Surgical Outpatient Department Research Articles

Advanced Hepatocellular Carcinoma in a Patient with Type 1 Neurofibromatosis

The rare case is reported of advanced hepatocellular carcinoma (HCC) in a 50-year-old male with type 1 neurofibromatosis (NF 1). The patient presented in the surgical outpatient department with a 4-year history of multiple neurofibromas over the trunk and complaints of pain in the right upper abdomen for 4 months, progressive weight loss and loss of appetite. Investigation for both the abdominal complaints and the multiple neurofibromas led to the diagnosis of advanced HCC (according to the Barcelona Clinic Liver Cancer Sstaging and Treatment Strategy) with NF 1, and the patient is being managed on oral Sorafenib as palliative treatment. NF 1 occurs due to mutation in the NF 1 gene located on 17q, which codes for the protein neurofibromin, which has a tumor suppressor function. NF1 presents rarely with malignancy, in which case tumors of the central nervous system are the most common type. To the best of our knowledge this is only the second documented case of NF 1 presenting with HCC.

A non-operative management of chronic anal fissure.

OBJECTIVESAssessment of efficacy of topical 0.2% glyceryl trinitrate ointment in the treatment of chronic anal fissure.PATIENTS AND METHODSA prospective study was carried out at surgical outpatient department Town Teaching Hospital from January 2017 to July 2017. Fifty consecutive patients were treated with 0.2% glyceryl trinitrate ointment and reviewed at 3, 6 and 12 weeks interval. Data was collected on a designed questionnaire.RESULTAt six weeks fissure healed in 70% patients. There was significant reduction in the symptoms of pain, bleeding and irritation. 30% Patient treated was not successful. At 03 months interval there was no recurrence with 70% healing rate. Patients whose fissure healed reported an improvement in bodily pain, health perception, vitality and mental health.CONCLUSIONThe use of topical 0.2% glyceryl trinitrate has proved to be as effective option in managing chronic anal fissure with 70% healing rate in this study bearable side effect and it leads to improvement in health related quality of life.

Pattern of breast ultrasound findings in Zaria, North Western Nigeria

Background: With increasing level of breast cancer awareness among Nigerians, more patients are presenting with breast symptoms. Ultrasound is relied upon significantly since mammographic facilities are few and breast magnetic resonance imaging is either too expensive or unavailable. Our study aimed at presenting the breast ultrasound findings among symptomatic and asymptomatic patients at Ahmadu Bello University Teaching Hospital, Zaria. Patients and Methods: This was a retrospective review of 603 patients who were referred from Surgical and general out-patient departments of our hospital for breast ultrasound scan between January 2015 and July 2017. Whole breast scans were performed using a single Mindray DC-8 (2011) Ultrasound machine, fitted with a 7–12 MHz transducer. The findings were described, recorded, and a final assessment category assigned using the American College of Radiology (ACR) Breast Imaging Reports and Data systems (BI-RADS) classification as follows: 1 (negative), 2 (benign), 3 (probably benign), 4 (suspicious), 5 (highly suggestive for malignancy), and 6 (known biopsy proven malignancy). Histological diagnoses were sought for abnormal ultrasound findings. Data analysis was done using Statistical Package for Social Sciences (SPSS) software for Windows version 20, Chicago, IL. Results: The patients comprised of 591 females and 12 males, with a mean age of 35.7 ± 13.0 years. The most common indication was breast lump (44.3%). BI-RADS 1 was the most common category (44.6%), followed by BI-RADS 3 (25.9%). Mass lesion was the most frequent sonographic finding (45.3%). Others were calcifications, 33 (5.5%); architectural distortion, 67 (11.1%); edema, 52 (8.6%); vascular lesion, 1 (0.16%); and ductal abnormalities, 55 (9.1%). The incidence of breast cancer increased with increasing age. Conclusion: Our predominant ultrasound findings were negative (normal or benign). This supports the use of ultrasound as a first-line diagnostic breast imaging modality in our community. Its added advantage of availability, radiation safety, and less cost makes it an indispensable tool.

