stuff about cysts

dee-dee

doc ira...just wanna ask. i have a cyst kc on my ryt breast...actuallly i discovered it a year ago. n last may i went to an ob-gyne, after a series of ob-gyne's who said i have to removed it, and since takot ako sa surgery she prescribed me some medicine...parlodel...eh after taking it...andun pa rin yung cyst. next week i'm going to another ob-gyne. do i really have no option but to have it removed? and what is it about cysts? i guess may family history kami ng mass...but i hope it doesn't develop into something serious...i mean i'm still 18!!! :(

Ira

Breast cysts at your age are usually either fibrocystic disease, which are cysts which enlarge around your menstrual period (this one should respond to Parlodel), or fibroadenoma, a benign type of mass (which is what you probably have). I seriously doubt if it's malignant, given your age, but since you have a family history of tumors, I would suggest that you have it excised and removed for your peace of mind. Cysts do grow larger, and since it did not respond to Parlodel, I don't think your cyst will shrink and disappear anymore. I don't think you'll want to wait for it to grow big, either, before you decide to have it taken out (the larger the cyst, the bigger the surgical scar). And don't worry about the surgery. It's a very, very minor outpatient procedure, done under local anesthesia, and will not even last half an hour. The pain is very minimal.

angelicDAW

i had a cyst removed too, but my doctor is an oncologist (i think) and he has a really good reputation. my cyst was not malignant at all, and he explained to me that cysts could be either just this thing filled with water or a solid mass. mine was solid so he can't just inject the water out. the surgery was painless and it's actually quite short. i would suggest u have it removed too, if u want u can call my doctor. his name is samuel ang and u can reach him at cardinal santos.

hat_tr1ck

I was diagnosed last weekend to have multiple tendon cysts on my right thumb. Just what is a tendon cyst and how does one get it? Does playing with the Playstation too much have something to do with this, since I mostly play car racing games that last for over an hour, which necessitates the use of my right thumb almost all the time? If so, does that mean that the ergonomics of the Playstation, to a certain degree, is at fault?

Ira

Ganglion tendon cysts are harmless, synovial fluid-filled cysts attached to tendons or joints. The exact cause of ganglion cysts is not known, although some people theorize that when we use and/or abuse our hands (in your case, your thumb) during activities, our muscles and joints squeeze the fluid and create pressure in the lubricating compartment. A small portion of fluid leaks out of the compartment, forming a lump.

FJ7

i had one removed too from my left breast.. i just want to ask if the pain is normal.. i mean it has been 2 or 3 years since... sometime it has this pricking kind of pain once in a while... it's in the part where the scar is... there's this kind of hard mass... i tried to use my thumb to see it moves or if it is stationary.. it's stationary... i thought maybe the place where the cyst has been removed has hardened or something... i just have this fear that another cyst will grow from it and i'll have to have another operation... does the pain mean something????

Ira

I assume the histopath was normal?

Post surgical pain on the operative site is an expected reaction due to the scarring and fibrosis inside. Sometimes, when it's cold, or when you do physical activities, you'll experience twinges of pain. This may last for years, and as long as the removed mass is benign and the pain is in the operative site, you have nothing to worry about. Pain is not really a frequent symptom when you're talking about malignancy.

hat_tr1ck

Originally posted by Ira
Ganglion tendon cysts are harmless, synovial fluid-filled cysts attached to tendons or joints. The exact cause of ganglion cysts is not known, although some people theorize that when we use and/or abuse our hands (in your case, your thumb) during activities, our muscles and joints squeeze the fluid and create pressure in the lubricating compartment. A small portion of fluid leaks out of the compartment, forming a lump.

Thanks for the info, Doc Ira!

Another question though a bit off-topic: I was at the PGH yesterday to have the cyst checked out and see what action needs to be taken. Three male doctors were looking at it. Nothing wrong there, right? But then one of the doctors (the most senior one I gather since they all deferred to him) made a comment that I feel was said at the most inopportune time; "Ipaputol na lang natin 'yan," to which the rest gamely laughed.

Honestly Doc, I felt insulted. It's like they were making fun of one's affliction. Is it normal for doctors to do this and I'm just being a tad too sensitive or were they so used to cases like mine they just became callous individuals who can make fun of one's distress? In any case, what action can you recommend? I wouldn't want future patients to experience what I went through in having my cause of distress as a source of "good-natured fun" among doctors.

munik

Hiya Doc!

I had a cyst removed more than a year ago. It's in my right knee and biopsy revealed no malignant cells. My oncologist had a little difficulty in removing them because according to him, ang dami na raw anak ng cyst and medyo malapit sa bone. Before he closed the incision, he made sure na wala nang natira which took a little time dahil nga spread out na raw yung mga anak nung cyst.
The problem is, I have them again. I don't know if there was something left which grew back or bago na naman. I can feel with my fingers two masses na parang kasing laki ng monggo. Same spot, same kind of cyst, gumagalaw, lumalaki na naman.

What do you think should I do? Have them removed again? If ever I do have them removed again, baka naman tumubo lang ulit, di na ko matatapos nagpapaalis ng cyst.
I haven't talked to my oncologist yet, di pa niya alam that I have them again. I'm thinking of seeing a different doctor this time, baka kasi may naiwan lang siya kaya meron na naman.

By the way, four other people in my family have a cyst of some sort. Two of them had theirs removed but theirs didn't grow back.

Thanks a lot.

