stuff about cysts

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.

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?

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????

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.

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.

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.

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.

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

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..