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El Ghoneimy A, Zaky I, Zamzam M, Kamel A, Mounir N, El Kenaey N. Wide Resection of Primary Malignant Bone Tumors of the Hand in Children and Reconstruction Using Nonvascularized Fibular Bone Graft: Case Series and Literature Review. J Hand Surg Am 2022; 47:1017.e1-1017.e7. [PMID: 34600792 DOI: 10.1016/j.jhsa.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/09/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Primary malignant bone tumors of the hand are rare in children. Resection and reconstruction of the digit are challenging and have been described in case reports. This retrospective study describes the functional and oncologic outcomes of resection and reconstruction using a nonvascularized fibular bone graft in a cohort of children. METHODS A total of 5 children were included. The mean age at diagnosis was 7.6 years (range, 1.6-12 years). Histologic diagnosis showed Ewing sarcoma in 3 and osteosarcoma in 2 patients. Four tumors were located in the metacarpal bones of the fingers, and 1 was located in the thumb. Four patients were treated with chemotherapy. All the patients were treated with wide resection and a cement spacer. This was followed by second stage reconstruction using a nonvascularized fibular bone graft. In tumors of the fingers, carpometacarpal joint fusion with a neighboring carpal bone was performed, whereas a pseudoarthrosis was created between the graft and the base of the proximal phalanx. In the thumb's case, the opposite was done, with fusion at the metacarpophalangeal joint and a pseudoarthrosis at the carpometacarpal joint. RESULTS The mean follow-up duration was 5.5 years (range, 2-9 years). Surgical margins were negative in all the patients. At their latest follow-up visit, none of the patients developed systemic or local recurrence. Two complications required a revision surgery, one due to graft subluxation and the other due to nonunion. At their final follow-up examination, the mean total arc of movement was 80° (range, 60°-100°), and all the patients were able to resume their grasping and writing capabilities. CONCLUSIONS The resection and reconstruction of primary malignant bone tumors of the metacarpals using a nonvascularized fibular bone graft in children can preserve the cosmesis and function of the digit without jeopardizing oncologic outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Ahmed El Ghoneimy
- Children Cancer Hospital 57357, Cairo, Egypt; Cairo University, Cairo, Egypt.
| | - Imane Zaky
- Children Cancer Hospital 57357, Cairo, Egypt; National Cancer Institute, Cairo, Egypt
| | - Manal Zamzam
- Children Cancer Hospital 57357, Cairo, Egypt; National Cancer Institute, Cairo, Egypt
| | - Ahmed Kamel
- Children Cancer Hospital 57357, Cairo, Egypt; National Cancer Institute, Cairo, Egypt
| | - Nada Mounir
- Children Cancer Hospital 57357, Cairo, Egypt
| | - Naglaa El Kenaey
- Children Cancer Hospital 57357, Cairo, Egypt; National Cancer Institute, Cairo, Egypt
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Yong CPC, Puhaindran ME, Das De S. Differential Diagnoses of Pediatric Upper Limb Masses. J Hand Surg Am 2022; 47:685.e1-685.e10. [PMID: 34332816 DOI: 10.1016/j.jhsa.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 04/02/2021] [Accepted: 06/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Upper limb masses are one of the most common presentations in the outpatient setting. However, there is a paucity of information in the literature regarding the epidemiology of upper-extremity masses in the pediatric population. The aim of this study was to determine the differential diagnoses and clinical characteristics in children aged ≤18 years presenting with upper limb masses. METHODS A retrospective review of patients aged ≤18 years managed at our institution over a 5-year period was performed. We obtained information on patient demographics, clinical features, radiological investigations, intraoperative features, and histology. We also evaluated the correlation between the clinical and histopathological diagnoses in patients who underwent surgery. RESULTS There were 141 upper limb masses in our series. The mean age at presentation was 12 years (SD, 5 years). The most common presenting complaints were asymptomatic swelling, pain, and paresthesia. The majority (128; 91%) of tumors were benign; there were 5 locally aggressive tumors and 6 malignant tumors. The dominant hand was involved in 60 patients. Of 140 patients, 43 (31%) patients had surgery. The procedures included incisional biopsy, excisional biopsy, wide resection, and reconstruction. One patient required a below elbow amputation for an osteosarcoma. CONCLUSIONS Ten percent of cases represented malignant or locally aggressive disease. We have used our observations to develop a clinical algorithm that can assist clinicians in evaluating and managing children and adolescents presenting with upper-extremity masses. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Cheryl Pei Chyi Yong
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore.
