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de Almeida CÁ, Nakamura R, Leverone A, Marchiori E, Canella C. High-frequency ultrasonography for subungual glomus tumor evaluation - imaging findings. Skeletal Radiol 2024; 53:891-898. [PMID: 37945770 DOI: 10.1007/s00256-023-04506-1] [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: 08/28/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This article aimed to describe the common imaging features of subungual glomus tumors. METHODS The study involved data collected between January 2019 and December 2022. Twenty-three patients with a total of 31 glomus tumors underwent high-frequency ultrasound examinations with a 24-MHz probe. Two experienced radiologists independently evaluated the images, and only data from the more experienced radiologist were used for subsequent analyses. RESULTS The average size of the tumors was 4.6 mm, and most of them appeared homogeneously hypoechogenic (90.3%). Bone remodeling of the distal phalanx was observed in 87.1% of cases, with an average axial circumference loss of 0.8 mm, indicating the slow and expansive growth of glomus tumors. Intense vascularization was found in 54.8% of cases on Doppler images, and the stalk sign, reflecting the vascular origin of the tumor, was present in 64.5% of cases. The most common clinical feature was pain, reported in 84.6% of cases, with a mean pain scale score of 7.0, indicating a negative impact on patients' lives despite being benign tumors. CONCLUSION The study concludes that ultrasound evaluation is highly useful for diagnosing glomus tumors, especially when multiple findings, such as bone remodeling, hypervascularization, and the stalk sign, are present. This method allows for accurate diagnosis, observation of periungual structures, and proper surgical planning, ultimately reducing recurrence rates.
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Affiliation(s)
- Carolina Ávila de Almeida
- Department of Radiology, Diagnósticos da América S/A (DASA), Rio de Janeiro, Rio de Janeiro, Brazil.
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Robertha Nakamura
- Department of Dermatology, Centro de Estudos das Unhas, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreia Leverone
- Department of Dermatology, Centro de Estudos das Unhas, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Clarissa Canella
- Clínica Alta Excelência Diagnóstica, DASA, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Radiology, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
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Dumontier C, Braga da Silva J. Nail dystrophy for the surgeon. HAND SURGERY & REHABILITATION 2024; 43S:101635. [PMID: 38367768 DOI: 10.1016/j.hansur.2024.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/23/2023] [Accepted: 12/24/2023] [Indexed: 02/19/2024]
Abstract
Injuries to the fingertips are the most frequently occurring damage to the hand. The nail is an exceptional structure within the human body that offers both stability and protection, as well as the ability to perform fine and precise movements. Nail dystrophies are numerous, post-traumatic, post-infection or even degenerative. They raise many difficulties for the treating hand surgeon. Which anatomical structure is dystrophic? Is there any secondary fungal superinfection to be treated before surgery? Among the various techniques proposed, which one will help to improve my patient as a complete cure is rarer than partial failures. In this chapter we have chosen to describe the surgical techniques, their difficulties and drawbacks, that are available for the most frequent dystrophies that the hand surgeons may treat.
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Affiliation(s)
- Christian Dumontier
- Centre de la Main, Clinique les EAux Claires, ZAC moudong Sud, 97122 Baie-Mahault, Guadeloupe.
| | - Jefferson Braga da Silva
- Service of Hand and Reconstructive Microsurgery, Hospital São Lucas, Av. Ipiranga, 6690/Centro Clínico PUCRS, Suite 216, RS 90610-000, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Av. Ramiro Barcelos 910, Porto Alegre, RS, 90035-000, Brazil
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Dąbrowski M, Rusek D, Dańczak-Pazdrowska A, Litowińska A. The Influence of Clinical Factors on Treatment Outcome and a Recurrence of Surgically Removed Protruded Subungual Osteochondroma and Subungual Exostosis. J Clin Med 2023; 12:6413. [PMID: 37835058 PMCID: PMC10573305 DOI: 10.3390/jcm12196413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Subungual exostosis (SE) and subungual osteochondroma (SO) are benign solitary lesions that grow from the distal phalanx. The mass itself is typically painless, but pressure on the nail plate can result in pain and deformity of the involved digit. Tumors can be correctly diagnosed based on clinical, histological and radiographic appearance alone. Surgical resection of SE/SO is typically curative, with a small risk of recurrence. METHODS The study was retrospective and observational, involving 74 patients with subungual SE/SO. The surgical procedure consisted of the removal of the tumor from the dorsal approach under digital anesthesia. The procedure was assessed using a questionnaire and photo documentation after a minimum of 6 months after surgery. RESULTS A total of 85% of respondents were satisfied with the procedure. Nearly 80% of patients rated the cosmetic effect as good or very good. Young age and pain intensity after surgery showed statistically significant associations with worse satisfaction. Age < 18 was associated with recurrence. CONCLUSIONS Worse satisfaction is strongly associated with recurrence. Gender, duration of symptoms, pain before surgery and tumor size and destruction of the nail plate had no significant effect on recurrence. The technique using burr appeared to be a more effective treatment.
