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Chong PQY, Choudhury MM, Chung SR, Yap RTJ, Chia DSY, Jiang JKH, Chin AYH, McGrouther DA. A multivariate analysis on characteristics of hand and wrist tumours: a multiethnic study. Singapore Med J 2024:00077293-990000000-00137. [PMID: 39175263 DOI: 10.4103/singaporemedj.smj-2023-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/27/2023] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Hand tumours are frequently encountered in clinical practice. However, large-scale epidemiological data of soft tissue tumours in the hand are infrequently published. Epidemiological data provide diagnostic cues to guide the workup and management of hand tumours. Assessing significant independent demographic factors and tumour characteristics associated with hand tumours is essential in health care. METHODS A retrospective review of patients who underwent excision of hand tumours in Singapore General Hospital between 2004 and 2015 was conducted. The data collected included age, gender, ethnicity, histological diagnosis, malignancy and location of tumour. Generalised linear latent and mixed models (GLLAMM) analyses were performed. RESULTS A total of 4476 tumours were identified from 4226 patients with a mean age of 51.3 (range 8-101) years and male to female ratio of 1 to 1.15. Most patients were Chinese (75%), followed by Malay (9%), Indian (8%) and others (8%). The most common hand tumours excised were ganglions (43%) (majority in the wrist), followed by giant cell tumours (9%) (commonly in the digits). Most soft tissue tumours were benign (97%), with only 3% of malignant cases. The GLLAMM analyses revealed further potential factors on the status of malignancy, tumour origin and tumour location. CONCLUSION Most soft tissue tumours in the hand and wrist are benign. This can guide workup and counselling of patients before the operation. While malignant tumours are uncommon, they have the potential for significant morbidity and mortality if not appropriately evaluated or treated. The application of GLLAMM analyses showed that age, ethnicity and gender were significant predictors of malignancy.
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Affiliation(s)
- Pamela Qin Yi Chong
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Muntasir Mannan Choudhury
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Sze Ryn Chung
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Robert Tze Jin Yap
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Dawn Sinn Yi Chia
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Jackson Kian Hong Jiang
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Andrew Yuan Hui Chin
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Duncan Angus McGrouther
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
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Goodall RJ, Pickford MA. Digital papillary adenocarcinoma: An important differential diagnosis for digital soft tissue masses. JPRAS Open 2024; 39:257-261. [PMID: 38328740 PMCID: PMC10847830 DOI: 10.1016/j.jpra.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Digital papillary adenocarcinoma (DPAC) is a rare, aggressive cancer with significant metastatic potential which arises from digital sweat glands. We present a case of a DPAC managed with surgical excision and reconstruction with a reversed homodigital island flap. Level of evidence: V.
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Affiliation(s)
- RJ Goodall
- Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, Sussex, UK
| | - MA Pickford
- Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, Sussex, UK
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3
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Joy A, Kumar A, Radhakrishnan N. Metastasis from renal cell carcinoma-unusual presentations. J Cancer Res Ther 2023:01363817-990000000-00034. [PMID: 38102914 DOI: 10.4103/jcrt.jcrt_2738_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/02/2023] [Indexed: 12/17/2023]
Abstract
ABSTRACT Renal cell carcinoma is one of the most lethal tumors of the urologic system and has high metastatic potential. The usual sites of metastasis are lung, bone, liver adrenal, lymph node, and brain. Thumb and oral cavity metastasis are unusual sites of metastasis. This case report describes two cases reported with unusual thumb and oral cavity metastasis. Patients with acral and oral metastasis are often misdiagnosed as benign inflammatory disease and treatment initiation is often delayed. This case report helps in drawing the attention that such lesions can be metastatic also.
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Affiliation(s)
- Anju Joy
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Aswin Kumar
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Jelti O, El Alaoui O, Lachkar A, Abdeljaouad N, Yacoubi H. An Unusual Case of a Giant Schwannoma of the Sciatic Nerve: A Case Report With a Review of Literature. Cureus 2023; 15:e51155. [PMID: 38283507 PMCID: PMC10811739 DOI: 10.7759/cureus.51155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Sciatic nerve schwannomas are rare tumors, mainly characterized by sciatic neuralgia rather than sensory-motor deficits. The poorly suggestive clinical presentation of this localization leads to a delayed diagnosis. Here, we describe the case of a 47-year-old female patient with a nine-month history of schwannoma localized in the sciatic nerve, just above the left popliteal fossa. Although magnetic resonance imaging (MRI) is the imaging modality of choice, the final diagnosis rests on the histological examination of the tumor. The schwannoma must be surgically removed without severing the nerve trunk.
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Affiliation(s)
- Ousama Jelti
- Orthopedics, Mohammed VI University Hospital, Oujda, MAR
| | - Oussama El Alaoui
- Orthopedics and Traumatology, Centre Hospitalier Universitaire (CHU) Mohammed VI Oujda, Oujda, MAR
| | - Adnane Lachkar
- Department of Traumatology and Orthopedic, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Najib Abdeljaouad
- Department of Traumatology and Orthopedic, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Hicham Yacoubi
- Department of Traumatology and Orthopedic, Mohammed VI University Hospital, Oujda, MAR
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
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5
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Shin A, Fracol M, Roubaud MS. Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces for Prophylactic Pain Control in Neurofibromatosis Type 1 Amputees. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5405. [PMID: 38025622 PMCID: PMC10659716 DOI: 10.1097/gox.0000000000005405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an inherited multisystem disorder that affects one in 2500 to one in 5000 people. Neurofibromas are the second-most common benign peripheral nerve sheath tumors arising from Schwann cells and are associated with neurofibromatosis. Chronic pain and opioid use is elevated in patients with NF1 when neurofibromas are associated with sensory nerves. Surgical excision is the primary treatment of neurofibromas when they become large, malignant, or painful, but they are associated with high rates of recurrence. Targeted muscle reinnervation and regenerative peripheral nerve interfaces are two prophylactic surgical techniques that are used to prevent neuroma-associated residual limb and phantom pain in amputees. Both techniques stimulate physiologic regeneration of the nerve via trophic stimulus from denervated muscle. This case report describes two patients with NF1 who underwent targeted muscle reinnervation and/or regenerative peripheral nerve interfaces at the time of amputation. Despite the abnormality of the peripheral nerves involved, both patients had excellent postoperative outcomes with minimal pain. This experience advocates for the use of prophylactic nerve management techniques in neurofibromatosis patients despite baseline nerve pathology.