| | - Mark Edward Puhaindran
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Soumen Das De
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
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Lazerges C, Degeorge B, Coulet B, Chammas M. Diagnosis and treatment of hand tumors. Orthop Traumatol Surg Res 2022; 108:103153. [PMID: 34838755 DOI: 10.1016/j.otsr.2021.103153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
Hand tumors are a very common problem in hand surgery. While these lesions are most often benign, malignant lesions often have an atypical presentation and are discovered late, very often during an inappropriate treatment. To optimize the care of hand tumors and to reduce diagnostic and treatment errors, we will review the broad diagnostic and therapeutic principles and the most common clinical presentations.
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Affiliation(s)
- Cyril Lazerges
- Orthopedic surgery department, hand and upper limb and peripheral nerve surgery unit, CHU Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France.
| | - Benjamin Degeorge
- Orthopedic surgery department, hand and upper limb and peripheral nerve surgery unit, CHU Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - Bertrand Coulet
- Orthopedic surgery department, hand and upper limb and peripheral nerve surgery unit, CHU Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - Michel Chammas
- Orthopedic surgery department, hand and upper limb and peripheral nerve surgery unit, CHU Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
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Jawad MU, Bayne CO, Farhan S, Haffner MR, Carr-Ascher J, Alvarez E, Thorpe SW, Randall RL. Prognostic factors, disparity, and equity variables impacting prognosis in bone sarcomas of the hand: SEER database review. J Surg Oncol 2021; 124:1515-1522. [PMID: 34432316 PMCID: PMC9987264 DOI: 10.1002/jso.26659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Primary sarcomas originating from the bones of hand and wrist are rare but carry a significant burden of morbidity. METHODS National Cancer Institute's Surveillance, Epidemiology and End Result database from 1975 to 2017 was queried to report incidence and survival data in 237 patients in the United States. Kaplan-Meier and Cox regression were used to determine the prognostic factors affecting survival. χ2 test was used to assess the correlation. RESULTS Incidence of hand and wrist sarcoma was 0.017 per 100 000 persons in 2017 and has not significantly changed since 1975 (p > 0.05). Disease-specific 5-year and 10-year survival for the entire cohort was 90% and 84%, respectively. On multivariate analysis race "others," histology other than "osteosarcoma," "undifferentiated" grade, and size "≥6 cm" were predictors of worse disease-specific survival. Cross-tabulation of race with other significant prognostic factors on univariate analysis revealed a significant correlation of race with every other significant prognostic factor except for grade. CONCLUSIONS The current study is an analysis of a population-based registry reporting incidence and survival data for patients with sarcoma of hand and wrist. Independent prognostic factors include race, histology, grade, and size. There is a lack of improvement in survival over the last four decades.
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Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Saif Farhan
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Max R Haffner
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Janai Carr-Ascher
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Elysia Alvarez
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Steven W Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
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Fujibuchi T, Imai H, Miyawaki J, Kidani T, Kiyomatsu H, Miura H. Hand tumors: A review of 186 patients at a single institute. J Orthop Surg (Hong Kong) 2021; 29:2309499021993994. [PMID: 33624536 DOI: 10.1177/2309499021993994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The spectrum of diagnoses and clinical features of hand tumors differ from those of tumors in other body parts. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study aimed to elucidate the diagnostic distribution and the clinical features of hand tumors undergone surgery in our institute. PATIENTS AND METHODS A total of 235 lesions in 186 patients diagnosed with hand tumors between 1978 and 2020 were reviewed. Age at surgery, gender, chief complaint, tumor location, and pathological diagnosis were analyzed. RESULTS There were 121 benign bone tumors, 98 benign soft tissue tumors, and 16 malignant tumors. Chondroma and tenosynovial giant cell tumor were common benign bone and soft tissue tumors at the proximal phalanx of the ring finger and the palm, respectively. Meanwhile, chondrosarcoma and synovial sarcoma were common malignant tumors at the dorsal part of the hand. Local pain and painless mass were the chief complaints in patients with benign bone and soft tissue tumors, respectively. Most patients with malignant tumors were referred after unplanned resection. When patients were classified into two categories by tumor size according to maximal diameter, tumors larger than 19 mm had a significantly higher risk of malignant (p = 0.031) despite being smaller than other tumors in different body parts. CONCLUSION When a tumor malignancy is suspected, the patient should be referred to a specialist to avoid unplanned resection or delayed diagnosis due to misdiagnosis. Knowing the distribution and clinical features should help in diagnosing hand tumors.
