Pediatric hand tumors. A review of 349 cases

Ganglion cysts, foreign bodies and vascular malformations are some of the most common causes of a palpable mass in the pediatric hand. There are other rarer tumors, such as digital fibromas, which are unique to the pediatric population. Malignant tumors are exceedingly rare. An awareness of both the common and unusual tumors seen in the pediatric population is essential for the hand surgeon evaluating these patients.

Vascular tumors in children

Tumors with a vascular component are the most common masses seen in children. Malformations and hemangiomas predominate. Hemangiomas have a biphasic natural history consisting of initial proliferation followed by spontaneous involution; these tumors rarely require surgical intervention. Malformations present at birth or shortly after birth and have a wide spectrum of clinical presentations depending upon their predominant cell type and rheology. Physical examination and MR imaging will effectively define most of these anomalies. Surgery is reserved for very symptomatic lesions and is effective in all but the fast-flow, Type C group of malformations. Glomus tumors, pyogenic granulomas and both traumatic and iatrogenic aneurysms are also seen in the pediatric age group. All are benign and effectively treated surgically. Malignant vascular tumors are rare in this age group.

Benign and malignant vascular tumors of the upper extremity

Vascular tumors of the upper extremity comprise a wide and varied group of pathologies. A variety of benign and malignant tumors exist. Proper diagnosis is imperative for the proper management of these lesions. On occasion, diagnosis can be made by a careful history and physical examination. However, the differentiation of benign from malignant tumors often requires permanent histologic section analysis by an experienced tumor specialist. The malignant vascular lesions, although rare, are aggressive in their behavior and require prompt diagnosis and treatment for patient survival.

[Glomus cell clusters of the lymph node]

Nine lymph nodes with so-called benign nevus cell nevi were studied by light microscopy. In three cases the lymph nodes were also examined by electron microscopy. The solitary or multiple cell clusters were 35-645 mu in diameter and were usually found in the lymph node capsule or cortex. They were more frequent in the older patients. There was no predisposition for either sex. Specific morphologic features allowing clear cytologic identification of the cells were not evidient. In particular, there was no indication that they represented nevus cells. However, they showed a great morphologic similarity to glomus cells. In addition, they were usually found near blood vessels. We assume that the cell clusters were hamartias related to glomangiomas. We call them glomus cell clusters.