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• W2007402341 abstract "Sir: Most hand masses or tumors are benign. Ganglion cysts are the most common benign hand masses. They are often diagnosed on physical examination by their location and ability to transilluminate with a penlight.1 Typical locations include the dorsal and volar wrist, and the flexor tendon sheath. Lesions that do not transilluminate with a penlight are more likely to be solid masses that may require biopsy or excision for a definitive diagnosis. The literature on transillumination as it applies to the evaluation of hand tumors is sparse. It is mentioned as a diagnostic aid for ganglion cysts.2 We recently treated two patients with hand tumors that transilluminated as if they were ganglion cysts but that were actually solid peripheral nerve tumors. Our work corresponds with the ethical principles outlined by the Declaration of Helsinki (http://www.wma.net/e/policy/b3.htm). A 23-year-old man presented with a right dorsal wrist mass of 1 year's duration. This mobile 2.5-cm mass was located in a typical location for a dorsal ganglion cyst. It transilluminated with a penlight. Needle aspiration of the mass, however, yielded no fluid. An incisional biopsy of the solid tumor was performed. Pathologic examination revealed benign schwannoma (neurilemmoma) with significant Antoni B areas (hypocellular myxomatous areas). The mass was then excised completely. A 56-year-old woman presented with a “tender bump” on her left ring finger. It was a mobile 1-cm mass located on the volar surface of her left fourth proximal phalanx, and it transilluminated with a penlight. Needle aspiration revealed no fluid. An excisional biopsy was performed and the mass was found to be a solid lesion that easily separated from surrounding structures (Fig. 1). Pathologic evaluation revealed a benign peripheral nerve sheath tumor, a neurofibroma. There were significant Antoni B areas (Fig. 2).Fig. 1.: (Above) Transillumination of tumor with penlight. (Below) Excisional biopsy of tumor that proved to be solid.Fig. 2.: Histopathology of the mass showing predominance of hypocellular, myxomatous tissue (Antoni type B).Ganglion cysts commonly transilluminate on physical examination. Previous studies cite preoperative misdiagnosis of peripheral nerve tumors in the hand as ganglion cysts but do not mention the fact that these nerve tumors might transilluminate on examination.3,4 A mass “transilluminates” when it “lights up” with a penlight as if it were a water balloon under the skin. This subjective assessment usually implies that the mass has a relatively high water content. The abnormalities of both of our cases contained significant Antoni B areas. These hypocellular regions represent myxoid degeneration, with high water content.4 We theorize that peripheral nerve tumors with large Antoni B areas are more likely to transilluminate than tumors without large areas of myxoid degeneration. Transillumination is a helpful clinical tool for distinguishing between cystic and solid hand masses. However, transillumination is only part of the clinical evaluation and can be misleading. Further workup including aspiration, biopsy, or magnetic resonance imaging may be appropriate as determined by the clinical presentation. In light of these two cases, it should be noted that solid benign peripheral nerve tumors of the hand can transilluminate and be mistaken for ganglion cysts. Steven B. Daines, B.A. University of Washington School of Medicine Seattle, Wash. Robert J. Strauch, M.D. Department of Orthopaedics Columbia University New York, N.Y. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. ACKNOWLEDGMENT The authors thank the Pathology Department at Columbia University for their help." @default.
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• W2007402341 date "2010-02-01" @default.
• W2007402341 modified "2023-10-18" @default.
• W2007402341 title "Not All That Transilluminates Is a Ganglion Cyst: Two Transilluminating Solid Nerve Tumors of the Hand" @default.
• W2007402341 cites W1984366170 @default.
• W2007402341 cites W2114583246 @default.
• W2007402341 doi "https://doi.org/10.1097/prs.0b013e3181c7263a" @default.
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