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Affiliation(s)
- Taketsugu Fujibuchi
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Joji Miyawaki
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Teruki Kidani
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Hiroshi Kiyomatsu
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
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Boriani F, Raposio E, Errani C. Imaging Features of Primary Tumors of the Hand. Curr Med Imaging 2021; 17:179-196. [PMID: 32811403 DOI: 10.2174/1573405616999200817173154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Filippo Boriani
- Department of Plastic and Hand Surgery, Sanremo Hospital, Sanremo, Italy
| | - Edoardo Raposio
- Department of Surgical Sciences and Integrated Methodologies (DISC), University of Genova, Genova, Italy
| | - Costantino Errani
- Department of Musculo-Skeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Soft-tissue Sarcoma of the Hand: Patient Characteristics, Treatment, and Oncologic Outcomes. J Am Acad Orthop Surg 2021; 29:e297-e307. [PMID: 32932303 DOI: 10.5435/jaaos-d-20-00434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/28/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The aim of this study was to describe patient characteristics, treatment, and oncologic outcomes of soft-tissue sarcomas (STSs) of the hand. METHODS Sixty-nine STSs of the hand in adult patients treated at a tertiary referral center were retrospectively included. We describe patient and tumor characteristics along with oncologic outcomes. RESULTS Epithelioid sarcoma (23%) was the most common histologic subtype, followed by synovial sarcoma (15%). Of all tumors, 17 (25%) were grade I, 22 (32%) were grade II, and 30 (44%) were grade III. The 5-year disease-free survival for epithelioid sarcomas was 75% with a disease survival of 100%, along with a metastatic rate of 15%. Of the patients with a synovial sarcoma, 40% developed metastases, and the 5-year disease-free survival was 68% and the 5-year disease survival was 73%. CONCLUSION Hand STSs are aggressive tumors with a high metastatic potential. Even with adequate oncologic treatment, long-term clinical follow-up (10 years) in these tumors is advised. The treating surgical oncologist should not be deceived by their smaller size.
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8
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Alzaidi SA, Shah Mardan QN, Alotaibi A, Elmoursy M. Comparing the Diagnostic Accuracy of Clinical and Radiological Measures in Hand Soft-Tissue Masses. Cureus 2020; 12:e12145. [PMID: 33489557 PMCID: PMC7814418 DOI: 10.7759/cureus.12145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Imaging modalities are imperative to aid in diagnosing hand soft-tissue tumors. Limited insight is available into the diagnostic accuracy of history and physical examination in comparison to radiological diagnosis. Methods In this retrospective analysis, data of patients with hand soft-tissue tumors that were surgically treated and diagnosed through biopsy were extracted; taking this as a reference, the sensitivity, specificity and positive and negative predictive values and likelihood ratios of the clinical approach and radiological tools were contrasted against each other. Results Data of a total of 34 patients were revised in this study. With a mean age of 40.1 years, the most common anatomical area of the hand to be affected by the tumors was the index (n = 7, (18.9%); ganglion cysts were the most common tumor (n = 9, 26.5%) and magnetic resonance imaging was the most commonly used imaging modality (n = 24, 70.6%). Clinical diagnosis scored a sensitivity and specificity of 44.4% and 100% in ganglion cysts and 62.5% and 86.2% in giant cell tumors in contrast to the sensitivity and specificity of 66.7% and 100% for ganglion cysts and 50% and 90% for giant cell tumors scored by radiological modalities. Conclusion Clinical diagnosis could be non-inferior to radiological diagnosis, yet radiological examination remains a valuable adjunct to clinical examination. Larger scale, prospective studies are required before generalizing our results.