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Affiliation(s)
- Ashley Shin
- From the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex
| | - Megan Fracol
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Margaret S. Roubaud
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
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6
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Istefan E, Belstock J, Dahlin LB, Nyman E. Surgery of Schwannoma in the upper limb - sensitivity and specificity of preoperative magnetic resonance imaging and relation between tumour size and symptoms. BMC Musculoskelet Disord 2023; 24:713. [PMID: 37679701 PMCID: PMC10483856 DOI: 10.1186/s12891-023-06838-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Benign peripheral nerve tumours consist of different types, most commonly Schwannomas. Preoperative Magnetic Resonance Imaging (MRI) is commonly performed before surgery and Pathoanatomical Diagnosis (PAD) confirms the diagnosis. Our aims were to study the utility of MRI and the relation between tumour size and symptoms. METHODS Retrospectively, patients, surgically treated for benign nerve tumours between 2008 and 2019, were identified and preoperative MRI, with measurement of tumour size, PAD, symptoms, peroperative details, and symptomatic outcomes of surgery, were analysed. RESULTS The sensitivity and specificity to correctly identify Schwannomas with preoperative MRI were 85% and 50%, respectively, based on 30 Schwannomas and nine neurofibromas that were identified. Tumour size did not affect the presence of preoperative symptoms, but patients with sensory dysfunction at last follow-up had larger Schwannomas (p < 0.05). Symptoms as a palpable tumour, paraesthesia and pain improved by surgical excision (p < 0.001, p < 0.001 and p < 0.012, respectively), but sensory and motor dysfunction were common postoperatively. No malignant peripheral nerve sheath tumours (MPNST) were found. Using a surgical microscope, instead of only loop magnification, lowered the risk of perioperative nerve injuries (p < 0.05), but did not further diminish postoperative symptoms. CONCLUSIONS Early and accurate diagnosis of Schwannomas is valuable for adequate presurgical preparation and prompt surgical intervention. Preoperative examination with MRI has a high sensitivity, but low specificity; although recent advancement in MRI technology indicates improvement in diagnostic precision. Surgical excision is preferably performed early in conjunction with symptomatic debut to improve outcome.
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Affiliation(s)
- Emanuel Istefan
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 85, Sweden
| | - Johannes Belstock
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 85, Sweden
| | - Lars B Dahlin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 85, Sweden
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, 205 02, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, 205 02, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 85, Sweden.
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, 581 85, Sweden.
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7
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Istefan E, Zimmerman M, Dahlin LB, Nyman E. Benign nerve tumours in the upper limb: a registry-based study of symptoms and surgical outcome. Sci Rep 2023; 13:11500. [PMID: 37460574 DOI: 10.1038/s41598-023-38184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
Surgery for benign nerve tumours is performed for pathoanatomical diagnosis and symptomatic relief, but might cause residual problems. We aimed to assess patient-reported symptoms and disability before and after surgery at a national level. In total, 206 cases surgically treated for a benign peripheral nerve tumour 2010-2019 registered in the Swedish Quality Registry for Hand Surgery (HAKIR; response rates 22-34%) were analysed. Surgery reduced overall disability in the affected limb (QuickDASH 18/100 [IQR 5-36] preoperatively and 5/100 [IQR 0-22] 12 months postoperatively), improved ability to perform daily activities (HQ-8; 11/100 [IQR 0-50] preoperatively and 0/100 [IQR 0-20] 12 months postoperatively) and decreased three evaluated pain modalities: pain at rest (HQ-8; 20/100 [IQR 0-40] preoperatively and 0/100 [IQR 0-10] 12 months postoperatively), pain on motion without load (HQ-8; 20/100 [IQR 0-40] preoperatively and 0/100 [IQR 0-10] 12 months postoperatively), and pain on load (HQ-8; 24/100 [IQR 1-69] preoperatively and 1/100 [IQR 0-30] 12 months postoperatively). Cold sensitivity was a minor problem both before and after surgery (HQ-8; 0/100 [IQR 0-30] preoperatively and 1/100 [IQR 0-40] 12 months postoperatively). We conclude that surgery for benign peripheral nerve tumours provides good symptomatic relief with low risk for residual problems.
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Affiliation(s)
- Emanuel Istefan
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Malin Zimmerman
- Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
| | - Lars B Dahlin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University Hospital, 581 83, Linköping, Sweden.
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8
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Ejiyooye TF, Dirisanala S, Makky Abouzied H, Mahjabeen SS, Sajjad T, Khan A. A Rare Case of Plexiform Schwannoma of the Little Finger and Its Management: A Case Report. Cureus 2022; 14:e26391. [PMID: 35911312 PMCID: PMC9332030 DOI: 10.7759/cureus.26391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/05/2022] Open
Abstract
Schwannomas are tumors of the Schwann cells found in the myelin sheath. They cause 5% of all benign soft-tissue cancers, occur equally in males and females, and occur later in life. Since they remain asymptomatic, diagnosing and treating them becomes challenging; current guidelines recommend imaging followed by excision. Here, we present a case of a 19-year-old male who presents in an outpatient setting with a history of painless swelling of the fifth digit for the past four years. Past medical history and physicals are unremarkable. Microscopic findings from fine-needle aspiration cytology (FNAC) confirmed the schwannoma diagnosis, showing loosely arranged spindle cells with elongated nuclei with pointed ends dispersed within the myxoid stroma.
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9
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Thumser J, Cambon-Binder A, Even J, Babinet A, Anract P, Biau D. Sarcomas of the hand: A retrospective series of 26 cases. Orthop Traumatol Surg Res 2022; 108:102991. [PMID: 34144254 DOI: 10.1016/j.otsr.2021.102991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/17/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hand sarcomas frequently suffer from a delayed diagnosis, and the current guidelines for their management are often not followed. METHODS The objectives of our study were to determine: (1) the rate of inadequate initial treatments; (2) the rates of mortality, recurrence, and complementary excision in a cohort of patients with a sarcoma of the hand who were treated at our reference center between 2000 and 2015. RESULTS The series comprised 26 patients (mean age 40 years). Of the 20 patients not initially treated at a reference center, 17 had inadequate initial treatment. Of the six patients treated at our center, one had inadequate initial care. Significantly more patients had inadequate initial care outside a reference center (p=0.0045). The cumulative probabilities of recurrence or metastases at 5 years were 15% and 30%, respectively. Survival by cumulative incidence was 71% at 5 years and 56% at 10 years. CONCLUSIONS Sarcomas of the hand are a deadly pathology. All diagnostic uncertainty warrants referral of the patient to a reference center. LEVEL OF PROOF IV.
