RESUMO
Primary tumoral calcinosis is a rare and benign condition characterized by calcium salt deposition in periarticular soft tissues. It typically presents as a firm, rubbery mass that arises around large joints. While an estimated 250 cases have been described since its discovery, very few cases have been identified in the hand. We present a case of multiple calcified masses in the hand, one of which required meticulous dissection from a digital neurovascular bundle, and our technique for surgical excision. We present this case to lower the threshold for clinical suspicion of tumoral calcinosis for patients who present with a soft tissue mass in the hand. Furthermore, we recommend prompt surgical excision due to low success rates of alternative treatment options and to prevent potential neurovasculature or tendon injury.
RESUMO
PURPOSE: Giant cell tumors of the hand remain a treatment dilemma: treatment requires a balance between extensive dissections for excision versus risk of recurrence. There is no consensus regarding how best to manage this balance. The purpose of this study was to identify the recurrence rate of giant cell tumors of the hand, as well as the correlation with the specific tissue type involved. METHODS: Two hundred thirteen cases of giant cell tumor of the hand were recorded in a prospectively designed, anatomically based registry that identified tumor location and surgical planes entered and tissues excised during the procedure. Mean follow-up was 51 months. Demographic and follow-up data were also tracked. The primary outcome tracked was tumor recurrence. Statistical analysis was conducted using chi-square analysis and the Fisher exact test to determine which perioperative and intraoperative factors were associated with tumor recurrence. RESULTS: There were 27 recurrences among our cases. Tumors involving the extensor tendon, flexor tendon, or joint capsule had the strongest correlation with recurrence: 12, 8, and 12 cases, respectively. Conversely, there was only one recurrence among the patients who did not have any involvement of either the flexor or extensor tendons or joint capsules. There was no association for involvement of skin, neurovascular bundle, tendon sheath, or bone at the initial excision. No identifiable preoperative or postoperative factors were linked to recurrence. CONCLUSIONS: Our study shows that direct involvement of the extensor tendons, flexor tendons, or joint capsule puts patients in a high-risk category with respect to recurrence. Based on these findings, efforts regarding close monitoring and the role of adjuvant therapy should be directed at the high-risk population. This information may be helpful for hand surgeons developing evidence-based treatment algorithms for giant cell tumor in the hand. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.