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Affiliation(s)
- Salman A Alzaidi
- Plastic and Reconstructive Surgery, King Faisal Medical Complex, Taif, SAU
| | - Qutaiba N Shah Mardan
- Plastic and Reconstructive Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Abrar Alotaibi
- Otolaryngology - Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif, SAU
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Abstract
Primary malignant tumors in the hand are rare as compared to benign lesions; however, it is essential for orthopeadic surgeons to be familiar with their clinical presentation. The approach to working up a mass in the hand must be methodical and thorough, and clinicians must maintain high index of suspicion when evaluating these lesions. Successful identification and treatment of malignant tumors of the hand may include referral to a sarcoma center for staging, workup, and multidisciplinary treatment. Surgical treatment of malignant tumors in the hand is uniquely complicated by the increased number of critical structures that may be in close proximity to the tumor. It is therefore imperative to understand the principles of diagnosis, staging, biopsy, resection, and amputation before treating malignant tumors of the hand.
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10
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Abou Chaar MK, Jaber OI, Asha W, Abdel Al S. Novel Double Central Ray Amputation of the Third and Fourth Digits: Case Report and Literature Review. Case Rep Oncol 2020; 13:91-99. [PMID: 32110226 PMCID: PMC7036542 DOI: 10.1159/000504934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/20/2019] [Indexed: 12/16/2022] Open
Abstract
Whenever partial hand amputations for soft tissue sarcomas are attempted, special consideration should be given to achieve a balance between complete resection associated with negative margins and preservation of functionality to the patient so that the hand can support the contralateral intact hand for bimanual activities. This difficult decision is even more challenging within the limited anatomical confines of the hand. Based on our literature review, this is the first case of double central 3rd and 4th ray amputation, as far as we know with good hand function, evaluated by the Musculoskeletal Tumor Rating Scale.
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Affiliation(s)
| | - Omar I Jaber
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Wafa Asha
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Samer Abdel Al
- Department of Orthopedic Oncology, King Hussein Cancer Center, Amman, Jordan
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Giordano V, Giordano M, Giordano C, Giordano J, Koch HA, Knackfuss IG. Metastatic tumor of the hand of unknown primary origin. SAGE Open Med Case Rep 2019; 7:2050313X19836894. [PMID: 30899514 PMCID: PMC6419255 DOI: 10.1177/2050313x19836894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/19/2019] [Indexed: 11/15/2022] Open
Abstract
Acral metastases in the hand are exceedingly rare. We present the unusual case of a metastatic tumor of the hand of unknown primary site in a 77-year-old man with no known cancer history. The patient presented with pain and swelling in the tip of the left ring finger, which had previously been diagnosed as gout at another clinic. Laboratory tests, including white blood cell count, erythrocyte sedimentation rate/C-reactive protein, and uric acid were all within normal limits. Excisional biopsy was taken by amputation of the distal phalanx of the left ring finger through the distal third of the middle phalanx. Pathology confirmed the presence of a moderately differentiated adenocarcinoma of unknown primary site. Roentgenographic examination of the chest revealed no pathologic findings. The patient refused further investigation and adequate treatment. He died 4 months later. The current description confirms the rarity of metastatic malignancy of the hand and its poor prognosis.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Marcos Giordano
- Serviço de Traumato-Ortopedia, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brazil
| | | | | | - Hilton Augusto Koch
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Irocy Guedes Knackfuss
- Departamento de Ortopedia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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MacGillis KJ, Heaberlin J, Mejia A. Clinical Decision Making for a Soft Tissue Hand Mass: When and How to Biopsy. J Hand Surg Am 2018; 43:1123-1129. [PMID: 29908925 DOI: 10.1016/j.jhsa.2018.03.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/23/2018] [Indexed: 02/02/2023]
Abstract
Evaluation of a hand mass and subsequent surgical treatment is a frequent clinical encounter for the practicing hand surgeon. The clinical evaluation of benign and malignant hand tumors has traditionally focused on diagnosis, surgical excision, and reconstruction. There is a paucity of literature discussing the determining factors for a hand mass biopsy, its appropriate technique, and postbiopsy preparation and handling. This review discusses the approaches of the hand surgeon and orthopedic oncologist to a soft tissue mass in the hand and clarifies the term biopsy. Special attention is focused on preoperative decisions and indications for core needle, incisional, and excisional biopsies of hand masses. In addition, we include a discussion of surgical technique for obtaining a specimen, processing a specimen, and sending a specimen for pathological evaluation. This highlights specimen labeling and type of fixative utilized for pathological evaluation. This review features a section detailing clinical strategies to reduce morbidity associated with evaluation and treatment of benign and malignant hand masses and is based on recommendations from a synopsis of expert opinion and literature review.
