Giant Cell Tumor of the Tendon Sheath of the Hand: Analysis of Factors Impacting Recurrence.

Background Giant cell tumors of the tendon sheath (GCTTS) of the hand are considered the second most common benign tumors of the hand after ganglion cysts. Excision biopsy is considered the standard treatment at present. They are notorious for having a very high rate of recurrence as given in many studies. Many factors are said to be associated with recurrence of the tumors. The goal of this study is to evaluate the long-term results of a series of 48 patients operated on at a single institute and to find out if there is any correlation between the proposed risk factors with recurrence. Methods A retrospective analysis was done in cases of GCTTS operated on between 2015 and 2021. The patients were invited for follow-up for a minimum of 2 years, and the patient files were reviewed. Further data were collected at follow-up including recurrence, range of movement, sensation, skin necrosis, scarring, and digital neuropathy. A data analysis was done. The correlation between the proposed risk factors and recurrence was calculated with the Pearson correlation coefficient. A p -value of less than 0.05 was considered statistically significant. Results During the 6 years, 48 patients were operated on. Recurrence was observed in eight patients (16%) at an average of 38.7 months from the time of surgery. Of the risk factors, tumors with satellite nodules and tumor adjacency to joint correlated significantly with recurrence. No complications were observed during follow-up. Conclusion GCTTS of the hand has a high propensity to recur. The presence of satellite nodules and proximity to interphalangeal joints are two important risk factors for recurrence. Magnification during surgery ensures complete excision of the tumor and reduces the chance of recurrence.

Digital Papillary Adenocarcinoma in the Dorsal Proximal Ring Finger.

Digital papillary adenocarcinoma (DPA) is a rare and aggressive tumor arising from the eccrine sweat glands. It is found on the hands and feet and most commonly occurs on the volar and distal finger tips. In this report, we describe a DPA in a 45-year-old woman who presented with a slowly enlarging mass on the dorsal aspect of her proximal ring finger. This report shows that DPA may clinically present as a relatively benign-appearing mass and in an atypical location. Surgical excision, followed by histologic and immunohistochemical evaluations of even benign-appearing digital masses, is important because this is the only way a DPA can be diagnosed.

Primary tumors of the hand: Functional and restorative management.

Primary malignant tumors of the hand are rare. Most cases present to clinics unaffiliated with cancer centers, making it incumbent on all hand surgeons to understand the pathology indicative of malignancy and the proper course of treatment of hand neoplasms. In this review, we report, based on tumor type, the anatomical considerations, proper management, staging, surgical approaches, reconstructive considerations, and long-term surveillance of primary malignant tumors of the hand.

Extra-Axial Chordoma of the Hand.

Chordomas are low-grade malignant tumors that are locally aggressive and have the potential to metastasize. They most often occur in the sacrococcygeal and spheno-occipital portions of the vertebral column. Morphologically similar tumors have been found outside the axial skeleton and are referred to as extra-axial chordomas. Several case reports have described the radiologic, microscopic, and immunologic profiles of these tumors and their similarities to axial chordomas. The authors report a 24-year-old man who presented with a mass in his left hand and underwent surgical excision. Specimens stained positive for pancytokeratin, S100, and brachyury. Brachyury is a protein that is present during embryogenesis and is expressed by chordomas. This is the first report of an extra-axial chordoma within the interosseous muscle compartment of the hand in a young patient.

Synovial Cyst of the extensor digitorum superficialis: A case report.

Background: A synovial cyst is a herniation of synovial tissue through a joint capsule, often mistaken for a ganglion cyst. The key distinctions are that synovial cysts have a synovial cell lining, while a ganglion cyst is delineated by dense fibrous connective tissue. Typically found near joints, synovial cysts are associated with conditions like osteoarthritis, prevalent in females aged 20 to 50. We present a rare case of a synovial cyst in the extensor digitorum superficialis of the right hand. Case summary: A 53-year-old Hispanic female visited our hand clinic due to a 3-year history of pain on the back of her right hand. At exploration, a 3 × 3 cm soft tumor was identified. Surgery revealed a clear-yellowish mass within the extensor digitorum superficialis tendon. Following the surgery, synovial cyst was confirmed by pathology and the patient was discharged without complications. Conclusion: This case highlights the rare presentation of an intratendinous synovial cyst and emphasizes the importance of a comprehensive understanding of synovial cysts in the differential diagnosis of hand tumors.

Post Traumatic Neuroma in Continuity of the Median Nerve in a Child: A Case Report.

