Synovial metaplasia has been described in bone or soft tissues following surgical procedures or under experimental conditions. Three cases in which skin biopsies showed synovial metaplasia of the dermis are herein reported. The metaplastic foci were associated with cyst formation and transepidermal fistulae. All patients had a history of previous surgical procedures in the area, and in all, the lesions clinically resembled suture granulomas. Microscopically, the lesions bore a striking resemblance to hyperplastic synovium. The immunohistochemical studies showed strong staining with vimentin and scattered positivity with alpha-1-antichymotrypsin (alpha-1ACT) and lysozyme. No basement membrane antigens or elastic fibers were demonstrated. We believe that the name "metaplastic synovial cyst" is an appropriate pathologic designation for this entity. An increased awareness of its occurrence will help to establish its true incidence.
"On the other hand, CMSC, which was first described by Gonzalez et al.5 in 1987, is rare and unfamiliar to most dermatologists. Although the etiology is not proven, a history of preceding surgery or trauma was present in most cases1-7, and some cases occurred in patients with basal cell carcinoma12, Ehler-Danlos syndrome13 and rheumatoid arthritis14. "
[Show abstract][Hide abstract] ABSTRACT: Cutaneous metaplastic synovial cyst (CMSC) refers to a cyst lined by metaplastic synovial tissue including villous structures. It is thought to be a tissue reaction to local trauma, and most cases have a history of preceding surgery or trauma. Clinically, most of the lesion is a tender intradermal nodule that is associated with scar tissue. However, dermatologists have difficulty in diagnosing CMSC because CMSC is reported only rarely and its clinical manifestation can be confused with implantational epidermal cyst, suture granuloma or other cutaneous cysts. Thus, a histopathological exam is mandatory for diagnosis of CMSC. Herein we report the case of an 18-year-old man who developed CMSC on the left cheek on the posterior ramus of the mandible. He had a history of repetitive digital manipulation of the lesion before the onset of CMSC.
"CMSC lesions have been often misdiagnosed as suture granuloma given that the lesions are clinically associated with a surgical scar and observed as erythematous and painful subcutaneous nodules1,2,4,6,7. To this point, there have been two cases of multiple occurrences of CMSC6,11 and a single case of recurrent CMSC8. "
[Show abstract][Hide abstract] ABSTRACT: A cutaneous metaplastic synovial cyst (CMSC) is a cyst lined with metaplastic synovial tissue, which includes the formation of an intracystic villous structure resembling hyperplastic synovial villi. Clinically, the lesion is a tender, subcutaneous nodule that usually occurs at the site of previous surgical trauma and is frequently misdiagnosed as a suture granuloma. The actual cause remains unclear; however, trauma is presumed to be a precipitating factor, as most reported cases have demonstrated a history of antecedent cutaneous injury. Here, we present a case of CMSC in a 51-year-old woman who presented with a cystic mass localized in the left sole. She had no history of previous trauma or surgical procedures performed in the area. Although the case explained in this report is a spontaneous case of CMSC that occurred without a history of trauma, it is believed to have been caused by constant and chronic pressure since CMSC occurred in the first metatarsal head area, a part of the sole where heavy pressure is consistently applied.
[Show abstract][Hide abstract] ABSTRACT: Metaplastic synovial cyst, a recently described entity, is histologically characterized by a cystic cavity lined by metaplastic synovial tissue that is often hyperplastic and protrudes into its lumen as villous structures. Clinically, these lesions resemble suture granuloma and develop at the site of previous surgical trauma. We have studied 4 cases of this unusual entity and have investigated the immunohistochemical profile in an effort to determine the nature and derivation of their lining tissue. One of our cases is unique since the lesion was associated with a basal cell carcinoma. A history of previous surgery was noted in one, and history of trauma in 2 of the 4 cases. Our immunohistochemical observations confirmed a mesenchymal derivation for the "synovial like villous structures" but non-availability of a specific "synovial" marker does not permit us to conclude with certainty the synovial nature of the metaplastic tissue. Cutaneous metaplastic synovial cysts are unique lesions which deserve attention and should be included in the differential diagnosis of cutaneous cysts.
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