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Affiliation(s)
- Kyle J MacGillis
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, NY.
| | - James Heaberlin
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Alfonso Mejia
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
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13
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Martin H, Mariano-Bourin M, Antunes L, Bonhomme A, Cuny JF, Dubouis L, Truchetet F, Schoeffler A. [Cutaneous metastases on the extremities]. Ann Dermatol Venereol 2018; 146:115-120. [PMID: 30314638 DOI: 10.1016/j.annder.2018.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/01/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cutaneous metastases (CM) on the extremities are rare complication of cancer with poor prognosis. In general, lesions simulate an infection. Herein, we report two new cases with atypical presentation. PATIENTS AND METHODS Case no 1: a 71-year-old man consulted for suspicion of left hand pyogenic granuloma present for 3 months. His history revealed two treated squamous-cell carcinomas (tongue and lung). On physical examination, he presented three budding and foul-smelling lesions on his left hand. Histopathology showed metastasis of squamous-cell carcinoma. Radiographic examination revealed spread of pulmonary nodules with suspicion of metastasis. Case no 2: a 68-year-old man was hospitalized for indurated edema of the right leg present for several months. Six months earlier, he had undergone surgery for left pulmonary adenocarcinoma without metastasis. Physical examination revealed an indurated edema on the right foot. Histopathology showed metastasis from adenocarcinoma. A scan revealed several osteolytic lesions in the right foot as well as lymphadenopathy. DISCUSSION Herein, we report two original cases of CM of the extremities diagnosed as tumor progression. This is a rare complication of variable clinical presentation and impacts both cancer management and prognosis. It is important to consider the diagnosis when distal cutaneous lesions persist, particularly where there is a history of cancer.
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Affiliation(s)
- H Martin
- Service de dermatologie, CHRU Nancy, 54500 Vandœuvre-lès-Nancy, France.
| | - M Mariano-Bourin
- Service de dermatologie, CHRU Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - L Antunes
- Laboratoire national de santé, L-3555 Dudelange, Luxembourg
| | - A Bonhomme
- Service de dermatologie, CHR Metz-Thionville, 57000 Metz, France
| | - J-F Cuny
- Service de dermatologie, CHR Metz-Thionville, 57000 Metz, France
| | - L Dubouis
- Service d'anatomo-pathologie, CHRU Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - F Truchetet
- Service de dermatologie, CHR Metz-Thionville, 57000 Metz, France
| | - A Schoeffler
- Service de dermatologie, CHR Metz-Thionville, 57000 Metz, France
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Bowen CM, Landau MJ, Badash I, Gould DJ, Patel KM. Primary tumors of the hand: Functional and restorative management. J Surg Oncol 2018; 118:873-882. [DOI: 10.1002/jso.25202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/23/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Chase M. Bowen
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Mark J. Landau
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Ido Badash
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Daniel J. Gould
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Ketan M. Patel
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
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15
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Tumors of the hand. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:747-762. [DOI: 10.1007/s00590-017-1984-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/30/2017] [Indexed: 12/15/2022]
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Tos P, Piana R, Boux E, Colzani G, Artiaco S. Index Finger Pollicization for Functional Preservation of the Hand After Giant Liposarcoma Resection of the Thenar Eminence. J Hand Microsurg 2015; 7:216-9. [PMID: 26078547 DOI: 10.1007/s12593-014-0169-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/26/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Pierluigi Tos
- Microsurgery Unit, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center CTO, Via Zuretti 29, Turin, Italy
| | - Raimondo Piana
- Oncologic Orthopaedic Division, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center CTO, Via Zuretti 29, Turin, Italy
