Primary bone tumours of the hand. Report of 21 cases

Intraosseous epidermoid cyst of distal phalanx-Report of two cases

Key Clinical Message

Intraosseous epidermoid cysts in this report were related to a previous injury. A careful history taking is necessary to make a correct impression on the lesion. Definite diagnosis is made by histologic study.

Abstract

This report presents two cases of intraosseous epidermoid cyst of the finger treated with curettage and autogenous bone graft. Radiographs showed a radiolucent lesion with a sclerotic margin. Histologic examination revealed a cystic wall consisting of stratified squamous epithelial cells and keratinized material in the cyst, consistent with an epidermoid cyst.

The first case report of an intraosseous epidermoid cyst in the distal phalanx of the index finger with infection resulting in single clubbing finger: A case report and review of the literature

An intraosseous epidermoid cyst at the distal phalanx of the index finger is extremely rare. These cysts are asymptomatic unless ruptured, severely infected, or transformed into malignant squamous cell carcinoma. We present a case of a single clubbing finger in an adult diagnosed with an intraosseous epidermoid cyst in the distal phalanx of the left index finger with no history of pulmonary or cardiovascular diseases. Preoperative MRI showed an expansile lytic lesion with a sclerotic margin. Histopathological examination indicates that there is keratinous cell debris in the cyst with a wall of stratified squamous epithelium, which was the key to the correct diagnosis of an intraosseous epidermoid cyst. Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Timing of treatment in osteosarcoma: challenges and perspectives - a scoping review

BACKGROUND

The timing of events in the management of osteosarcoma may be critical for patient survivorship; however, the prognostic value of factors such as onset of symptoms or initiation of therapy in these patients has not been studied. This study sought to review the literature reporting treatment of osteosarcoma to determine the utility of event timing as a prognostic indicator. Due to significant heterogeneity in the literature, this study was conducted as a scoping review to assess the current state of the literature, identify strengths and weaknesses in current reporting practices, and to propose avenues for future improvement.

MAIN BODY

This review screened 312 peer-reviewed studies of osteosarcoma in any anatomic location published in an English journal for reporting of an event timing metric of any kind in a population of 6 or more. Thirty-seven studies met inclusion/exclusion criteria and were assessed for level of evidence, quality, and event timing metric. Reviewers also collated: publication year, population size, population age, tumor site, tumor type, surgical treatment, and adjuvant medical treatment. Extracted event timing data were further characterized using nine standardized categories to enable systematic analysis. The reporting of event timing in the treatment of osteosarcoma was incomplete and heterogenous. Only 37 of 312 (11.9%) screened studies reported event timing in any capacity. The period between patient-reported symptom initiation and definitive diagnosis was the most reported (17/37, 45.9%). Symptom duration was the second most reported period (10/37, 27.0%). Event timing was typically reported incidentally and was never rigorously incorporated into data analysis or discussion. No studies considered the impact of event timing on a primary outcome. The six largest studies were assessed in detail to identify pearls for future researchers. Notable shortcomings included the inadequate reporting of the definition of an event timing period and the pooling of patients into poorly defined timing groups.

CONCLUSIONS

Inconsistent reporting of event timing in osteosarcoma treatment prevents the development of clinically useful conclusions despite evidence to suggest event timing is a useful prognostic indicator. Consensus guidelines are necessary to improve uniformity and utility in the reporting of event timing.

Inflammatory conditions of the pediatric hand and non-inflammatory mimics

Hand involvement can assume an outsized role in the perception and presentation of disease as a result of functional impairment, visual conspicuity and susceptibility to early structural damage. Rheumatologic referral for inflammatory conditions can be delayed because of assumptions of a traumatic, infectious or neoplastic etiology; conversely, initial rheumatologic evaluation might be pursued for many of the same non-inflammatory causes. This pictorial essay highlights inflammatory conditions affecting the pediatric hand, including juvenile idiopathic arthritis, infectious arthritis, systemic connective tissue disorders, and a variety of less common inflammatory diseases, as well as non-inflammatory congenital, vascular, neoplastic and metabolic differential considerations.

