Intraosseous Epidermoid Cyst of the Distal Phalanx-A Case Report

遠位指骨之骨內上皮樣囊腫－個案報告

劉品含(Pin-Han Liu) ； 李曜洲(Yao-Chou Lee)

《臺灣整形外科醫學會雜誌》 31卷2期 (2022/06) Pp. 135-141

摘要

Background: The intraosseous epidermoid cyst is a rare benign tumor and usually occurs in the skull and digits. Diagnosis relies on the awareness of this disease so as to avoid any unwanted overtreatment, such as digital amputation, in fear of the malignancy due to the presence of bony destruction. The common treatment is complete excision with curettage. Simultaneous bone grafting to prevent the future pathological fracture is also suggested. Aim and Objectives: We presented a case with an intraosseous epidermoid cyst at distal phalanx who was treated by curettage without the use of bone graft. The subsequent osteogenic remodeling was promising, precluding the need of bone graft. Materials and Methods: A 33-year-old woman complained of a bulging mass with intermittent tenderness at the distal phalanx of right ring finger for 2 years. The radiography showed an expansile osteolytic lesion within. The tumor was removed by curettage without the use of bone graft. Results: The pathology revealed an epidermoid cyst. Postoperative course was uneventful. In 1-year follow-up, there was no evidence of tumor recurrence and the destructed distal phalanx had no pathological fracture. Furthermore, the osteogenic remodeling was observed even without the use of bone graft. Conclusion: For its rarity, there is no consensus for the treatment of the intraosseous epidermal cyst in the phalanx. We reported a case that was successfully treated by complete removal of the cystic wall only but without simultaneous bone grafting. The subsequent osteogenic remodeling precluded the need of secondary bone grafting and minimized the risk of pathologic fracture.

關鍵字

intraosseous epidermoid cyst ； phalanx

並列摘要

背景：骨內上皮樣囊腫為一罕見良性腫瘤，好發於顱骨及指骨。診斷上必須認知到有此種疾病，才能避免誤診為惡性腫瘤而採取不當的過度治療（例如：截肢）。常見的治療為手術刮除腫瘤，並同時做骨移植以預防病理性骨折。目的及目標：本篇報告一個遠位指骨之骨內上皮樣囊腫，經由刮除的方式移除腫瘤，並且在未使用骨移植的情況下達到良好的預後。材料及方法：一位三十三歲女性近兩年來在右手無名指的遠位指骨上有一個逐漸增大的突起並伴隨壓痛，影像上呈現的是一個骨內膨大的蝕骨性病灶。此病灶經由刮除的方式去除，且未使用骨移植物填充指骨內的空洞。結果：病理結果顯示此為一骨內上皮樣囊腫，術後恢復狀況良好，在一年的追蹤下，沒有復發或病理性骨折的現象。除此之外，原本的指骨內空洞也經由骨質再生填滿。結論：由於骨內上皮樣囊腫相當罕見，針對此疾病並沒有治療上的指引。本篇報告一個刮除後並未使用骨移植卻達到良好骨質重塑的案例，同樣地也能減少病理性骨折的風險。