An 8-year-old girl suffered a wrist laceration from a sharp glass, severing the median nerve. The nerve was end-to-end repaired at the time by a pediatric orthopedic surgeon. Six months later, the girl suffered wrist pain and hyperesthesia over the previous surgical incision, significantly affecting her daily activities. Physical examination revealed a palpable mass over the median nerve with a positive Tinel sign, and the diagnosis of a painful neuroma in continuity was set. She underwent another surgery where the defective neuroma in-continuity was excised, and the median nerve was reconstructed using sural nerve cable autografts. At 18 months follow-up after the second surgery, the girl appeared with a full passive and active painless range of motion and a negative Tinel sign. This is the first case of neuroma in continuity presenting in a child in the literature, successfully managed surgically.

Coexisting Benign Tumors in a Finger Are Rare but Not Impossible.

Giant cell tumors of the tendon sheath (GCTTS) and enchondroma are identified as the most prevalent benign soft tissue and bone tumors of the hand. While their individual presence is a common finding, their concurrent appearance in the same anatomic region is exceptionally rare, making simultaneous diagnosis more burdensome. We present a noteworthy case of GCTTS and enchondroma in the index finger of a young patient, along with the therapeutic strategy for correct diagnosis and effective treatment of such an occurrence.

Benign Hand Tumors (Part I): Cartilaginous and Bone Tumors.

Background: Benign tumors of the hand present in a wide array of histological subtypes and compose most of the bony tissue tumors in the hand. This study evaluates the characteristics and treatment of benign bone tumors in light of one institution's experience. Methods: Histologically confirmed benign tumors of the hand were retrospectively identified using International Classification of Diseases codes from 1992 to 2015. A medical chart review was conducted to collect patient characteristics and tumor epidemiology and treatment. Results: A total of 155 benign bone tumors were identified. The median age of patients at the time of surgery was 39.9 ± 12.8 years. All bone tumors were located in the digits, and most were treated by intralesional curettage (n = 118, 76%). Pathologic fractures occurred in 79 bone tumors (51%). Conclusion: Enchondromas (n = 118, 76%) were the most common bone tumor in this series, whereas giant cell tumors were the most destructive and also had the highest recurrence rate (40%). Awareness of tumor features may help physicians with diagnosis, and awareness of recurrence rates is important when counseling patients.

Fast growing myopericytoma of the hand: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Myopericytoma (MPC) is a rare benign soft tissue neoplasm that arises from perivascular smooth muscle-like myoid cells that share features of both glomus and smooth muscle cells. It usually slow growing solitary tumor that might mimic aggressive sarcoma. CASE PRESENTATION: 45 years old male, with unremarkable medical history, presented with fast growing mass on the left 1st webspace that was noticed 6 months prior to presentation. Investigations with US and MRI showed highly vascular solid mass that was worrisome for malignant lesion. Surgical excision was done and histopathology confirmed the diagnosis of myopericytoma. CLINICAL DISCUSSION: MPC is a rare perivascular neoplasm that's reported mainly in the extremities with lower limbs are most affected sites. Usually it presents as solid painless slowly growing mass. However, Multiple papers reported different rare presentations like multiple, painful and some with malignant transformation. CONCLUSION: MPC is a benign tumor that might mimic aggressive sarcoma. Such cases should be approached with high suspicion and proper investigation and management should be followed promptly.

Imaging Features of Primary Tumors of the Hand.

Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues, ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences, data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis, prognosis and therapy. The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.

Presentation and Management Outcome of Glomus Tumors of the Hand.

BACKGROUND: To document the clinical presentation of glomus tumors of the hand and evaluate the outcome of complete surgical excision in terms of relief of symptoms, any postoperative nail deformities and tumor recurrence over a period of one year. METHODS: This descriptive case series spanned over a period of twelve years. All patients of either gender and all ages who had histologically confirmed glomus tumors of the hands were included. All of them underwent surgical excision under local anesthesia. RESULTS: Out of 17 patients, majority (n=12; 70.58%) were females. The mean age was 41.17±13.7 years. The dominant hand was involved in 11 (64.70%) patients. There were 14 patients (82.35%) with subungual tumors whereas 3(17.64%) had volar pulp glomus tumors. The mean diagnostic delay was 18.88±9.3 months. The tumor size ranged from 2 mm to 1.1cm with a mean of 4.05±4.3mm. All the patients (n=17,100%) experienced complete symptomatic relief within 2-4 weeks after surgical excision. There were no postoperative nail deformities. There was no recurrence over a period of one year. CONCLUSION: Glomus tumors of the hands were more frequently found among women in their fourth and fifth decades. Dominant hand, index finger and distal phalanx represented the commonest affected anatomic locales. Majority of the tumors were subungual. Majority of the patients suffered over 12 months in distressful pain before being diagnosed. Complete surgical excision under local anesthesia provided rapid relief of the symptoms. Creation of awareness about the tumor among doctors as well as public would help to ensure early presentation to plastic surgeon, prompt diagnosis and hence avoidance of the prolonged periods of agonizing misery.

