Fibro-osseous pseudotumor that may be mistaken for a malignant tumor in the hand: a case Report and review of the literature

Benign growing mass of the digit presenting as an ulcerated mass - case report and review of the literature

A 68 year-old female presents with an ulcerated mass of the 5th digit, with rapid growth during the previous month to surgery. The mass was excised and covered with a 4th dorsal metacarpal artery perforator flap. The histologic analysis was compatible with the diagnosis of fibro-osseous pseudotumor of the digit.

Osteosarcoma of the Trapezium

Osteogenic sarcoma is a malignant tumor that rarely affects the hand. When it does, it most often involves the phalanges or metacarpal heads. We present the case of a 51-year-old woman with a low-grade osteosarcoma affecting the trapezium bone of her left hand. A total trapeziectomy with partial removal of the first metatarsal, scaphoid, trapezoid, and capitate bones was performed, and no adjuvant therapy was administered. Six years after the intervention, the patient is disease-free, with excellent functionality and yearly imaging tests showing no signs of recurrence.

Fibro-Osseous Pseudotumor of the Hand

Fibro-osseous pseudotumor of digits (FOPD) is an uncommon histological diagnosis. Clinical and imaging findings may resemble high-grade sarcoma or infection. We describe a patient with progressive pain and swelling at the dorsal surface of the first web space. MRI and CT imaging revealed an intramuscular heterogenous soft tissue mass defined by a mineralized peripheral ring. Core needle biopsy diagnosed FOPD. Eight months later a matured ossified nodule that was quite smaller than the initial soft tissue mass was excised. The patient is symptom free without local recurrence at 1 year follow up. Soft tissue masses of the hand pose a challenging diagnostic and therapeutic issue. An in depth interpretation of clinical, imaging and histology findings is important to avoid erroneous diagnosis and treatment.

Florid reactive periostitis in the fifth phalange of a professional boxer: A case report

RATIONALE

Florid reactive periostitis is a rare, benign bone and chondrogenic lesion that develops most frequently in the phalanges of the hands. Although the definitive cause of florid reactive periostitis is unknown, the major inciting factor is generally considered to be trauma, including repetitive minor trauma.

PATIENT CONCERNS

We present a case of florid reactive periostitis affecting two contiguous phalangeal bones of the left fifth phalange of a 23-year-old male professional boxer. The patient had experienced chronic pain around the metacarpophalangeal joint of the left fifth phalange when punching with the left hand; this pain was improved but not resolved after conservative treatment.

INTERVENTIONS

Plain radiography of the fifth phalange revealed a bulging bone lesion on the volar side of the proximal phalanx and metacarpal of the left fifth phalange. Computed tomography also showed raised bony lesions on the volar side of these bones without bony destruction or intraregional calcification. Surgery was performed and histopathology revealed that the bone specimens comprised a mixture of fibrous connective tissue and relatively immature bone covered by bland osteoblasts.

DIAGNOSES

These findings were suggestive of a benign bone formation process, and the lesion was diagnosed as florid reactive periostitis.

OUTCOMES

The pain and tenderness in the left fifth phalange experienced during boxing had completely resolved by 6 months postoperatively, and 12 years postoperatively the patient had full range of motion and no recurrence of pain.

LESSONS

Traction force, such as those associated with "leading jabs," may induce repetitive minor trauma and subsequent periosteal damage, resulting in the gradual development of bulging bone ridges on the volar surface of the proximal fifth phalange and metacarpus of the hand.

Fibro-Osseous Pseudotumour of the Digit: An Illustrative Case and Review of the Literature

Fibro-osseous pseudotumour is a rare, benign ossifying tumour of soft tissue that should be considered in the differential diagnosis of any tumour affecting the digits. Clinical diagnosis is difficult and fibro-osseous pseudotumour is often mistaken for malignancy, leading to inappropriate treatment. Knowledge of its clinical and histopathological features thus allows for appropriate primary treatment, sparing the patient from unnecessary radical surgery associated with presumed malignancy. We present the case of a 48-year-old male with fibro-osseous pseudotumour affecting the right ring finger, successfully treated with local excision. This is the second reported Australian case of fibro-osseous pseudotumour, and we present an extensive review of the literature relating to the diagnosis and management of this rare tumour.

Florid reactive periostitis of the metacarpal and phalanx: 2 case reports

Florid reactive periostitis is a rare benign fibro-osseous proliferative lesion of soft tissue and is mainly composed of fibrous connective tissue and mature bone. The lesion usually occurs in the finger and seldom in the metacarpal. The lesion mimics malignant and infectious disorders, thus often leading to inappropriate treatment. Radiography usually shows an ossified mass attached to the underlying hand bones without interruption of the cortex. We report 1 case of florid reactive periostitis with unossified mass and underlying bone marrow edema in the metacarpal of hand and 1 case with adjacent cortical destruction in the phalanx. In addition, we describe the imaging findings of computed tomography CT and magnetic resonance imaging MRI and discuss their diagnostic values compared with routine radiographic examination.

Fibro-osseous pseudotumor of the thenar eminence: a rare aggressive but benign tumor

Fibro-osseous pseudotumor is a rare benign lesion that is characterized by fibroblastic proliferation with foci of osseous differentiation. The tumor commonly involves the digits and is usually mistaken for malignancy because of its aggressive nature thus resulting in surgical over treatment. We report a patient with fibro-osseous pseudotumor that involved the thenar eminence and was managed successfully by local resection from the surrounding structures with no residual loss of function.

Fibro-osseous pseudotumor of the digits: a rare tumor in an unusual location

Fibro-osseous pseudotumor of the digits (FOPT) is a rare benign lesion of the hand. When FOPT originates in an unusual anatomic region (other than the digits), it can imitate a malignant neoplasm, and consequently surgical treatment can be improper. This report describes a case of FOPT that developed in an unusual anatomic region: the first dorsal-extensor compartment of the wrist.

Rapidly growing fibro-osseous pseudotumor of the digits mimicking extraskeletal osteosarcoma

Fibro-osseous pseudotumor of the digits is a rare benign lesion characterized histopathologically by a fibroblastic proliferation with foci of osseous differentiation. We report a case of fibro-osseous pseudotumor of the digits with a rapidly growing lesion in a 30-year-old woman. Because of its rapid growth and aggressive histopathological appearance, this lesion can be mistaken for a malignant neoplasm such as extraskeletal or parosteal osteosarcoma, despite its benign clinical behavior. For a soft tissue mass in the digit with a clinicopathological feature of pseudomalignancy, the clinician should consider fibro-osseous pseudotumor of the digits as a possible diagnosis, thereby avoiding inappropriately aggressive surgery.