Ewing's sarcoma of the hand: localization and treatment

Prognostic factors, disparity, and equity variables impacting prognosis in bone sarcomas of the hand: SEER database review

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.

Imaging Features of Primary Tumors of the Hand

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.

Malignant Tumors of the Hand

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.

Ewing Sarcoma in an Infant Metacarpal

We describe a case of Ewing sarcoma in the metacarpal of a 5-month-old male. After pain, erythema, and swelling of the hand failed to resolve with antibiotics, radiographs and magnetic resonance imaging raised suspicion for a neoplastic condition. Open biopsy confirmed the diagnosis of Ewing sarcoma and treatment with chemotherapy and surgical resection was initiated. Ewing sarcoma of the hand in a patient this young is an exceedingly rare diagnosis, which highlights the importance of a broad differential diagnosis when the treatments for more common conditions fail.

Ewing Sarcoma in the Fifth Metacarpal of an Adult Woman: A Case Report

CASE

Atypical presentations of Ewing sarcoma (ES) can lead to misdiagnosis and delays in treatment. We present a rare case of ES in the hand of an adult woman who underwent multiple interventions prior to referral to our institution. At 22 months after definitive treatment, the patient remained pleased with the result and had no evidence of recurrence.

CONCLUSION

To our knowledge, ES of the hand in an adult woman has not yet been reported in the literature, and a lack of recognition of this condition might be secondary to the absence of features traditionally associated with malignant bone neoplasms. A broader differential diagnosis after intervention failures offers the opportunity for diagnosis and appropriate treatment.

Ewing sarcoma of the first metacarpal with a 9-year follow-up: case report

Ewing sarcoma is a primary bone tumor that rarely occurs in the hand. We present a case involving the thumb metacarpal with long-term follow-up. Carpometacarpal and metacarpophalangeal arthrodeses with autograft are relatively simple procedures that stabilized the thumb and preserved satisfactory function.

Ewing's sarcoma of the finger: report of two cases and literature review

Ewing's sarcoma of the finger is extremely rare. Pain and swelling of the affected finger are the most frequent presenting features. We report two cases of Ewing's sarcoma located at ring finger and the thumb in two children aged 14 and 10 years. The first patient died of generalised metastases despite surgery, chemotherapy and radiation therapy. The second had no localised recurrence or metastases after surgery and chemotherapy at last follow-up of 4.5 years after tumour resection. The tumour's surgical accessibility, chemotherapy, and radiation therapy improve the prognosis of this tumour.

Extra-osseous Ewing's sarcoma of the thumb

The hand is an uncommon location for Ewing's tumour of the bone. This paper details the presentation, pathology and management of an extra-osseous Ewing's sarcoma of the thumb in an adult woman. The management entailed a combination of neo-adjuvant chemotherapy and surgical excision, followed by reconstruction with an interposition bone graft from the subcutaneous surface of the ulna.

Rare presentation of Ewing's sarcoma: a case report and literature review

Ewing's sarcoma rarely occurs in the bones of the hand and feet. The clinical presentations represent a degree of overlap among various benign and infective etiologies. The diagnosis was confirmed by gold standard biopsy. We present a case of Ewing's tumor in a 13-year-old girl and discuss its rare presentation, and also offer a literature review.

Improved survival for sarcomas of the wrist and hand

PURPOSE

To evaluate survival characteristics of malignant hand tumors compared with those occurring in other musculoskeletal locations over a 30-year period.

METHODS

Patients were identified through a computerized database maintained at the authors' institution over the past 30 years. Each patient's records were reviewed retrospectively. Diagnoses were categorized and survival data for patients with hand malignancies were compared with those of patients having similar tumors in other musculoskeletal sites by using multivariate statistical analysis.

RESULTS

The most common malignancies were epitheloid sarcoma, synovial sarcoma, and malignant fibrous histiocytoma. Improved survival during the follow-up period was found for hand malignancies versus those occurring in other musculoskeletal sites as a whole, and this difference was statistically significant. No significant survival benefit was identified for individual tumors.

CONCLUSIONS

Patients presenting with primary malignancies of the hand may survive longer than those with similar tumors in other musculoskeletal locations

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic, Level II.

[Ewing's sarcoma of the hand: a case report]

Ewing's sarcoma of the hand is rare. This tumor was first described in 1921, since then, only a few cases with hand involvement have been reported. We report a case of Ewing's sarcoma of the left hand, presenting as a swelling of the hand gradually enlarging over six months. Plain radiographs showed marked osteolysis of the second, third and fourth metacarpals. Histological confirmation was made following biopsy. Despite amputation and post-operative chemotherapy, death occurred two months later due marrow aplasia.

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.

Tumeur d'Ewing du pouce : présentation d'un cas clinique et revue de la littérature

The authors report a case of an Ewing sarcoma of the thumb. It is a rare localisation of this disease and it should not be unknown. Based on the literature, the appropriate treatment is discussed.

Bone-forming tumors of the upper extremity and Ewing's sarcoma

This article presents an overview of bone-forming tumors that occur in the upper extremity. Osteoid osteoma, osteoblastoma, osteosarcoma, and Ewing's sarcoma are covered. Each tumor type is described, and suggestions are made for diagnostic workup and differential diagnosis. Locations in the upper extremity where each tumor typically occurs are given. Preferred treatment regimens and incidence of recurrence are also presented.

Ewing's sarcoma of the hand: magnetic resonance images and treatment

Two cases of Ewing's sarcoma of the hand were treated by preoperative chemotherapy and radiation therapy to decrease tumor volume. Magnetic resonance images were useful in showing the soft tissue mass and in estimating the effect of the chemotherapy. The results of surgery were satisfactory with this treatment regimen.

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.