Thyroid Function Test, C- Reactive Protein And Blood Lipids In Subclinical Hypothyroidism Patients Reporting At Surgical Wards

Objective: To investigate the thyroid function, C-reactive protein (CRP) and blood lipid profile in the subclinical hypothyroidism (SH) patients in surgical wards and outpatient department. Study design: Cross sectional study Place and Duration: Department of surgery, Isra University Hospital from August 2014 to May 2017. Materials and Methods: 100 subclinical hypothyroid cases and 100 controls were included according to inclusion and exclusion criteria. Serum TSH level > 6.2 (µIU /ml) with normal free T4 and T3 was considered as subclinical hypothyroidism. Venous blood was taken from ante cubital vein, centrifuged and processed. Sera were used for the assay of thyroid hormones, TSH, blood lipids and C-reactive protein. Data variables were analyzed by Statistix 8.0 (95% confidence interval) (P-value =0.05). Results: Age in controls and cases was noted as 51.3±12.5 and 50.8±11.95 years respectively. SH cases show serum T3, T4 and TSH as 0.89±0.18 µg/dl, 4.96±0.85 µg/dl and 11.95±2.85 µU/ml respectively. Serum total cholesterol, triglycerides and LDLc were raised with concomitant low HDLc in SH cases. C- reactive protein in SH cases was 6.91±3.38 ng/ml compared to controls 2.56±1.51 ng/ml (P=0.0001). Serum TSH showed negative correlation with HDLc, serum T3 and T4. Conclusion: The present study reports dyslipidemia with elevated inflammatory marker of C-reactive protein in subclinical hypothyroid patients.

Awareness about Anesthesia amid General Populace

Background: The public consciousness towards anesthesiologist and anesthesia is limited even in urban population. Our cross-sectional analysis highlights this lack of public awareness and discusses possible remedies to overcome these limitations. Materials and Methods: Surgical outpatient department was screened for 6 months period in King Abdulaziz Hospital. A questionnaire divided into three parts (awareness about anesthesiologist, consent, present surgical experience) was filled out for each patient. The patients on the basis of their answers were classified as aware or unaware, furthermore, source of patient data was analyzed. Results: Even with an exceptionally low threshold, only 44.86% of population could be categorized as aware, and commonest source of their information was not anesthesiologist but surgeon (56%). 89.7% patients were not aware of contents of pre-operative consent they had signed and further, only 21.4% were aware of anesthesia-related issues. Pain was reported as the most mutual pre-operative fear and post-operative patient concern. 40.2% patients due to lack of pre-operative counseling were not able to recognize the type of anesthesia and thought they had received both general anesthesia and spinal anesthesia. Finally, after explaining the role of anesthesia for surgery, 98.1% patients presented desire to meet the anesthesiologist before if they were to be operated in future. Conclusion: The awareness about anesthesia is particularly low likely due to low knowledge rates and lack of pre-operative counseling by anesthesiologist. Both patient and anesthesiologist should understand the significance of consent, as it is not only a legal binding but can eliminate pre-operative factitious fears of patients and can improve patient satisfaction towards surgery.

Community Screening of Prostate Cancer in Eastern Nepal

Background: Prostate cancer incurs a substantial incidence and mortality burden, and it ranks among the top ten specific causes of death in males.
 Objectives: To explore the situation of prostate cancer in a cohort of healthy population in Eastern Nepal.
 Methods: This study was conducted in the Department of General surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal in the department of surgery from July 2010 to June 2011. Males above 50 years visiting Surgical Outpatient Department in BPKIHS were enrolled in the study. Screening camps were organized in four Teaching district hospitals of BPKIHS in Eastern Nepal. Digital rectal examination (DRE) was done by the trained professionals after collecting blood for serum prostatic specific antigen (PSA). Trucut biopsy was done for all individuals with abnormal PSA, DRE or both findings.
 Results: A total of 1521 males more than 50 years of age were assessed and screened after meeting inclusion criteria. Maximum individuals 1452 (96.2% ) had PSA ≤ 4.0 ng/ml. Abnormal PSA ( > 4 ng/ml) was found in 58 (3.8%) individuals. Abnormal DRE was found in 26 (1.72%) individuals. Both DRE and PSA was abnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals were subjected to digitally guided trucut biopsy. Biopsy report revealed Benign Prostatic Hyperplasia in 47 (3.11%) individuals and adenocarcinoma prostate in 11 (0.73%) individuals. The specificity of DRE was 65.95% sensitivity 90.9% and positive predictive value 38.46%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostate was 100% and the positive predictive value for serum PSA was 18.96%.
 Conclusion: The overall cancer detection rate in this study was 0.73% and those detected were locally advanced. Larger community-based studies are highly warranted specially among high-risk groups.

