Grip strength and sensation in the hand are intact.  Which of the following is the most appropriate initial management for this patient's condition?

Quizplus · Accepted Answer

11ec25c8_d86d_bc9c_bc81_6345c3daaf6f_MD0003_00 This patient has a ganglion cyst, a connective tissue outpouching arising from tendon sheaths, joint capsules, or bursae. Clear mucinous, gelatinous fluid accumulates in the sac, giving rise to a round, well-circumscribed, firm cyst that transilluminates on penlight examination. Ganglion cysts are found adjacent to the structure of origin, most commonly on the dorsal wrist. More than 50% of ganglion cysts resolve spontaneously and do not require treatment. Therefore, asymptomatic cysts can be observed. Cysts that raise cosmetic concerns or cause pain or paresthesia (due to nerve compression) can be treated with needle aspiration (Choice B). However, recurrence is common after aspiration, and patients may eventually need surgical excision for recurrent cysts (Choice E). (Choice A) Intralesional corticosteroid injection can be used for treatment of an inflamed epidermal cyst, which presents as a painful, nontransilluminating nodule with an overlying punctum. Corticosteroid injections are not indicated for ganglion cysts because they are unhelpful and can lead to subcutaneous atrophy. epidermal cyst (Choice D) Cyclic citrullinated peptide antibodies are specific for rheumatoid arthritis (RA). RA can be associated with subcutaneous rheumatoid nodules, which present as hard, fixed, nontransilluminating nodules at pressure points (not rubbery, mobile nodules at the dorsal wrist). RA typically affects the metacarpophalangeal and proximal interphalangeal joints; this patient's deformities, which are most prominent at the distal interphalangeal joints, are very typical for osteoarthritis rather than RA. rheumatoid nodules metacarpophalangeal and proximal interphalangeal joints Educational objective: A ganglion cyst is a connective tissue outpouching arising from tendon sheaths and joint capsules. It presents as a rubbery, mobile, transilluminating nodule, most commonly on the wrist. Most ganglion cysts resolve spontaneously, and asymptomatic cysts can be observed. References: Treatment of ganglion cysts. (http://www.ncbi.nlm.nih.gov/pubmed/24967120)

A 78-Year-Old Woman Comes to the Office Due to an Enlarging