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Xanthomatous synovial cyst (Xanthomatous ganglion cyst)

Deba P Sarma, MD Omaha

M 74, left proximal palm, cystic mass

Well-circumscribed multiloculated cyst in the subcutaneous tissue showing lobular aggregates of clear cells in the fibrocollagenous septae between the cystic spaces.

Cyst contains clear fluid. Lumen of the cyst is lined by flat spindle cells. Note the aggregates of clear cells with small dark nuclei.

The clear cells have foamy cytoplasm and uniform, dark round nuclei.

On high power, the clear cells are lipid laden foam cells (xanthoma cells).

A multinucleated giant cell containing foreign material (non-polarizing) is noted in the lesion suggesting prior injection In the cyst.


Synovial or ganglion cyst with aggregates of foam cells.

May be a secondary histiocytic response to previous intralesional injection.