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Affiliation(s)
- Joannie Thumser
- Hôpital privé Armand-Brillard, 3-5, avenue Watteau, 94130 Nogent-sur-Marne, France.
| | - Adeline Cambon-Binder
- Sorbonne University, Orthopaedic and Trauma Department, Saint-Antoine Hospital, Paris, France
| | - Julien Even
- Clinique Internationale du Parc Monceau, Paris, France
| | - Antoine Babinet
- Paris-Descartes University, Orthopedic and Trauma Department, Cochin Hospital, Paris, France
| | - Philippe Anract
- Paris-Descartes University, Orthopedic and Trauma Department, Cochin Hospital, Paris, France
| | - David Biau
- Paris-Descartes University, Orthopedic and Trauma Department, Cochin Hospital, Paris, France
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Shah RK, Rahman SM, Pywell M, Ibanez J. Management of a rare, giant multicompartmental lipoma of the hand: a case report and review of the literature. J Surg Case Rep 2022; 2022:rjac306. [PMID: 35774476 PMCID: PMC9238300 DOI: 10.1093/jscr/rjac306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/01/2022] [Indexed: 11/21/2022] Open
Abstract
Lipomas are the commonest benign tumour, made up exclusively of adipose tissue, and can arise anywhere in the body. However, giant lipomas of the hand, defined as >5 cm in diameter, are rare. They have the potential to invade into surrounding areas and cause a multitude of symptoms due to the compression and proximity of underlying structures. We describe a case of a 64-year-old woman who presents with a swelling of the left thenar eminence, associated with numbness and tingling in all fingers. Magnetic resonance imaging and nerve conduction studies confirmed the diagnosis of a lipoma causing median nerve compression. The patient underwent elective surgical excision with good postoperative recovery. The excised lesion, measuring 12 × 7 × 2.4 cm, is one of the largest giant lipomas of the hand reported in literature, and the first to demonstrate invasion from the mid palmar space into both the dorsal sub-aponeurotic space and carpal tunnel.
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Affiliation(s)
- Rushabh K Shah
- Department of Plastic and Reconstructive Surgery, Guy’s and St Thomas’ NHS Foundation Trust , London , UK
| | - Shakeel M Rahman
- Department of Plastic and Reconstructive Surgery, Guy’s and St Thomas’ NHS Foundation Trust , London , UK
| | - Matthew Pywell
- Department of Plastic and Reconstructive Surgery, Guy’s and St Thomas’ NHS Foundation Trust , London , UK
| | - Javier Ibanez
- Department of Plastic and Reconstructive Surgery, Guy’s and St Thomas’ NHS Foundation Trust , London , UK
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Diffuse Type Neurofibroma of the Forearm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4341. [PMID: 35620496 PMCID: PMC9126514 DOI: 10.1097/gox.0000000000004341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
Nerve sheath tumors comprise 5% of soft tissue masses of the upper limb in adults. Neurofibromas are divided into three types: localized, diffuse, and plexi- form. The diffuse type is rare and is typically found in the head and neck region. We present a rare case of diffuse type neurofibroma found in the forearm, presented to our clinic as a slowly enlarging mass of the left forearm of 3 years duration. The lesion was suspicious in the magnetic resonance imaging, and biopsy revealed diffuse type neurofibroma. We opted for total excision of the lesion that was found to be not possible due to involvement of the major nerves. The final pathology report showed no malignancy. Nerve tumors of the upper limb can be either benign or malignant. Neurofibroma associated with neurofibromatosis has malignant potential. The diffuse type is rare, and it most commonly occurs in the head and neck region. It has a low malignant transformation rate. Magnetic resonance imaging is the diagnostic modality of choice; however, it can be inconclusive. Biopsy should be taken to confirm the diagnosis and plan for management. Our case was managed by near total excision in order to preserve the major forearm nerves because of high clinical suspicion.
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12
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Lander RD, O’Donnell MJ. A Case of Metastatic Prostate Cancer to the Distal Phalanx. Hand (N Y) 2022; 17:NP1-NP4. [PMID: 34218699 PMCID: PMC9112744 DOI: 10.1177/15589447211028922] [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: 11/15/2022]
Abstract
Metastatic bone tumors to the hand are extremely rare. We present a case of metastatic prostate cancer to the right middle finger distal phalanx. To our knowledge, there is one other case of metastatic prostate cancer to the hand in the literature. In our case, a 59-year-old man with a history of widely metastatic prostate cancer presented to urgent care and was diagnosed with a nail plate avulsion injury. He was referred to hand surgery and treated with amputation of the right middle finger distal phalanx. The pathology reported high-grade poorly differentiated adenocarcinoma with primary lesion from the prostate.
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Affiliation(s)
| | - Marc J. O’Donnell
- University of Rochester Medical Center, NY, USA,Marc J. O’Donnell, Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA.
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13
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Ogur HU, Arik A, Kapi E, Cicek H, Seyfettinoglu F, Bulut M. An analysis of cases presenting with a mass in the hand and an evaluation of treatment methods. Acta Orthop Belg 2022; 88:190-197. [PMID: 35512171 DOI: 10.52628/88.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to present and discuss our clinical experience of patients presenting with a mass in the upper extremity, in respect of demographic characteristics, localisation of the mass, clinical and pathological characteristics. A retrospective evaluation was made of 114 cases (60 females, 54 males) who presented at our clinic with complaints of localised pain and swelling in the upper extremity between 1 June 2016 and 31 December 2018. The cases were separated into 3 groups; Group 1 with a mass determined in the carpal region, Group 2 with localisation between the wrist and the metacarpophalangeal joint, and Group 3, in the distal of the metacarpophalangeal joint. The mass was of soft tissue origin in 90 cases, and of bone origin in 24 cases. The distribution of cases was 6 in Group 1, 20 cases in Group 2, and 88 in Group 3. The tumour was benign in 105 (92%) cases and a primary malignancy in 9 (7.8%) cases. Recurrence occurred in 4 cases, of which 2 were enchondroma, 1 was a giant cell tendon sheath tumour, and 1 was hemangioma The majority of painful masses seen in the hand are benign and very few are malignant. In the approach to hand tumours, clinical evaluation guided by demo- graphic data, and the evaluation of diagnostic and treatment options according to the radiological ap- pearance and anatomic localisation will determine the ideal approach providing a full cure.