Evaluation of Breast Masses by Sonomammography and X-ray Mammography in Correlation with Histopathological Findings

Abstract Introduction: Breast lumps are common presenting complaints in the female surgical outpatient department, which are due to varied breast pathologies. Breast infection most commonly affects women aged 18 to 50 years; in this age group, it can be divided into lactational and nonlactational infections. The process can affect the skin overlying the breast, where it can be a primary event, or it may be secondary to a lesion, such as sebaceous cyst or hidradenitis suppurativa. Aim: The aim of this article was to find out sonographic features of benign and malignant masses and correlate X-ray mammography and sonographic findings with histopathology with classification of all breast lesions according to the breast imaging reporting and data system final assessment categories (BI-RADS) (mammography). Materials and methods: This was a prospective diagnostic study conducted on 50 female patients from September 2015 to August 2016 in the Department of Radiodiagnosis in a tertiary care hospital. Results: In benign lesion, 24 (48%) of the patients had fibroadenoma, 2% intraductal papilloma, and 1 (2%) each had galactocele and tubercular abscess; in malignant lesion, 23 (46%) had ductal malignancy. Conclusion: The ultrasound features are helpful in differentiating benign from malignant masses. Classification of the lesions according to BI-RADS helps to improve the management of lesions.

A study on diabetes mellitus among diabetic foot ulcer patients in a tertiary care centre

Background: Diabetes mellitus is a chronic disease which occurs either when the pancreas does not reproduce enough insulin, the hormone that regulates blood sugar level or when the body cannot effectively use the insulin it produces. Hyperglycemia or raised blood sugar level is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the system of the body especially nerves and blood vessels. Diabetes mellitus has become the cause for growing public health concern in developing countries as it has been for a long time in most developed ones. The reason for increase in prevalence of diabetes mellitus in developing countries may include unhealthy life style, rapid westernization, poor knowledge, negative attitude and poor practice towards diabetes mellitus among general population. Objective of the study was to find out the knowledge, and awareness towards diabetes mellitus among diabetic foot ulcer patients attending in a tertiary care Centre.Methods: A cross sectional study was carried out in the surgical outpatient department of a tertiary care Centre. All diabetic foot ulcer patients attending surgical outpatient department for the period of two months was included. Juvenile diabetic patients, Type II diabetes mellitus patients with co morbidities are excluded.Results: Out of the 100-study participant’s majority are males (61%). 55% of the study participants are not aware of the major cause of diabetes mellitus. 92% of the population knew the accurate method of monitoring diabetes mellitus. 70.6% of people are aware of normal blood sugar level. 51% of people are aware of the complications of diabetes mellitus and 84.3% of people know the symptoms of diabetes mellitus. 68.6% of the population knew regular exercise can control diabetes mellitus yet only 50.8% of population exercise regularly.Conclusions: This study reflects that there is a need to improve diabetic knowledge among the patients which can be achieved through health education.

Laparoscopic versus Open Repair of Para-Umbilical Hernia- A Prospective Comparative Study of Short Term Outcomes.

Para-Umbilical Hernia (PUH) is one of the most common surgical problems. Since the prosthetic repair has become the standard of practice for inguinal hernia management, the same has been adapted for para-umbilical hernia management with better outcome. There is still debate going on regarding the optimal surgical approach. There are very few prospective studies comparing the laparoscopic and open method of para-umbilical hernia mesh repair. This study compared the short term outcomes following laparoscopic versus open mesh repair of PUH. To compare the early complications of open repair with laparoscopic repair of PUH. To compare the post-operative hospital stay of open repair with laparoscopic repair of PUH. This was a prospective comparative clinical study done from August 2014 to August 2016. All the patients above the age of 13 who attended our surgical outpatient department with PUH were taken into our study. Exclusion criteria included 1) Patients with obstructed or strangulated PUH 2) Patients with abdominal malignancies 3) Patients with coagulopathy, severe cardiopulmonary disease, ascites and renal failure 4) Patients who had PUH repair in combination with another major surgical operation such as laparoscopic cholecystectomy and inguinal hernia repair 5) Patients with recurrent PUH. Institute Ethical Committee clearance was obtained for this study. Out of 40 patients with PUH, 20 received open meshplasty and 20 patients received laparoscopic meshplasty. Postoperative pain and length of hospital stay is significantly less in laparoscopic PUH repair. Postoperative complications like wound infection, seroma, and haematoma are relatively less in laparoscopic group though statistically not significant. Laparoscopic PUH repair has significantly better outcome in terms of postoperative pain and postoperative hospital stay.