| | - Elena Boux
- Oncologic Orthopaedic Division, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center CTO, Via Zuretti 29, Turin, Italy
| | - Giulia Colzani
- Microsurgery Unit, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center CTO, Via Zuretti 29, Turin, Italy
| | - Stefano Artiaco
- Microsurgery Unit, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center CTO, Via Zuretti 29, Turin, Italy
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Sluijmer HCE, Becker SJE, Bossen JKJ, Ring D. Excisional biopsy of suspected benign soft tissue tumors of the upper extremity: correlation between preoperative diagnosis and actual pathology. Hand (N Y) 2014; 9:351-5. [PMID: 25191167 PMCID: PMC4152428 DOI: 10.1007/s11552-014-9641-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tumors of the upper extremity are common and mostly benign. However, the prevalence of discordant diagnosis of a solid hand tumor is less studied. The objectives of this retrospective study were (1) to determine the proportion of patients with a different (discrepant or discordant) pathological diagnosis compared to the preoperative diagnosis, (2) to determine the prevalence of the types of pathologies encountered at excisional biopsy for suspected benign tumors, and (3) to determine the types of tumors diagnosed when the surgeon does not make a preoperative diagnosis. METHODS One hundred and eighty-two suspected benign soft tissue tumors of the upper extremity with a preoperative diagnosis other than ganglion cyst were excised by one of three surgeons over a 10-year period. A preoperative diagnosis was applied for 125 tumors. No preoperative imaging was used. RESULTS Only 26 of the 125 tumors (21 %) with a preoperative diagnosis were discrepant. The tumors that were most likely to have a discrepant diagnosis were vascular tumors (32 %) and other less common benign tumors (33 %). Among the entire cohort of 182 tumors, lipomas (19 %), giant cell tumors of tendon sheath (GCTTS; 19 %), and vascular tumors (16 %) were the most frequent pathological diagnoses. Among the 57 tumors that did not have a preoperative diagnosis, most were vascular tumors (23 %), fibromas (14 %), and GCTTS (11 %). One tumor without a preoperative diagnosis was a malignant tumor, but we consider this unusual and possibly spurious. CONCLUSIONS A hand surgeon's preoperative diagnosis without imaging is usually correct prior to excision of a mass in the hand. Discrepant diagnoses are usually benign and do not alter treatment. LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Heleen C. E. Sluijmer
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Stéphanie J. E. Becker
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Jeroen K. J. Bossen
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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Osteosarcoma of the hands and feet: a distinct clinico-pathological subgroup. Virchows Arch 2012; 462:109-20. [PMID: 23212264 DOI: 10.1007/s00428-012-1339-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 10/12/2012] [Accepted: 11/02/2012] [Indexed: 11/12/2022]
Abstract
Osteosarcomas of hands or feet are rare, and seemingly these cases differ in presentation and behavior compared to those in usual locations. The clinico-pathological presentation of patients with osteosarcomas of the hand or foot was studied and compared with published cases. Forty osteosarcomas were identified among 4,221 cases, representing 0.95 % of all osteosarcomas. Thirty of these were well documented. Mean age at diagnosis was 43 years (hands) and 36 years (feet) and male-female ratio was 1.2:1 and 2.0:1, respectively. In the hand, 62 % of the osteosarcomas presented in the metacarpals and 23 % in the phalanges, and only two cases occurred in the carpal bones. Distribution in the foot was tarsal bones 56 %, metatarsal bones 33 %, and phalanges 11 %.Of the cases in the hand 54 % were of high grade and of those in the foot 71 %. Survival of osteosarcomas of the hand or foot was 81 %. Only patients with high-grade osteosarcoma died of the disease. Histological grade was the only significant variable related to survival. High-grade osteosarcoma of the hand or feet should be treated similar to those in conventional sites. Osteosarcomas of hands or feet are rare and in a relative high proportion are of low grade. Survival in high-grade cases is comparable to that in conventional sites.
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