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14
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Yue KLC, Lans J, Castelein RM, Suster DI, Nielsen GP, Chen NC, Lozano-CalderÓn SA. Benign Hand Tumors (Part I): Cartilaginous and Bone Tumors. Hand (N Y) 2022; 17:346-353. [PMID: 32506966 PMCID: PMC8984707 DOI: 10.1177/1558944720922921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background: Benign tumors of the hand present in a wide array of histological subtypes and compose most of the bony tissue tumors in the hand. This study evaluates the characteristics and treatment of benign bone tumors in light of one institution's experience. Methods: Histologically confirmed benign tumors of the hand were retrospectively identified using International Classification of Diseases codes from 1992 to 2015. A medical chart review was conducted to collect patient characteristics and tumor epidemiology and treatment. Results: A total of 155 benign bone tumors were identified. The median age of patients at the time of surgery was 39.9 ± 12.8 years. All bone tumors were located in the digits, and most were treated by intralesional curettage (n = 118, 76%). Pathologic fractures occurred in 79 bone tumors (51%). Conclusion: Enchondromas (n = 118, 76%) were the most common bone tumor in this series, whereas giant cell tumors were the most destructive and also had the highest recurrence rate (40%). Awareness of tumor features may help physicians with diagnosis, and awareness of recurrence rates is important when counseling patients.
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Affiliation(s)
| | - Jonathan Lans
- Harvard Medical School, Boston, MA,
USA,Jonathan Lans, Department of Orthopaedic
Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital,
Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA
02114, USA.
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15
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Anderson O, Langley‐Hobbs SJ. A peripheral nerve sheath tumour in the median nerve of a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Dharmani C, Wang E, Salas M, McCabe C, Diggs A, Choi Y, Jiang J, Keedy VL. Turalio risk evaluation and mitigation strategy for treatment of tenosynovial giant cell tumor: framework and experience. Future Oncol 2022; 18:1595-1607. [PMID: 35105158 DOI: 10.2217/fon-2021-1475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
For drugs with enhanced serious safety risks, Risk Evaluation and Mitigation Strategy (REMS) may be required. Pexidartinib is approved for treatment of adult symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery. Its approval was conditional on its prescription via a mandatory REMS due to serious and potentially fatal liver injury seen in clinical trials. Turalio® REMS aims to mitigate this risk by ensuring provider education on pexidartinib use and required REMS components, prescriber adherence to baseline and periodic monitoring, and enrolling patients in a registry to further assess safe use and acute, chronic and irreversible hepatotoxicity. Through Turalio REMS, benefits of treating patients with pexidartinib may be preserved.
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Affiliation(s)
- Charles Dharmani
- Daiichi Sankyo, Inc. 211, Mt. Airy Rd., Basking Ridge, NJ 07920, USA
| | - Eric Wang
- Daiichi Sankyo, Inc. 211, Mt. Airy Rd., Basking Ridge, NJ 07920, USA
| | - Maribel Salas
- Daiichi Sankyo, Inc. 211, Mt. Airy Rd., Basking Ridge, NJ 07920, USA
| | - Colleen McCabe
- Vanderbilt-Ingram Cancer Center 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN 37232, USA
| | - Alvileen Diggs
- Daiichi Sankyo, Inc. 211, Mt. Airy Rd., Basking Ridge, NJ 07920, USA
| | - Youngsook Choi
- Daiichi Sankyo, Inc. 211, Mt. Airy Rd., Basking Ridge, NJ 07920, USA
| | - Jason Jiang
- Daiichi Sankyo, Inc. 211, Mt. Airy Rd., Basking Ridge, NJ 07920, USA
| | - Vicki L Keedy
- Vanderbilt-Ingram Cancer Center 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN 37232, USA
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17
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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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18
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Bilateral Hand Metastases From a Pleomorphic/Dedifferentiated Leiomyosarcoma: A Case Report. Am J Dermatopathol 2021; 44:118-120. [PMID: 34783705 DOI: 10.1097/dad.0000000000002083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Leiomyosarcomas of the lower extremity are heterogeneous tumors with high recurrence and metastasizing rates, which, rarely, can suffer a dedifferentiation process, making them extremely aggressive and unpredictable. We report the case of a 72-year-old female patient who presented the clinical and histopathological features of a rare leiomyosarcoma of the foot that was completely excised, but because of the interruption of adjuvant oncological treatment and lack of compliance for the follow-up, the patient suffered a dedifferentiation process and the tumor metastasized in the fingers-an unprecedented site for this type. The present case proves the fact that there is still a lot we do not know about the behavior of this disease, and there is always room to learn. Also, through this report, we are emphasizing a frequently encountered and never-ending problem in our country-that of difficult and resource-consuming cases derived from disconsidering medical advice by noncompliant patients when faced with a malignant diagnosis, making all attempts to offer them a better quality of life futile.
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19
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Ebeid WA, Badr IT, Mesregah MK, Hasan BZ. Outcome of Surgical Resection of Primary Malignant and Aggressive Benign Metacarpal Bone Tumors. Orthopedics 2021; 44:e633-e638. [PMID: 34590957 DOI: 10.3928/01477447-20210817-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Primary bone tumors of the hand are relatively rare. Different treatment options have been described in case reports. In this study, the authors present the diagnostic methods and treatment strategies that they used. The goal of this study is to present the oncologic and functional outcomes of surgical resection of primary malignant and aggressive benign metacarpal bone tumors. This retrospective study included 7 patients with primary malignant and aggressive benign bone tumors of the metacarpals who underwent surgical resection with or without metacarpal reconstruction between 2000 and 2017, with a minimum follow-up of 2 years. Clinical and radiologic evaluations were reviewed, and functional evaluation was performed with the Musculoskeletal Tumor Society scoring system. Seven patients (6 female; 1 male), with a mean age of 30.9±11.3 years, were included in the study. Six tumors were de novo, whereas 1 was recurrent. After resection, 5 patients had metacarpal reconstruction. Nonvascularized fibula was used for 3 patients, extracorporeal freezing of the metacarpal using liquid nitrogen was used for 1 patient, and metacarpal shift was used for 1 patient. Mean follow-up was 52.6±26.7 months. At the final follow-up, mean Musculoskeletal Tumor Society score was 27.4±1.6, and no local recurrence was documented. One patient had chest metastasis after 8 years of follow-up. The results show that surgical resection of primary malignant and aggressive benign tumors of the metacarpal bones can achieve satisfactory functional and oncologic outcomes. [Orthopedics. 2021;44(5):e633-e638.].