Hepatoid adenocarcinoma of stomach: a morphological curiosity

Hepatoid adenocarcinoma is a rare histological form of gastric cancer with a poor prognosis. We describe a 53-year-old woman who presented to the surgical gastroenterology outpatient department with a history of abdominal pain, vomiting and loss of appetite for one month. Laboratory investigations revealed anaemia (haemoglobin 5.6 g/dL). On gastrointestinal endoscopy, an ulceroproliferative growth was seen in the pylorus with gastric outlet obstruction. Endoscopic biopsy was suggestive of a well differentiated adenocarcinoma. Computed tomography of abdomen revealedirregular circumferential thickening of pylorus with perigastric and common hepatic nodes without distant metastasis. Patient underwent radical subtotal gastrectomy. The final histopathology was reported as hepatoid adenocarcinoma. Further immunohistochemistry with alpha-foetoprotein showed intense cytoplasmic positivity. She was treated with adjuvant Macdonald regimen. She developed liver metastasis eight months after surgery and received palliative chemotherapy. She died 13 months after surgery. Our experience and previous reports suggest that hepatoid adenocarcinoma is an aggressive cancer. Radical surgery and chemotherapy still remain the main stay of treatment.

Clinicopathological Profile of Breast Cancer Patients at a Tertiary Care Hospital in Kashmir Valley

Introduction: Breast cancer is the commonest malignancy in women worldwide. There are considerable variations in risk factors and presentation of the disease region wise. The present study aimed to describe clinical and pathological profile of breast cancer patients attending tertiary care hospital. Method: All consenting patients attending to surgical out-patient department (OPD) with complaints pertaining to breast disease were enrolled from 16th June 2015 to 15th June 2016. The patients were followed and demographic, clinical and pathologic information was recorded and analysed. Results: Total Of 180 patients with breast disease were enrolled. 34/100 were diagnosed of malignancy and formed the cases of the present study. Age of the patients ranged from 22 to 60 years with mean age of 42.06 ± 10.7 years. All the patients presented as breast lump variably associated with pain or discharge. Infiltrating Ductal Carcinoma Not Otherwise Specified (IDC NOS) was common histologic diagnosis (76.47%). Conclusion: Breast carcinoma presents with painless lump and patients are usually diagnosed in our setup at locally advanced stage. Implementation of the simple and effective screening programs for early detection is urgent need in our population.

A rare case of ganglion cyst of sternoclavicular joint diagnosed and treated by fine-needle aspiration cytology

Ganglion cyst although a common swelling observed near joints of hands and feet, it is extremely rare in the sternoclavicular joint. Diagnosis is usually based on clinical examination, radiological investigations, or fine-needle aspiration cytology (FNAC). We hereby report a case of an 8-year-old girl who presented to the surgical outpatient department with a nontender, nonerythematous swelling over the right sternoclavicular joint for 3 months. Ultrasonography revealed a cystic swelling measuring 0.4 cm × 0.3 cm × 0.3 cm. The diagnosis of ganglion cyst was finally confirmed on FNAC. The aspiration acted both as diagnostic and therapeutic modality thus avoiding surgery. The patient is under follow-up for the chance of recurrence.

Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica.

Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.