Hand's aneurysmal bone cyst: A rare localization. Case report and systematic literature review

Aneurysmal bone cysts are benign, rare bony tumours frequently observed among children and young adults principally located in the long bones, pelvis, and spine and rarely in other anatomical district such as the hand. We report the case of a 12-year-old girl with an aneurysmal bone cyst, in active stage, involving the still-open epiphysis of the fourth metacarpal of the right hand, which was in a first time treated by curettage, and 3 months later, occurring a recurrence, by a radically excision of the bone and reconstruction with a graft from the iliac crest. At 10-year follow-up the patient had good cosmetic results and a functioning hand. We also performed a systematic Literature review in order to retrieve the key information regarding: the diagnosis, the clinical features and the treatment.

Intraosseous Epidermoid Cyst of the Radius

We report the rare case of an intraosseous epidermoid cyst of the distal radius associated with an acute infection in a 79-year-old woman.

Proximal Phalanx Osteoid Osteoma: A Case Report and Literature Review

Osteoid osteoma is a rare clinical entity often mistaken for osteomyelitis, enchondroma, osteochondroma and other bony pathologies. Cardinal features include localized swelling and nocturnal pain often relieved by nonsteroidal antiinflammatory drugs. Definitive treatment requires surgical removal of the lesion by curettage or en bloc excision. The following case report details the diagnosis and management of a recurrent case of osteoid osteoma in a long finger proximal phalanx. Included with this case report is a literature review of osteoid osteomas on the hand and the anatomic distribution of 289 cases published in the last 30 years.

Delays in diagnosis of paediatric cancers: a systematic review and comparison with expert testimony in lawsuits

Delayed diagnosis of paediatric cancers is reported regularly and is a source of remorse for physicians and parents and a leading cause of malpractice claims. We did a systematic review of information about the distribution, determinants, and consequences of time to diagnosis of paediatric malignancies and compared these findings with those of court-appointed expert witnesses in malpractice claims in Canada and France. Time to diagnosis varied widely between tumour types in the 98 relevant studies (medians ranged from 2-260 weeks) without any significant decrease with time. Determinants of a long delay in diagnosis included older age, qualification of the first physician contacted, non-specific symptoms, histological type, and tumour localisation. Delayed diagnosis was associated with poor outcome for retinoblastoma and possibly for leukaemia, nephroblastoma, and rhabdomyosarcoma (data were insufficient for definitive conclusions). It was not associated with an adverse outcome for most CNS tumours, osteosarcoma or Ewing's sarcoma, and, paradoxically, was frequently associated with better outcomes than was short time to diagnosis in these cancers. A third of the court-appointed experts provided testimony concordant with the medical literature. The relations between delay in diagnosis and outcome are complex and probably depend more on tumour biology than on parental or medical factors.

Treatment of a recurrent aneurysmal bone cyst with bioactive glass in a child allows for good bone remodelling and growth

A recurrent aneurysmal bone cyst of the proximal phalanx of the index finger of a three-year-old child, treated with bioactive glass, is presented. Over a two-year follow-up, the treated area appeared dense on X-rays. At two years, no cavity was observed and the homogenous region resembled normal trabecular bone. The phalanx had grown in length and remodelled to an almost normal shape.

Intraosseous epidermoid cyst of the finger phalanx: a case report

Epidermoid cysts of the finger phalanx are rare pseudotumours. They are benign lesions with a satisfactory outcome after excision. We describe a case of an epidermoid cyst in the distal phalanx of the ring finger. It was treated successfully and the patient had excellent functional results and radiological healing at one-year follow-up.

Ewing?s sarcoma and primitive neuroectodermal tumor of hand and forearm

PURPOSE

Because Ewing's sarcoma (EWS) is extremely rare in the hand and forearm, only limited data are available for planning treatment or predicting prognosis.

METHODS

Data of 33 patients with EWS of the forearm or hand who were enrolled in studies of the German Association for Paediatric Oncology/Haematology and the European Intergroup Cooperative Ewing's Sarcoma Study Group were analyzed. Patients received neoadjuvant multi-agent chemotherapy according to the valid protocol. Local treatment consisted of surgery (n=7), radiotherapy (n=7), or a combination of both (n=19).

