Benign nerve tumours of the hand (excluding wrist)

Diagnostic accuracy of multiparametric ultrasound for peripheral nerve schwannoma

BACKGROUND

Ultrasound (US) diagnostic techniques have the advantages of low cost, convenient operation, and high availability.

PURPOSE

To explore the diagnostic accuracy of multiparametric US in evaluating signs of peripheral schwannoma.

MATERIAL AND METHODS

This retrospective case-control study included patients with soft-tissue masses on the limbs (divided into the schwannoma and non-schwannoma groups) between January 2017 and November 2020. US features were compared between the two groups, and receiver operating characteristics analysis was used to evaluate the diagnostic efficacy of these features.

RESULTS

A total of 165 patients were included in this study; of them, 63 (38.2%) were diagnosed with schwannoma. Regular morphology (95.2% vs. 39.2%), cystic degeneration (71.4% vs. 27.5%), target sign on elastography (82.5% vs. 0), and polar blood supply sign (87.3% vs. 14.7%) were more common in schwannomas than in non-schwannoma lesions (all P < 0.001). Combining the four signs for diagnosis of schwannomas, the sensitivity, specificity, and accuracy were 95.24%, 96.08%, and 95.76%, respectively, with an area under the curve (AUC) of 0.987 (95% confidence interval = 0.955-0.998). Entering and exiting nerve sign was observed in 87.3% of schwannomas and in 3.0% of non-schwannoma lesions (P < 0.001), while split-fat sign was similar between the two groups (9.5% vs. 2.0%; P = 0.068).

CONCLUSION

Polar blood supply sign and target sign on elastography are specific US signs in peripheral schwannomas. The combination of two-dimensional imaging, color flow imaging, and elastography can achieve an excellent diagnostic accuracy in schwannomas.

Giant Neurofibroma of the Left Median Nerve Associated With Damage of the Ipsilateral Distal Radius

A 74-year-old Caucasian woman presented with a large mass on her left distal radius, which had previously caused a fracture of the bone at this site and the palmar site that was treated with external fixation a year ago. The patient did not mention tumor-related family history and other neoplasms before the fracture of the distal radius. She noticed that the gradually growing mass had appeared after the fracture treatment. A thorough evaluation of the lesion confirmed the diagnosis of a large benign neurofibroma with distal radius impairment. The diagnostic and therapeutic procedure included the complete excision of the tumor and a six-week cast immobilization of the radius. On the final follow-up two years postoperatively, her clinical situation was satisfactory with no signs of recurrence. Although rare, isolated benign neurofibromas of enormous sizes are associated with bone damage. In our view, immediate surgical excision is crucial and enables total recovery postoperatively.

Deep HT: A deep neural network for diagnose on MR images of tumors of the hand

Background

There are many types of hand tumors, and it is often difficult for imaging diagnosticians to make a correct diagnosis, which can easily lead to misdiagnosis and delay in treatment. Thus in this paper, we propose a deep neural network for diagnose on MR Images of tumors of the hand in order to better define preoperative diagnosis and standardize surgical treatment.

Methods

We collected MRI figures of 221 patients with hand tumors from one medical center from 2016 to 2019, invited medical experts to annotate the images to form the annotation data set. Then the original image is preprocessed to get the image data set. The data set is randomly divided into ten parts, nine for training and one for test. Next, the data set is input into the neural network system for testing. Finally, average the results of ten experiments as an estimate of the accuracy of the algorithm.

Results

This research uses 221 images as dataset and the system shows an average confidence level of 71.6% in segmentation of hand tumors. The segmented tumor regions are validated through ground truth analysis and manual analysis by a radiologist.

Conclusions

With the recent advances in convolutional neural networks, vast improvements have been made for image segmentation, mainly based on the skip-connection-linked encoder decoder deep architectures. Therefore, in this paper, we propose an automatic segmentation method based on DeepLab v3+ and achieved a good diagnostic accuracy rate.

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.

Hoffa's Fat Pad-associated Solitary Neurofibroma as the Cause of Anterior Knee Pain: A Case Report

Introduction:

Infrapatellar peripheral neural tumors, particularly neurofibromas, are rather rare entities reported in the literature. They are slow-growing lesions that usually do not exhibit clinical manifestations other than interspecific swelling or pain; hence, their diagnosis can be quite challenging. Therefore, scrutiny should include not only traditional clinical assessment and imaging but also more specific molecular biology techniques, such as immunohistochemistry.

Case Report:

We present the clinical, imaging, histological, and immunohistochemical features of a unique case of solitary neurofibromain a 33-year-old female presenting chronic anterior knee pain. The tumor was completely removed through a surgical approach.

Conclusions:

Although cases of a solitary neurofibroma originating within Hoffa’s fat pad are extremely rare; the entity should be considered in the differential diagnosis when symptomatology is not alleviated with appropriate treatments.

Schwannoma of the Palmar Cutaneous Branch of the Median Nerve

Peripheral schwannomas are benign tumors originating from the Schwann cells of the peripheral nerve sheath. They make up a small percentage of the overall incidence of tumors of the hand, most commonly involving the ulnar nerve. The authors report a case of a 59-year-old patient with a slowly enlarging mass over his right wrist and no other symptoms. During surgery, a schwannoma involving the palmar cutaneous branch of the median nerve was found and successfully removed. This is a rare clinical entity, with few cases reported in the literature. In the current case, the lesion did not cause significant symptoms, and the authors demonstrated successful surgical enucleation of the lesion without complication. [Orthopedics. 2018; 41(4):e572-e573.].

The efficacy of open partial aponeurectomy for recurrent Dupuytren's contracture

INTRODUCTION

To evaluate the efficacy of open partial aponeurectomy for recurrent Dupuytren's contracture.

METHODS

Eighteen patients with recurrent Dupuytren's contracture of 22 fingers were retrospectively assessed with a mean follow-up time of 94 months (range: 70-114 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and subjective outcome (disabilities of the arm, shoulder and hand (DASH) questionnaire).

SURGICAL TECHNIQUE

Dissection with special regard to former skin incision and expected wound defect. Modified incisions after Bruner (Mini-Bruner incisions) were facilitated. Dissection started at the palm. Fibrous tissue was resected proximally within the palm including vertical fibrotic septae. Direct preparation of the neurovascular bundles (NVB) was facilitated from proximal to distal. If the anatomy of the neurovascular structures became unclear around the natatory ligament preparation of the NVB at the distal end of the fibrous cord was performed. After complete preparation of a NVB, dissection was continued from medial to lateral until the other bundle was completely released. Transposition flaps and skin transplants were often used for sufficient wound closure.

RESULTS

Recurrence rate was 36 % applying the definition of van Rijssen et al. Fifteen patients had a grip strength of 90 % or higher in comparison to the contralateral side. Ten patients had a pinch strength of 90 % or higher in comparison to the contralateral side. All patients except for one had pain reduction or none postoperatively. Fifteen patients had a DASH score of 15 or lower (range: 0-47). An unrelated ray amputation was suffered due to wound healing complications.

CONCLUSIONS

Open partial aponeurectomy performed by a board certified hand surgeon proved to be safe. The postoperative functional outcome seemed to be related to the individual course of the disease.