An Unusual Presentation of Large Glomangioma of the Hand.

Glomangiomas are rare and benign hamartomas that commonly occur in the upper extremities. It is not typical for benign glomangiomas to be larger than one centimeter in size, and they usually present as a faint, blue-red subungual papule associated with a triad of symptoms of paroxysmal pain, pain with cold exposure, and tenderness to touch. We herein report a case of a 72-year-old man with multiple comorbidities presented to our clinic as a case of right-hand middle finger swelling for the past five years. Initially, it was not painful. However, the pain became more noticeable when he lowers his hand, and it was relieved when he kept it elevated. There were no skin changes around it with minimal tenderness over the swelling. Hand MRI demonstrated a well-defined small lobulated nodule at the radial aspect of the middle finger, at the level of the middle phalanx with no invasion to an adjacent structure. Surgical excision was done and the patient was diagnosed by histopathology to have glomangioma. Glomangiomas, also known as glomus tumors, are rare and benign hamartomas that commonly occur in the upper extremities. The hand is the most common site for glomus tumors, particularly the subungual area, the lateral aspect of the digits, and the palms. Female patients are the most common to present with subungual glomangioma. Multiple papers reported different presentations, and due to the rarity of the conditions and overlapping in clinical and imaging characteristics with other conditions, it was challenging to diagnose. Such atypical cases must be approached with high clinical suspicion and proper imaging and investigations so as to not delay diagnosis and management.

A Juxta-Articular Myxoma of the Thumb.

Juxta-articular myxomata are benign tumors that are mostly encountered in the vicinity of larger joints. Few cases in the hand have been reported. We present a case of a juxta-articular myxoma at the metacarpophalangeal joint of the thumb in a 40-year-old man. The preoperative diagnostic work-up included 4-dimensional magnetic resonance angiography and ultrasound. The histochemical examination of the resected tumor established the diagnosis definitively. Follow-up magnetic resonance imaging scheduled with no clinical suspicion of tumor recurrence 9 months after surgery revealed no obvious recurrence. At 14 months, the patient had full motion without pain and declined further imaging.

A Subperiosteal Proximal Phalanx Osteoid Osteoma: A Challenging Diagnosis.

A relatively rare tumor, osteoid osteoma most commonly affects the lower extremity. In 10% of the cases, it can affect the hand and wrist. We present a case of osteoid osteoma in the proximal phalanx of ring finger that was initially misdiagnosed as a soft tissue lesion. The soft tissue lesion was resected, but the symptoms recurred shortly thereafter, leading to repeat diagnostic workup. Despite X-rays, magnetic resonance imaging, and tissue biopsy, the diagnosis remained elusive until surgical re-exploration. Based on the lessons learned from this case and the experience reported in literature, we discuss the intricate nature of osteoid osteoma diagnosis in the hand, the obstacles often encountered, and how to approach these challenging patients in a stepwise and critical fashion.

Common Soft Tissue Tumors Involving the Hand with Histopathological Correlation.

Soft tissue tumors involving the hand are common and most often benign. It is important to know the spectrum of soft tissue tumors of the hand and understand the typical as well as atypical imaging features are seen on different imaging modalities. The imaging features are largely determined by the tumor histopathology; thus, the basic idea about the tumor histopathology will always be useful. This article intends to focus on a comprehensive approach including demographics, clinical presentation, and imaging findings required to diagnose the tumor definitely or narrow the differentials. This article discusses common soft tissue tumor mimics of the hand as well, however, excludes the bone tumors for the sake of brevity.

Deep palmar tumorous conditions of the hand.