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Affiliation(s)
- Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, 61-545 Poznan, Poland
- Anmedica-Healthy Foot Center, Grunwaldzka Street 121, 60-313 Poznan, Poland;
| | - Damian Rusek
- Department of Pathomorphology, Regional Hospital in Poznań, Juraszów 7 St., 60-479 Poznan, Poland;
| | | | - Anna Litowińska
- Anmedica-Healthy Foot Center, Grunwaldzka Street 121, 60-313 Poznan, Poland;
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Ammar A, Salon A, Moulonguet I, Drapé JL. MRI of squamous cell carcinoma of the nail apparatus: report of 6 cases. Skeletal Radiol 2023; 52:613-622. [PMID: 36038786 DOI: 10.1007/s00256-022-04164-9] [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: 03/06/2022] [Revised: 08/09/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
Malignant tumors of the nail apparatus are rare and dominated by squamous cell carcinomas (SCC). Routinely, their pre-therapy imaging is limited to radiography. Our purpose is to determine the MRI characteristics in the locoregional assessment of SCC of the nail apparatus through a series of 6 consecutive cases explored by MRI and operated, carried out over a period of 12 years. IRB approval was obtained. Two in situ and 4 invasive squamous cell carcinomas were found, sex ratio was 0.5, and the age was 55 ± 10 years (mean ± SD). Most tumors showed specific signal behavior different from that of the epidermis and dermis with high signal on T2wi (5/6) and complete or partial enhancement (6/6). The mean thickness was 3.4 mm. The deep margin of the tumor with the dermis was always well defined for Bowen's disease (2/2) and blurred for invasive SCC. Localization involved the nail bed epithelium in all cases. Changes of the nail plate were detectable. Extension to lateral and posterior folds, hyponychium, cul-de-sac matrix, deep dermis, and bone was determined. MRI could be proposed as preoperative imaging of squamous cell carcinoma for locoregional assessment and guide biopsy.
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Affiliation(s)
- Amine Ammar
- Department of Radiology B, Cochin Hospital, AP-HP Center - University of Paris, 27 rue du Faubourg Saint-Jacques 75014, Paris, France.
| | - Arielle Salon
- Hand Surgery Department, Clinique de La Main de Paris, 36 Bis Rue Nicolo, 75016, Paris, France
| | - Isabelle Moulonguet
- Department of Anatomopathology, Cabinet de Dermatopathologie Mathurin Moreau, 35 Avenue Mathurin Moreau, 75019, Paris, France
| | - Jean-Luc Drapé
- Department of Radiology B, Cochin Hospital, AP-HP Center - University of Paris, 27 rue du Faubourg Saint-Jacques 75014, Paris, France
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Gore Karaali M, Gurel MS, Sarı Y, Kara Polat A, Leblebici C. Solitary Subungual Orf. J Hand Surg Am 2022; 47:194.e1-194.e3. [PMID: 33663886 DOI: 10.1016/j.jhsa.2020.12.010] [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: 05/15/2020] [Revised: 09/30/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023]
Abstract
Orf-ecthyma contagiosum-is an endemic cutaneous disease caused by parapoxvirus that is transmitted via direct contact with contagious animals. The lesions are located frequently on the hands and fingers. Subungual presentation of orf is very rare. We report a case of solitary subungual orf. Suspicious subungual nodular lesions may be cases of orf, especially in endemic areas. Orf disease should be considered in the differential diagnosis of subungual nodular lesions to avoid unnecessary surgical interventions.
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Affiliation(s)
- Muge Gore Karaali
- Department of Dermatology, Erzincan Binali Yıldırım University, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey.
| | - Mehmet Salih Gurel
- Department of Dermatology, Medeniyet University Faculty of Medicine, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Yasin Sarı
- Department of Dermatology, Dörtyol State Hospital, Hatay, Turkey
| | - Asude Kara Polat
- Department of Dermatology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey
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Darmawan CC, Ohn J, Mun J, Kim S, Lim Y, Jo SJ, Kim Y, Kim B, Seong M, Kim BJ, Lee C, Kwak Y, Chung HJ, Virós A, Lee D. Diagnosis and treatment of nail melanoma: A review of the clinicopathologic, dermoscopic, and genetic characteristics. J Eur Acad Dermatol Venereol 2022; 36:651-660. [DOI: 10.1111/jdv.17975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Affiliation(s)
- C. C. Darmawan
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J. Ohn
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - J.‐H. Mun
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. Kim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Lim
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - S. J. Jo
- Department of Dermatology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Institute of Human‐Environment Interface Biology Seoul National University 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Department of Dermatology Seoul National University Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
- Skin Cancer/Chemotherapy Skin Care Center Seoul National University Cancer Hospital 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y.‐g. Kim
- Department of Laboratory Medicine Green Cross Genomic Laboratories 107 Ihyeonro 30beon‐gil Giheng‐gu Yongin‐Si Gyeonggi‐do 16924 Korea
| | - B. Kim
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - M.‐W. Seong
- Department of Laboratory Medicine Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - B. J. Kim
- Department of Plastic and Reconstructive Surgery Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - C. Lee
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - Y. Kwak
- Department of Pathology Seoul National University College of Medicine 101 Daehak‐ro, Jongno‐gu Seoul 03080 Korea
| | - H. J. Chung
- Department of Dermatology Harvard Medical School Boston Massachusetts 02215 USA
| | - A. Virós
- Skin Cancer and Ageing Lab Cancer Research UK Manchester Institute The University of Manchester Manchester SK10 4TG UK
| | - D.Y. Lee
- Department of Dermatology Samsung Medical Center Sungkyunkwan University 81 Irwon‐Ro, Gangnam‐gu Seoul 06351 Korea
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Abstract
This article reviews the nomenclature, anatomic components, and physiologic growth involving the perionychium. Fingertip and nailbed injuries are commonly encountered problems in hand surgery. This article focuses primarily on dealing with chronic nailbed deformities following traumatic injury such as nonadherence, split nails, avulsion loss, and hook nails. Nail deformities secondary to pincer nail, mass effect, and pigmented lesions are reviewed as well. The underlying pathology and treatment options are examined for each deformity. The senior author highlights technical pearls and surgical planning for his preferred methods of reconstruction.
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