Kun-Chi Wua, b, Huan-Ming Tanga, Kuang-Ting Yeha, Dah-Ching Dingb, c
a Department of Orthopedics Surgery, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
b Institute of Medical Science, Tzu Chi University, Hualien, Taiwan
c Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
There has been recent interest in tuberculosis of the hand because of its rising incidence. Musculoskeletal tuberculosis accounts for only 20% of cases of tuberculosis. The most common musculoskeletal sites are the spine, hip and knee. Hand involvement is seen in 10% of patients with musculoskeletal tuberculosis. This study reports an unusual case of extrapulmonary tuberculosis in the soft tissues of the wrist, presenting as a ganglion cyst-like lesion with concurrent lung cancer. The condition occurred in a 55-year-old woman with underlying rheumatoid arthritis that had been diagnosed 3 years previously and was under control with regular medication. For several months the patient had noted a metapharyngeal joint mass in her right wrist and hand. The unmovable soft mass was approximately 2 cm × 2 cm in the metapharyngeal joint and 4.5 cm × 4.5 cm in the wrist, and displayed local tenderness and limited range of motion. Under the impression of a ganglion cyst-like soft tissue mass, the patient underwent marginal excision. However, the pathological report indicated tuberculosis. Antituberculosis treatment was prescribed. Simultaneously, lung cancer was also diagnosed. The patient then received chemotherapy and regular follow-up. Although the case described here is rare, preoperative evaluation can help considerably in early detection of cancer. Additionally, postoperative pathology can help define tuberculosis. Medical treatment plays a major role in tuberculosis.
Extrapulmonary tuberculosis; Ganglion cyst; Lung cancer; Wrist