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20
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Ferrando E, Navarro J, Rojas R, Mata D, Silvestre A. Osteosarcoma of the Trapezium. J Hand Surg Am 2021; 46:717.e1-717.e5. [PMID: 33277099 DOI: 10.1016/j.jhsa.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Emilio Ferrando
- Department of Orthopaedic Surgery and Traumatology, Clinic University Hospital, Valencia, Spain.
| | - Javier Navarro
- Department of Orthopaedic Surgery and Traumatology, Clinic University Hospital, Valencia, Spain
| | - Raúl Rojas
- Department of Orthopaedic Surgery and Traumatology, Clinic University Hospital, Valencia, Spain
| | - Daniel Mata
- Department of Pathological Anatomy, Clinic University Hospital, Valencia, Spain
| | - Antonio Silvestre
- Department of Orthopaedic Surgery and Traumatology, Clinic University Hospital, Valencia, Spain; Department of Surgery. Medicine School, University of Valencia, Valencia, Spain
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21
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Abstract
Most tumors of the hand and the wrist are benign; however, malignant conditions can mimic benign tumors and must be worked up accordingly.
Advanced imaging should be followed by biopsy before definitive treatment of tumors of unknown diagnosis. The most common soft-tissue masses in the hand and the wrist are ganglion cysts, whereas the most common bone tumors are enchondromas.
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Affiliation(s)
- Sophia A Strike
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark E Puhaindran
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
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22
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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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23
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Blum AG, Gillet R, Athlani L, Prestat A, Zuily S, Wahl D, Dautel G, Gondim Teixeira P. CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings. Insights Imaging 2021; 12:16. [PMID: 33576888 PMCID: PMC7881081 DOI: 10.1186/s13244-020-00958-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/29/2020] [Indexed: 12/30/2022] Open
Abstract
Vascular lesions of the hand are common and are distinct from vascular lesions elsewhere because of the terminal vascular network in this region, the frequent hand exposure to trauma and microtrauma, and the superficial location of the lesions. Vascular lesions in the hand may be secondary to local pathology, a proximal source of emboli, or systemic diseases with vascular compromise. In most cases, ischaemic conditions are investigated with Doppler ultrasonography. However, computed tomography angiography (CTA) or dynamic contrast-enhanced magnetic resonance angiography (MRA) is often necessary for treatment planning. MR imaging is frequently performed with MRA to distinguish between vascular malformations, vascular tumours, and perivascular tumours. Some vascular tumours preferentially affect the hand, such as pyogenic granulomas or spindle cell haemangiomas associated with Maffucci syndrome. Glomus tumours are the most frequent perivascular tumours of the hand. The purpose of this article is to describe the state-of-the-art acquisition protocols and illustrate the different patterns of vascular lesions and perivascular tumours of the hand.
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Affiliation(s)
- Alain G Blum
- Service D'imagerie Guilloz, CHRU Nancy, 54 000, Nancy, France.
| | - Romain Gillet
- Service D'imagerie Guilloz, CHRU Nancy, 54 000, Nancy, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHRU de Nancy, 54 000, Nancy, France
| | | | - Stéphane Zuily
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases and Vascular Medicine Division, CHRU Nancy, INSERM UMR-S 1116 University of Lorraine, 54 000, Nancy, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases and Vascular Medicine Division, CHRU Nancy, INSERM UMR-S 1116 University of Lorraine, 54 000, Nancy, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHRU de Nancy, 54 000, Nancy, France
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24
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Qiu W, Gu PR, Chuong CM, Lei M. Skin Cyst: A Pathological Dead-End With a New Twist of Morphogenetic Potentials in Organoid Cultures. Front Cell Dev Biol 2021; 8:628114. [PMID: 33511139 PMCID: PMC7835531 DOI: 10.3389/fcell.2020.628114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/17/2020] [Indexed: 01/07/2023] Open
Abstract
A cyst is a closed sac-like structure in which cyst walls wrap certain contents typically including air, fluid, lipid, mucous, or keratin. Cyst cells can retain multipotency to regenerate complex tissue architectures, or to differentiate. Cysts can form in and outside the skin due to genetic problems, errors in embryonic development, cellular defects, chronic inflammation, infections, blockages of ducts, parasites, and injuries. Multiple types of skin cysts have been identified with different cellular origins, with a common structure including the outside cyst wall engulfs differentiated suprabasal layers and keratins. The skin cyst is usually used as a sign in pathological diagnosis. Large or surfaced skin cysts affect patients' appearance and may cause the dysfunction or accompanying diseases of adjacent tissues. Skin cysts form as a result of the degradation of skin epithelium and appendages, retaining certain characteristics of multipotency. Surprisingly, recent organoid cultures show the formation of cyst configuration as a transient state toward more morphogenetic possibility. These results suggest, if we can learn more about the molecular circuits controlling upstream and downstream cellular events in cyst formation, we may be able to engineer stem cell cultures toward the phenotypes we wish to achieve. For pathological conditions in patients, we speculate it may also be possible to guide the cyst to differentiate or de-differentiate to generate structures more akin to normal architecture and compatible with skin homeostasis.
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Affiliation(s)
- Weiming Qiu
- Department of Dermatology, General Hospital of Central Theater Command of Chinese People’s Liberation Army, Wuhan, China
| | - Pei-Rong Gu
- Integrative Stem Cell Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Cheng-Ming Chuong
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mingxing Lei
- Integrative Stem Cell Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
- “111” Project Laboratory of Biomechanics and Tissue Repair, Key Laboratory of Biorheological Science and Technology of the Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
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25
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MRI evaluation of solid soft tissue masses of the fingers with pathology correlation. Eur J Radiol 2020; 135:109465. [PMID: 33341071 DOI: 10.1016/j.ejrad.2020.109465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/11/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Space occupying lesions of the fingers are commonly encountered in clinical and radiology practice. The objective of this study was to determine the characteristics of these lesions on MRI and to correlate with surgical pathology results. MATERIAL AND METHODS This IRB-approved HIPAA-compliant study retrospectively evaluated the clinical, imaging and pathology findings of 100 consecutive patients referred for evaluation of solid soft tissue masses of the fingers. Only solid lesions with MR imaging prior to surgery were included in this study. MR images and when available corresponding radiographs were evaluated by two radiologist in regard to signal characteristics, relation to surrounding structures and enhancement. All masses were classified into different groups based on pathology results. RESULTS Tenosynovial giant cell tumor (TSGCT) and fibroma of the tendon sheath were the most common solid tumors (36 %) and malignant tumors represent only 5% of the cohort. 70 % of masses with low T2 signal were TSGCT and fibroma of tendon sheath; 100 % of masses with peripheral high T2 signal and central low T2 signal/thrombus were vascular lesions, representing 41 % of the total vascular lesions in the cohort. Additionally, 100 % of serpiginous/tubular shaped masses were vascular lesions and 67 % of masses with infiltrative borders were malignant masses. Enhancement was important in identifying solid lesions but there was no statistical difference between groups related to enhancement pattern. There was a good agreement for all analyses between both readers. CONCLUSION Typical MR findings can help to narrow the differential diagnosis in the evaluation of finger masses and provide crucial information to guide further management.