RESULTS

The 5/10-year overall survival rate was 84.1% (95% CI: 71.2-96.9)/74.1% (95% CI: 56.8-91.5), and both 5/10-year event-free survival rate were 71.3% (95% CI: 55.4-87.1). Only one of seven patients with secondary metastases was in remission at the time of analysis. One patient with local recurrence and another with primary metastases died. Altogether, eight of 33 patients died of their disease. The event-free survival rate was 80.6% in patients with good response to chemotherapy and 33.3% in patients with poor response. Surgery in combination with radiotherapy achieved a higher survival rate compared with radiotherapy or surgery alone. One out of two patients with non-wide margins of resection died of disease.

CONCLUSIONS

The results demonstrate a remarkably high survival rate for patients with EWS of the hand and forearm.

Intracortical epidermoid cyst of the tibia

Epidermoid cyst in a long bone is an extremely rare condition. The authors describe such a tumor located in the cortex of the tibia in a 21-year-old woman. She was successfully treated with curettage and autogenous bone grafting.

MRI of the abnormal pediatric hand and wrist with plain film correlation

Based on a pool of 24 selected cases of nontraumatic pathology of the hand and wrist in patients under the age of 18 years, collected from three pediatric hospitals, the authors have illustrated a number of congenital, inflammatory, and infectious conditions as well as tumors of bones and soft tissues, utilizing MRI with plain film correlation. Due to different MR signal characteristics, the etiology of macrodactyly may be recognized, e.g., vascular and/or fatty versus neurofibromatosis, etc. In septic arthritis, MR has shown abnormal marrow signal in adjacent bones denoting osteomyelitis, often unexpected from the plain film appearance. Tenosynovitis has a specific MR appearance: Fluid in the tendon sheath gives high signal on T2-weighted imaging. In arthritis--because of the associated hyperemia--there is definite synovial enhancement easily visible immediately after Gd-chelate injection. Gd also helps identify viable tissues postinfection as well as viable tumor tissue (versus scar or necrotic tissue) in tumors. Plain radiography is the imaging method of choice for diagnosis and differential diagnosis of most cases of bone cysts, tumors, and tumor-like conditions, e.g., simple and aneurysmal bone cysts, enchondroma, and osteoid osteoma. In the study of masses, MRI gives excellent detail regarding tumor staging and the extent of soft tissue tumors as well as the soft tissue component of bone tumors. In the hand and wrist, aneurysmal bone cysts are usually confined within a metacarpal or carpal bone, showing high signal intensity on T2-weighted imaging, often with fluid/fluid levels. If ganglion cysts are excluded, the most commonly encountered soft tissue masses are the vascular malformations. MR angiography can demonstrate the vascularity of the lesion. Some benign soft tissue lesions have a characteristic MR appearance, e.g., ganglion cysts, lipomata, and accessory muscles.

Case report 802: Ewing's tumor of the proximal phalanx of the third finger with radiographic progression documented over a 6-year-period

In summary, a case of Ewing's tumor of the proximal phalanx of the long finger of the right hand was presented. This case is unusual because of its location as well as the unusually long clinical course before the correct diagnosis was made. The major point to be stressed is that Ewing's tumor may initially present with a "benign" appearance mimicking a bone cyst [17] or angioma [12]. Timely follow-up of so-called benign lesions, particularly when recurrent swelling occurs, would help in avoiding prolonged delays in diagnosis.

Skin and bones. II

Skin disorders in which a radiograph may detect associated bony changes or abnormalities of calcification are discussed. They are grouped into eight categories: (1) inherited diseases (e.g., alkaptonuria, neurofibromatosis); (2) congenital disorders (e.g., Sturge-Weber and Proteus syndromes); (3) inflammatory conditions (e.g., dermatomyositis, sarcoidosis); (4) infections (e.g., dental sinus, syphilis); (5) neoplasias (e.g., histiocytosis, mastocytosis); (6) drug- and environment-induced (e.g., acroosteolysis, retinoid toxicity); (7) calcinosis cutis; and (8) osteoma cutis. The first part of this review, published in the August 1991 issue of this JOURNAL, dealt with the first two categories; part II discusses categories 3 through 8.