Surgical patient’s satisfaction with services at a tertiary hospital in south -south state of Nigeria

Background: Healthcare managers now incorporate patient centered care as a major component in the healthcare mission using patients assessment of the services rendered. These surveys have become routine as part of total quality management in developed countries. Periodic patient satisfaction surveys provide feedback to hospital management and staff regarding the quality of services rendered. Aims and Objectives: Our objective therefore was to investigate patients assessment and satisfaction of services rendered in the University of Uyo Teaching Hospital, Uyo, using the Surgery department as a case study. Study Design: cross-sectional. Setting: Surgical units and accident and emergency (A/E) unit of the University of Uyo teaching hospital. Materials and Methods: Structured questionnaires were administered on a of 130 surgical patients using systematic random sampling method, out of which 108 completed the questionnaire/interview and were included in the study. Results: Overall, 86.85% of the patients were satisfied with the services received from the University of Uyo Teaching Hospital, while 18.9% were dissatisfied, the remaining 4.45% non respondents. In assessing the service units; 82.61%, 90.00%, 83.00%, 70.59%, 85.72%, 77.97%, 84.64% and 96.60% of the patients were satisfied with services rendered at accident and emergency unit, Pharmacy, laboratories, blood bank, surgical wards, surgical outpatient department (SOPD), medical records and theatre units of the hospital respectively. In provider relationship, 91.90%, 93.7%, 90.63%, 86.20%, 92.30% and 84.20% were satisfied with the conducts of Doctors, Nurses, Pharmacies, Medical Records, Medical Laboratory Scientist, and administrative staff respectively. Patients were generally satisfied with the ease of assessing care in the hospital. However, waiting time of more than one hour for services at the SOPD, A&E, Laboratories, Blood bank, medical records, and pharmacy were 41.7%, 22.72%, 31.03%, 21.05%, 16.67%, and 14.29% respectively. Also, 37.51% and 22.25% of the patients were dissatisfied with cleanliness of conveniences and charges in the hospital respectively. Some others (7.4 %) of respondents were not happy with electricity supply in the hospital. Conclusion: There is high patient satisfaction in the University of Uyo Teaching Hospital, health workers need to be more responsive by reducing waiting time for consultation, improving electricity supply and keeping the conveniences more tidy and comfortable for patients. A more robust plan should be put in place to sustain and enhance patients care in this hospital.

A Study on Incidence and Risk Factors of Inguinal Hernia in ESI Population

Background: Inguinal hernia is one of the most common surgical pathologies. Research studies on clinical factors predisposing a person for the development of inguinal hernia, however, remain scarce. Aims and objective: the present study was to evaluate the incidence and risk factors for the development of inguinal hernia in adult males. Material and Methods: The study was done for a period of one year (January 2015 to December 2015) among the people attending surgical outpatient and inpatient department at Government Medical College and ESIC Hospital, coimbatore. Results: The study population included 130 patients with inguinal hernia , 95% were males and the majority 23% belonged to 41 to 50 years. Approximately 23.8% presented with bilateral inguinal hernia at the time of first presentation. The common risk factors found were heavy object lifting and chronic cough and other co morbid illness. Conclusion: The study had shown a slightly high incidence of bilateral inguinal hernia with the commonest risk factors being chronic cough and heavy weight lifting and affecting the productive group of Esi population.

Skin Sparing Fistulectomy with Primary Sphincters Repair by Special Sutures for Management of High Perianal Fistula

Background: Fistula in ano is a common disease seen in the surgical outpatient department. Many procedures are advocated for the treatment of fistula in ano. However, none of the procedures is considered the gold standard. Aim of this study was to evaluate our procedure in the managing high perianal fistula.

Incidence of colorectal carcinoma in patients with bleeding per rectum

Objectives: To determine the incidence of carcinoma of rectum and sigmoid colon in patients with bleeding per rectum using sigmoidoscope(rigid). Design Observational and interventional study. Setting A total of 231 patients attending surgical outpatient department from 1-1-2000 to 31-12-2002 with complaints of bleeding per rectum. Interventions: Per rectal digital and sigmoidoscopic examination was done in all patients. Biopsy taken of all ulcers, bleeding or hyperemic areas, polyps and growths and histological examination was done to determine the true positive case of rectal or sigmoid colon cancer. Results: Endoscopic Examination completed in 204 subjects. Three rectal and one growth at recto sigmoid junction were found (frequency 1.96%) three were males and one was female. The two growths in rectum were polypoid and one was annular involving whole circumference. The growth at recto sigmoid junction was fungating mass. All were Aden carcinoma. Three were well differentiated and one moderately differentiated sigmoidoscopy identified bleeding source in 197 subjects (96.6%). No significant complication was observed. Conclusion: Rectal and sigmoid carcinoma is less frequent in our population than western community. Sigmoidoscopy (rigid) is an important diagnostic tool in evaluation of bleeding per rectum with less frequent complications.