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26
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Zhou HY, Jiang S, Ma FX, Lu H. Peripheral nerve tumors of the hand: Clinical features, diagnosis, and treatment. World J Clin Cases 2020; 8:5086-5098. [PMID: 33269245 PMCID: PMC7674743 DOI: 10.12998/wjcc.v8.i21.5086] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
The majority of the tumors arising from the peripheral nerves of the hand are relatively benign. However, a tumor diagnosed as malignant peripheral nerve sheath tumor (MPNST) has destructive consequences. Clinical signs and symptoms are usually caused by direct and indirect effects of the tumor, such as nerve invasion or compression and infiltration of surrounding tissues. Definitive diagnosis is made by tumor biopsy. Complete surgical removal with maximum reservation of residual neurologic function is the most appropriate intervention for most symptomatic benign peripheral nerve tumors (PNTs) of the hand; however, MPNSTs require surgical resection with a sufficiently wide margin or even amputation to improve prognosis. In this article, we review the clinical presentation and radiographic features, summarize the evidence for an accurate diagnosis, and discuss the available treatment options for PNTs of the hand.
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Affiliation(s)
- Hai-Ying Zhou
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shuai Jiang
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Fei-Xia Ma
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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27
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Panwar H, Tandon A, Joshi D, Goel G, Mahabharti K, Kapoor N. Cytomorphological spectrum of hand, wrist, and foot lesions at tertiary care center in central India. Diagn Cytopathol 2020; 48:1048-1053. [PMID: 32559023 DOI: 10.1002/dc.24528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) being a fast technique is used as a primary investigation to diagnose wide spectrum of hand, wrist, and foot lesions. These sites are prone to trauma, reparative, and infectious process, which forms mass lesions mimicking neoplasia. Our study highlighted the importance of FNAC with the chance of reduction in biopsy or excision. AIMS AND OBJECTIVES To report the prevalence and cytomorphological spectrum of hand and foot lesions with the aim of consolidating the diagnostic potential and also correlate the cytological evaluation with histopathology. MATERIALS AND METHODS This retrospective observational study was done in central India for the period of 5.5 years. The archive cytology slides of patients with palpable lesions at these sites are reviewed and analyzed. RESULTS Of the total 6512 FNAC cases, 115 cases presented as swelling in the hand, wrist, and foot are reviewed. Age ranged from 4 months to 80 years with M:F = 1.25:1. Of the 111 satisfactory smears (96.7%), 21 cases (18.9%) diagnosed as inflammatory lesion, including synovitis, tuberculosis, gout, and fat necrosis. Sixty cases as benign non-neoplastic (tumor-like) lesions with the most common being ganglion (29). Of the 30 neoplastic lesions, 26 were benign tumor with the most common being mesenchymal neoplasms (19), followed by giant cell tumor of tendon sheath. Malignant tumors included malignant melanoma, small round cell tumor, and squamous-cell carcinoma. CONCLUSION FNAC is useful investigation for early diagnosis of hand and foot lesions. These lesions are benign mostly with less malignancy occurrence (<2%), compared with other soft tissue lesions.
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Affiliation(s)
- Hemlata Panwar
- Department of Pathology & Lab Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Ashwani Tandon
- Department of Pathology & Lab Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Deepti Joshi
- Department of Pathology & Lab Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Garima Goel
- Department of Pathology & Lab Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Kodavali Mahabharti
- Department of Pathology & Lab Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Neelkamal Kapoor
- Department of Pathology & Lab Medicine, All India Institute of Medical Sciences, Bhopal, India
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28
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Sugiyama Y, Naito K, Goto K, Nagura N, Kaneko K. Intratendinous ganglion in the extensor digitorum communis. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2020; 7:120-123. [PMID: 33134430 PMCID: PMC7580778 DOI: 10.1080/23320885.2020.1833335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We encountered a patient with intratendinous ganglion which developed in the extensor digitorum communis tendon. Although its developmental mechanism is unclear, synovitis is considered the cause. For treatment, it may be necessary to prepare for tendon transfer and tendon grafting in consideration of the risk of tendon injury.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan.,Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan
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29
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Ozcanli H, Ozaksar K, Cavit A, Gurer EI, Cevikol C, Ada S. Deep palmar tumorous conditions of the hand. J Orthop Surg (Hong Kong) 2020; 27:2309499019840736. [PMID: 30955477 DOI: 10.1177/2309499019840736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Haluk Ozcanli
- 1 Department of Orthopaedics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Kemal Ozaksar
- 2 Hand Microsurgery Orthopaedics and Traumatology (EMOT) Hospital, Izmir, Turkey
| | - Ali Cavit
- 1 Department of Orthopaedics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Elif Inanc Gurer
- 3 Department of Pathology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Can Cevikol
- 4 Department of Radiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Sait Ada
- 2 Hand Microsurgery Orthopaedics and Traumatology (EMOT) Hospital, Izmir, Turkey
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30
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Marteau É, Le Nail LR, Rosset P, de Pinieux G, Laulan J, Roulet S, Bacle G. Epidemiological, clinical and histological features of adipose tumors in the hand and wrist: Findings from a continuous series of 37 cases. Orthop Traumatol Surg Res 2020; 106:329-334. [PMID: 32037290 DOI: 10.1016/j.otsr.2019.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/01/2019] [Accepted: 12/10/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Adipose tumors are the most common soft tissue tumor in adults; however, their epidemiology and histology in the hand and wrist are not well-defined. The aim of this study was to describe the histology and treatment strategy for this type of tumor at a specialized cancer center. HYPOTHESIS The frequency of these tumors is underestimated, and their histology signature varies. MATERIALS AND METHODS The clinical and paraclinical data of adults treated for an adipose tumor lesion in the hand or wrist were analyzed retrospectively: age, clinical history, time elapsed between discovery and treatment, type of treatment. The dimensions, location and histology of the tumor were collected. The patients were contacted to inquire about persistent symptoms and sequelae. RESULTS Thirty-seven tumors (37 patients) were included between January 2003 and December 2018, thus making up 7.5% of all the soft tissue tumors in the hand or wrist. The mean patient age was 59years (28-84years). Except for one fortuitous discovery, the tumors were discovered because the patient had an unusual lump. The lump was associated with distal paresthesia in six cases. The mean time to treatment was 47.5months (1-240months). The lesion was a conventional lipoma (31 cases) or one of its benign variants (6 cases). The mean size was 3.76cm in the long axis (1-11.5cm) and the mean weight was 9.8g (3-60g). The mean follow-up was 73.5months (2-177months). Tumors in the fingers were smaller and lighter than those in the wrist (p=0.004 and p=0.034). DISCUSSION The prevalence of adipose tumors is underestimated within hand and wrist tumors. The most common way these tumors are discovered is due to compressive neuropathy with paresthesia and/or dysesthesia. While these tumors are nearly always benign, this does not justify ignoring the opinion of the multidisciplinary tumor board or underestimating the small possibility of the lesion being a liposarcoma. LEVEL OF EVIDENCE IV, retrospective, single-center study.