Ira

You didn't tell me what exactly the histopathology results are, but if the lesions before were benign and cystic, chances are, what you have right now is the same thing which just regrew. Anyway, the endpoint of your problem is you'll undergo surgery anyway if the cyst enlarges. Undergoing early surgery, if your orthopedic sugeon advices you to, means that you won't get as much problems now compared to when you delay the surgery until the cyst becomes larger.

hat_tr1ck

Doc Ira, who/what/where do I complain in a hospital regarding the doctors who had a jolly good time laughing about my predicament?

And since it's definite my thumbs gonna be operated on by cutting up my thumb pad, what's going to happen to my thumb mark? Is it going to change drastically or there won't be any real change afterwards?

Ira

I don't think the orthopedic surgery resident made that remark maliciously--knowing the general personality of the PGH ortho residents, that remark was just made in jest, since the PGH ortho people have always been known as maloko and palabiro. It's a bit tactless for the orthopedic resident to make that comment, but unless they give you the wrong medical treatment, the worst thing you can do with poor "bedside" manners is to write the PGH Orthopedic Surgery Department Resident Training Officer about it. No guarantees that your complaint will get anywhere, though.

hat_tr1ck

Now Doc Ira, I have a question about my thumbmark and the operation. Since the cysts are located on my thumbpad (is that what you call where the fingerprint is?) and on the side of my thumb, I was wondering what's going to happen to my thumbmark?

It's quite certain that the doctor will extract the cyst by going through my thumbpad. My question is, what'll happen to my thumbmark? Will my thumbmark be altered drastically by having a big, permanent scar on it or will it heal just fine leaving only a faint scar? Or does it all depend on how good the doctor is?

I'm sorry if I ask too many questions, it's just that I'm scheduled to have it operated on sometime this week and honestly, I'm afraid of blood.

Dog_Lover

Ira, allow me to answer some of Hat_trick's queries....

The thumbpad is a layman's term. Technically, the area where the fingerprints are located
is called the "pulp". So in this case, the thumb pulp.

The thumb pulp is very rare and unusual location to find a "tendon cyst". Anatomically, the last
tendon and sheath attachment in the palmar surfarce of the thumb is at the base of the thumb's distal phalanx which
corresponds to an area just adjacent(mm) to the joint where the thumb bends/flexes on itself and where you see
a skin crease. The final histopath will reveal what it is exactly. I personally think its a palmar fibroma - a benign tumor nevertheless with the same management- excision. But I don't have the benefit of a physical exam....

Your surgeon would probably be approaching the cyst through a lateral incision or a side incision in the thumb instead of
cutting directly over the pulp until the cyst is exposed. The finger pulps are abundant in nerve endings because these parts serve as very sensitive receptors of tactile stimuli, so a direct incision through the pulp will potentially produce more post-operative pain and might produce a painful scar upon healing or diminished sensation in the involved area. Incisions through the pulp are also observed to produce contracted scars. So to avoid these problems, the lateral approach is ideal. You can discuss all these with your surgeon and he can explain the reasons if he intends to utilize a direct incision, which may be necessary in some cases.

A finger tourniquet is routinely used to keep the surgical field devoid of any bleeding, "almost bloodless" and easier to work in.
Local anesthesia and mild sedation is enough for this quick procedure, at most a regional anesthesia block (wrist or axillary). General anesthesia is an "overkill" but may be requested if you're the very anxious type.

Don't worry too much about the procedure. It's simple and safe.

munik

Originally posted by Ira
You didn't tell me what exactly the histopathology results are, but if the lesions before were benign and cystic, chances are, what you have right now is the same thing which just regrew. Anyway, the endpoint of your problem is you'll undergo surgery anyway if the cyst enlarges. Undergoing early surgery, if your orthopedic sugeon advices you to, means that you won't get as much problems now compared to when you delay the surgery until the cyst becomes larger.

Guess i really have to have it removed again then. Thanks.

Ira

You're welcome, munik. And again, thanks, Dog_Lover.

hat_tr1ck

Thanks for the info, Dog_Lover. Since I'm afraid of blood, being able to get a local anesthesia for my procedure is very comforting to know.

Dog_Lover

You're welcome (Ira and Hat_trick).

I'll be glad to share my inputs regarding orthopedic problems and questions in the future. Althoug Ira, really does one heck of a great job in this forum as moderator. Mapa-OB,mapa-Derma,mapa,-Pedia,mapa-I.M.,mapa-Neuro,mapa-Surgery,etc. kaya niya lahat.

rating: 41/2 stars out of 5 *okay*

Ira

Thanks for the compliment, although my ortho professors and those I've assisted in orthopedic procedures would probably give me a 1/5 (if I'm lucky, that is). :teehee: So I'm glad (and grateful!) to have an orthopedic surgeon on board to answer questions. Again, thanks! :up:

pigarotti

the last time i had my fibroadenoma removed, i was wide awake and was assisted into the operating room. i felt like lying down on my own sacrificial table hehehe.. then they inject me with something to make me fall asleep.

lagi bang nasa operating room ginagawa yun? nde pwede clinic? mas freaky kse pag sa O.R. e

i think kaya ako pinatulog, kse ayoko makita pinanggagawa nila. i can just imagine hearing the doctor asking for a knife or something..

eyedoc

The beauty of doing surgical procedures is that the doctor is ready for anything. For example, if a patient's blood pressure goes up, he can give something for it. If there is a change of plan during the surgical procedure, the necessary materials and instruments are close at hand. There is complete monitoring equipment. There are resident doctors who assist you. Also, the environment is sterile (you don't want to pick up microorganisms while you have an incision, do you?)