PURPOSE: Deep palmar tumors of the hand are very rare, and reported cases are usually benign. The most important issue is frequent anatomical variations with challenging surgical exposure and excision of these lesions. Some case reports or a small series of patients have been reported in the literature. The aim of this study was to present our experience with the deep palmar tumors of the hand. PATIENTS AND METHODS: In the study, retrospective analyses of 43 patients treated with deep palmar tumors of the hand between January 1998 and June 2015 were evaluated. Tumors and tumor-like pathologies of the deep palmar space of the hand were retrospectively evaluated according to age, gender, localization, preoperative symptoms, size, site, treatment methods, histopathology, and early and late complications. Statistics and data analyses were also performed. RESULTS: All 43 pathologies were benign, and histopathologic diagnoses were 10 lipomas, 8 ganglions, 5 giant cell tumor of the tendon sheath, 4 schwannomas, 3 hemangiomas, 3 palmar fibromatosis, 2 epidermal cysts, 2 neurofibroma, 1 angiolymphoid hyperplasia with eosinophilia, 1 granuloma, 1 calcifying aponeurotic fibroma, 1 digital fibroma, 1 foreign body granuloma, and 1 lipofibromatous hamartoma. The most common complication was temporary numbness and paresthesias of the digits. Marginal excision was performed in 40 patients, excision with nerve grafting in 2 patients (with neurofibroma) and carpal tunnel release in one patient with lipofibromatous hamartoma. CONCLUSION: In the deep palmar space of the hand, pathologies are closely associated with tendons, muscles, and neurovascular structures. Preoperative magnetic resonance imaging is helpful for the preoperative diagnosis, evaluating tumor extension, and successful surgical planning. Level of Evidence: IV Therapautic.

Aneurysmal Bone Cyst Involving the Pisiform: A Case Report.

BACKGROUND: Aneurysmal bone cysts are an uncommon form of benign primary bone tumors; affection of the hand is very rare. METHODS: A rigorous review of the literature showed that this type of tumor has not previously been described in the pisiform. In this article, we report the occurrence of an aneurysmal bone tumor in the pisiform of the left hand of a 19-year-old male. RESULTS: This tumor was successfully treated through surgical excision with an uneventful recovery. We describe the process behind the diagnosis of the lesion and the subsequent treatment in an attempt to highlight the rare but possible occurrence of aneurysmal bone cysts in the pisiform. CONCLUSION: Appropriate treatment of aneurysmal bone cysts in this location is required, due to the anatomical nature of the pisiform itself with the risks of pathologic fracture and ulnar nerve compression.

Osseous tumours of the hand: a review of 99 cases in 20 years.

BACKGROUND: Tumors involving the hand skeleton are rare. However, a basic knowledge of hand tumors is necessary for every clinician. This is due to the importance of distinguishing typical benign tumors from life or limb threatening malignant ones. METHODS: This study is a review of 99 cases of osseous hand tumors presented to the department of orthopedic surgery, Imam Khomeini Hospital in Tehran, Iran, from December 1990 to February 2011. RESULTS: Ninety-one cases were benign osseous tumors of the hand and eight tumors were malignant which four of them were considered as primary and four considered as metastatic type. The most common benign tumors were enchondroma and osteoid osteoma. Other benign tumors were epidermoid bone cyst, giant cell tumor of the bone, aneurysmal bone cyst, osteoblastoma, and osteochondroma. Primary malignant tumors were extremely rare and we have reported two chondrosarcomas, one osteosarcoma and one Ewing's sarcoma involving the hand skeleton. CONCLUSION: This study indicates that the history, physical examination, laboratory and radiographic data as well as clinicians' knowledge of specific hand tumors are required for the best management strategy. New techniques could lead to earlier diagnosis, prevent complications and indentify the most effective type of treatment.

Tumores da mão parte III: tumores de pele da mão / Tumors of the hand, Part III: Skin tumors of the hand

O tumor de pele da mão corresponde ao câncer primário mais comum dessa região. Apesar de proporcionalmente cobrir uma pequena superfície do corpo, corresponde a uma parte considerável de todos os tumores de pele. O objetivo principal deste trabalho é mostrar de forma simples e clara as lesões mais prevalentes e encontradas no ambulatório médico, de uma forma que este pode ser usado para consulta e orientação do profi ssional médico das mais diversas especialidades, objetivando um diagnóstico rápido e assertivo, que interferirá positivamente no desfecho da doença. Nesta terceira parte do trabalho são abordados fundamentos, conceitos, classifi cações e abordagens para o melhor prognóstico do paciente.

Skin tumor of the hand is the most common primary cancer of this region. Although covering a proportionally small surface of the body, it accounts for a substantial part of all skin tumors. The main aim of this work is to show simply and clearly the most prevalent injuries found in the outpatient clinic, so that it can be used by healthcare providers from various specialties as a consultation and guidance resource, aiming at a quick and assertive diagnosis that will interfere positively with disease outcome. This third part of the work covers the fundamentals, concepts, classifi cations and approaches for a better prognosis.