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Affiliation(s)
- Émilie Marteau
- Unité de chirurgie de la main, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Louis-Romée Le Nail
- Service de Chirurgie Orthopédique et Traumatologique, Réunion de Concertation Pluridisciplinaire d'Oncologie de l'Appareil Locomoteur, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Philippe Rosset
- Service de Chirurgie Orthopédique et Traumatologique, Réunion de Concertation Pluridisciplinaire d'Oncologie de l'Appareil Locomoteur, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Gonzague de Pinieux
- Service d'Anatomie et de Cytologie Pathologiques, Réunion de Concertation Pluridisciplinaire d'Oncologie de l'Appareil Locomoteur, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Jacky Laulan
- Unité de chirurgie de la main, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Steven Roulet
- Unité de chirurgie de la main, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Guillaume Bacle
- Unité de chirurgie de la main, Hôpital Trousseau, CHRU de Tours, Tours, France; UMR 1253 Imagerie et Cerveau (iBrain), Faculté de Médecine, Université de Tours, Tours, France.
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31
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Abstract
Imaging studies of the hands and fingers are common, and radiologists are generally comfortable with traumatic and degenerative conditions which arise frequently in daily practice. However, a variety of common and uncommon soft-tissue tumors also occur in the hand, the appropriate diagnosis of which can be a source of confusion for both clinicians and radiologists. These lesions often have overlapping imaging characteristics; however, a structured approach can help provide a focused differential diagnosis and impact further workup and management. We discuss several such tumors, categorizing them as cystic-appearing, noncystic masses along tendons and aponeuroses, adipocytic tumors, vascular lesions, and miscellaneous lesions with imaging features that can aid diagnosis.
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Affiliation(s)
| | - Jeffrey Bonham
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Anthony Chang
- Department of Radiology, Sharp Rees Stealy Medical Group, San Diego, CA, USA
| | - Stephen Thomas
- Department of Radiology, University of Chicago, Chicago, IL, USA
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32
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Abstract
Benign peripheral nerve tumors encompass a wide range of neoplasms and non-neoplastic tumor like lesions. Some of these lesions if not encountered in the setting of genetic syndromes, are occurring sporadically. The principles of oncology should be respectfully followed in every step of diagnostic approach and surgical management. Albeit, classified as benign, some of them do have different level of malignant potential, thus the treating physicians should be aware of that to avoid possible pitfalls with devastating outcomes. This article reviews the most common benign peripheral nerve tumors discussing the clinicopathological findings, imaging appearance and the current trend in their approach.
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Affiliation(s)
- Zinon T Kokkalis
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Rio-Patras, Greece.
| | - Nikolaos A Stavropoulos
- Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Andreas Panagopoulos
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Rio-Patras, Greece
| | - Panayotis N Soucacos
- "Panayotis N. Soucacos" Orthopaedic Research & Education Center (OREC), National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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Abstract
Acrometastasis caused by malignancy is a very rare phenomenon, and gastric malignancy metastasising to the hands is an even rarer entity. It accounts for only 0.1% of all metastatic osseous involvement, and may be a late manifestation of malignancy or may even be a presenting symptom. It is generally seen with lung primary, followed by kidney and breast, and less frequently with colon, liver, prostate, rectum and stomach primaries. The terminal phalanges are the most common sites of metastases, followed by the metacarpals and the proximal phalanges. We present a case of stomach carcinoma with metastases to the liver and adrenals which was managed with three lines of chemotherapy. He was lost to follow-up and reported after 1 year with swelling over his left hand, which was managed with palliative radiation to the hand in view of severe pain, followed by chemotherapy.
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Affiliation(s)
- Ashok Kumar
- Department of Radiation Oncology, Army Hospital R & R, Delhi, India
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34
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Wang W, Hong J, Meng J, Wu H, Shi M, Yan S, Huang Y. Nomograms Predict Cancer-Specific and Overall Survival of Patients With Primary Limb Leiomyosarcoma. J Orthop Res 2019; 37:1649-1657. [PMID: 30977539 DOI: 10.1002/jor.24298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/27/2019] [Indexed: 02/04/2023]
Abstract
To date, there have been no data to predict the survival of patients with leiomyosarcoma from soft limb tissue because of the rarity of this disease. Nomograms have been widely applied in clinical oncology to precisely predict the survival of individual patients. This was a retrospective study to construct and validate nomograms to predict the cancer-specific survival (CSS) and overall survival (OS) of patients with primary limb leiomyosarcoma (PL-LMS). A total of 1,208 patients with LMS from limb soft tissue were collected from the Surveillance, Epidemiology, and End Results database from 1975 to 2015. We identified independent prognostic factors using univariate and multivariate Cox analyses. These prognostic factors were then included in the nomograms to predict 3- and 5-year CSS and OS rates. Finally, we validated the nomograms internally and externally. A total of 1208 patients were collected and divided into validation (N = 604) and training (N = 604) groups. Age, race, grade, tumor size, stage, and surgical types were demonstrated as independent prognostic factors for CSS and OS (all p < 0.05) and further used to construct the nomograms. The concordance index (C-index) for CSS was 0.857 for internal validation and 0.727 for external validation. The C-index for OS and CSS both demonstrated that the nomogram prediction agreed perfectly with actual survival. We developed nomograms to predict CSS and OS in PL-LMS patients and can benefit from using them to identify patients' mortality risk and make more precise assessments regarding survival. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1649-1657, 2019.
