Post-Traumatic Epidermoid Cyst of the Palm-Case Report and Review of the Clinical Characteristics and Differential Diagnosis with Tenosynovitis

手掌創傷後產生的表皮囊腫－病例報告和臨床特性回顧以及與腱鞘炎鑑別診斷

劉恭志(Gong-Jyh Liou) ； 陳宏基(Hung-Chi Chen) ； 張家寧(Chia-Ning Chang) ； 吳肇毅(Chao-I Wu) ； 李宗勳(Tzong-Shiun Li) ； 許永昌(Yung-Chang Hsu) ； 陳信翰(Hsin-Han Chen)

《臺灣整形外科醫學會雜誌》 21卷2期 (2012/06) Pp. 149-157

https://doi.org/10.7096/TJTSPS.201206.0149

摘要

背景：表皮囊腫是最常見的皮膚囊腫，它幾乎呈現在任何的皮膚表面。表皮囊腫是一個凸出、圓形、光滑表面並且可自由移動的不同大小的腫塊。不到10％的表皮囊腫發生於四肢，出現在手掌和腳掌的機會更少。目的及目標：於此，我們報告一個左手掌表皮囊腫的病例。超音波檢查時，破裂的表皮囊腫可能與腱鞘炎相似。因此我們回顧關於表皮囊腫的臨床特性以及與腱鞘炎的鑑別診斷的相關文章。材料及方法：一名17歲男性病人3年前其左手手掌意外被圓規刺傷，它癒合後形成一個可觸及且輪廓明確的皮膚腫塊。約4個月前，他接受切開引流手術，但腫塊持續存在，並且有黃色分泌物排出。超音波檢查結果傾向是腱鞘炎。我們安排手術探查，而腫塊被完全切除。結果：病理報告確定診斷為一個破裂的表皮囊腫。為期一年的後續追蹤沒有復發的情形出現。結論：創傷後產生的表皮囊腫主要發生在手掌、手指和足底。超音波檢查時，破裂的表皮囊腫可能與任何其他軟組織腫塊或疾病相似。因此，縝密的病史詢問和身體檢查是幫助確診的最重要因素。完全切除囊腫是最佳的治療選擇。

並列摘要

Background:Epidermoid cyst is the most common cutaneous cyst, and it can occur on almost any skin surface. It often presents as a bulging, round, smooth-surfaced, and freely mobile mass with variable size.Less than 10% of epidermoid cysts occur on the extremities, and even fewer occur on the palms and soles.Aim and Objectives:Herein, we report a case with an epidermoid cyst of left palm. Sonographically, ruptured epidermoid cysts may mimic tenosynovitis. Articles about the clinical characteristics of epidermoid cysts and differential diagnosis with tenosynovitis are reviewed.Materials and Methods:A 17-year-old male patient had an accidental penetrating injury to his left palm from a compass 3 years ago, and it healed as a palpable and well-defined skin mass. He received incision and drainage about 4 months ago, but the mass still persisted with yellowish discharge. Ultrasonographic findings were in favor of tenosynovitis. We performed exploratory surgery, and the mass was excised completely.Results:The pathologic report confirmed the diagnosis of a ruptured epidermoid cyst. There was no recurrence after a one-year follow-up.Conclusion: Post-traumatic epidermoid cysts occur mainly on palms, fingers and soles. Sonographically, ruptured epidermoid cysts may mimic any other soft tissue mass or disease. A thorough history taking and physical examination are the most important factors for definite diagnosis. Complete excision is the curative treatment of choice.

並列關鍵字

epidermoid cyst ； inclusion cyst ； palm ； trauma ； tenosynovitis