Diagnostic Accuracy of FNAC in Evaluation of Breast Lumps

Background and objectives: This study was conducted to compare the diagnostic accuracy of fine needle aspiration cytology (FNAC)in differentiating the benign and malignant lesions of palpable breast lump with histopathological correlation. Methods: This study was conducted at MNR MEDICAL COLLEGE AND HOSPITAL, Sangareddy , Telangana. The study included 50 patients who presented with palpable breast lumps to the surgical out-patient department. Thorough physical examination was done and the patients were subjected to fine needle aspiration cytology of the palpable breast lump. The cytological examination was classified as: Insufficient sample - C1, Benign - C2, Probably Benign - C3, Suspicious of malignancy - C4, Malignant - C5.All these patients were subjected to open/excision biopsy followed by histopathological examination. The diagnostic accuracy of the fine-needle aspiration was then compared with the gold standard histopathology. Results: Most of the cases were of benign pathology of which Fibroadenoma were most common (64%). It was seen that all the patients were female patients in the age group of 15-75 years. Majority of the lumps were found to be in the upper outer quadrant (46%). The sensitivity of fine needle aspiration cytology was found to be 83.33% , The specificity 100%, Positive predictive value 100% and Negative predictive value 97.77% . Conclusion: In patients with a palpable breast lump fine needle aspiration cytology can help to rule out a malignant lesion. This can hence afford as a cost –effective method in diagnosing breast lesions. Also due to its good tolerability and high diagnostic accuracy the patient need not be subjected to further evaluation which helps in the psychological well being of the patient. But, FNAC results when negative or suspicious should be correlated with clinical examination and imaging findings to prevent false positives and false negatives. A diagnosis suspicious for malignancy should be confirmed by open biopsy.

James Patrick Payne

James Patrick Payne, known to his friends as Jimmy, was born in Dalkeith, near Edinburgh, the eldest of four children. His family then moved to Larkhall, Lanarkshire, when his father...

Cutaneous Metaplastic Synovial Cyst.

A 31-year-old male patient presented to the surgical outpatient department at the Armed Forces Hospital, Muscat, Oman, in September 2014 with a swelling on the left side of his forehead that had been on-going for 10 months. A clinical examination showed a subcutaneous, mobile and non-tender swelling. He had a past history of a similar swelling at the same site, which had been operated on four years previously at another hospital. No reports were available regarding the nature of this previous swelling. At presentation, the swelling was diagnosed clinically as a recurrent dermoid cyst and was excised and sent for histopathological examination. The pale grey firm nodular mass (1.2 × 1.0 × 0.8 cm) showed a solid cystic mass when sliced. An irregular cyst lined by hyperplastic synoviocytes forming broad villi and papillae with hyalinised cores infiltrated by lymphocytes and plasma cells was observed on microscopic examination [Figure 1]. Foci of chond-roid metaplasia, haemorrhage and pigment-laden macrophages surrounded by skeletal muscle with atrophic changes and giant cell formation were noted. A histopathological diagnosis of cutaneous metaplastic synovial cyst (CMSC) was made. Immunohistochemistry (IHC) showed vimentin-positive [Figure 2A] and cluster of differentiation (CD) 68-positive [Figure 2B] synoviocytes. However, IHC was negative for pan-cytokeratin and CD34. Figure 1: Haematoxylin and eosin stain at ×4 magnification showing the cyst wall with broad papillae and villi lined by synoviocytes (red arrow) with hyalinised cores (black arrow) in a 31-year-old patient with a cutaneous metaplastic synovial cyst. Figure 2A & B: Immunohistochemistry stains at ×20 magnification showing (A) vimentin-positive (arrows) and (B) cluster of differentiation 68-positive (arrows) synoviocytes in a 31-year-old patient with a cutaneous metaplastic synovial cyst.