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Affiliation(s)
- Wei Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Jianqiao Hong
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Jiahong Meng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Haobo Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Mingmin Shi
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Shigui Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
| | - Yiting Huang
- Division of Reproductive Medicine & Infertility, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, P. R. China
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35
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Rastogi K, Dadhich P, Bhaskar S, Gupta S. Nasal Cavity Cancer with Distal Phalanx Metastasis: An Extremely Rare Case Report. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_255_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractCancers of nasal cavity are relatively uncommon; and osseous metastases distal to the elbow and knee joints are also very rare. We herein report the two rare occurrences of nasal cavity carcinoma and acrometastasis together in the same patient, which is the first such case report to the best of our knowledge. The features associated with acrometastasis in the present study are similar to what has been cited in the literature, such as male gender, older age, widespread metastasis, single bone metastasis, lytic lesion, third finger, distal phalanx, poor prognosis, and short survival; however, involvement of left hand and nasal cavity as the primary site of tumor were the exceptions.
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Affiliation(s)
- Kartick Rastogi
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Prashant Dadhich
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Sandeep Bhaskar
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Shivani Gupta
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
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36
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Nepal P, Songmen S, Alam SI, Gandhi D, Ghimire N, Ojili V. Common Soft Tissue Tumors Involving the Hand with Histopathological Correlation. J Clin Imaging Sci 2019; 9:15. [PMID: 31448166 PMCID: PMC6702939 DOI: 10.25259/jcis-6-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/16/2019] [Indexed: 01/14/2023] Open
Abstract
Soft tissue tumors involving the hand are common and most often benign. It is important to know the spectrum of soft tissue tumors of the hand and understand the typical as well as atypical imaging features are seen on different imaging modalities. The imaging features are largely determined by the tumor histopathology; thus, the basic idea about the tumor histopathology will always be useful. This article intends to focus on a comprehensive approach including demographics, clinical presentation, and imaging findings required to diagnose the tumor definitely or narrow the differentials. This article discusses common soft tissue tumor mimics of the hand as well, however, excludes the bone tumors for the sake of brevity.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | | | | | - Darshan Gandhi
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Neeta Ghimire
- Department of Pediatric Dentistry, Kathmandu University, Nepal
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
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37
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Abstract
Nerve sheath tumors of the upper extremity are among the common neoplastic pathologies encountered by hand surgeons. A majority of these tumors are benign schwannomas or neurofibromas and may be associated with neurofibromatosis. Clinical signs of malignant transformation include new onset of pain and rapid growth. Imaging characteristics, such as standardized uptake value greater than 4.0 on PET scan, may aid in the diagnosis of a malignant tumor. Surgical excision, often with intrafascicular dissection with nerve preservation, is recommended treatment of benign lesions. Wide surgical excision is recommended for malignant lesions.
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Affiliation(s)
- Sophia A Strike
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Outpatient Center, 601 North Caroline Street, Suite 5252, Baltimore, MD 21287, USA.
| | - Mark E Puhaindran
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Level 11, NUHS Tower Block, 1E Kent Ridge Road, Singapore 11928, Singapore
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38
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Recurrent Adolescent Giant-Cell Tumor of the Scaphoid: Scaphoid Excision with Intracarpal Fusion after Failed Curettage and Bone Grafting. Case Rep Orthop 2019; 2019:7571486. [PMID: 31093399 PMCID: PMC6481125 DOI: 10.1155/2019/7571486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/23/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022] Open
Abstract
We present a case of the giant-cell tumor of bone in the scaphoid of a 17-year-old female. Imaging revealed an expansile lytic lesion of her scaphoid, and the diagnosis was confirmed with open biopsy. She was treated with curettage and iliac crest bone graft, in an effort to spare reconstruction of her wrist. After one year, she developed increasing tightness and pain. Local recurrence was apparent on radiographs, and CT revealed increased lucency with bony destruction in the area of prior excision. She was successfully treated, without recurrence to date, with complete scaphoid excision and a four-corner wrist fusion. Local recurrence of the giant-cell tumor of bone is high, especially in carpal bones. When treating patients with advanced lesions, more aggressive initial options should be considered.
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39
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Wollina U, Tempel S, Albert W, Hansel G, Heinig B. Advanced Ulcerated Squamous Cell Carcinoma of the Hand with Locoregional Axillary Lymph Node Metastasis - Case Report and Literature Review. Open Access Maced J Med Sci 2019; 7:791-793. [PMID: 30962841 PMCID: PMC6447345 DOI: 10.3889/oamjms.2019.200] [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: 01/26/2019] [Revised: 03/02/2019] [Accepted: 03/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND: Cutaneous squamous cell carcinoma (SCC) of the hand is the most common soft-tissue malignancy in this particular region. A literature survey suggested a higher rate of metastases in advanced SCC of the hand compared to head-and-neck cutaneous SCC. CASE REPORT: An 84-year-old man presented with an ulcerated firm tumour on the dorsum of his right hand. A diagnostic biopsy confirmed the diagnosis SCC. Imaging suggested an involvement of the tendons of digits 3 and 4. A diagnostic ultrasound suggested a loco-regional axillary lymph node metastasis. After discussion in the interdisciplinary tumour board, amputation of the affected digits followed by lymph node excision was recommended. CONCLUSIONS: Advanced SCC of the hand requires interdisciplinary management. Amputation is part of the surgical spectrum in advanced cases.
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Affiliation(s)
- Uwe Wollina
- Academic Teaching Hospital Dresden, Department of Dermatology and Allergology, Dresden, Germany
| | - Sven Tempel
- Department of Trauma, Reconstructive, and Hand Surgery, Städtisches Klinikum Dresden, Dresden, Germany
| | - Wolfgang Albert
- Department of General, Visceral and Thoracic Surgery, Städtisches Klinikum Dresden, Dresden, Germany
| | - Gesina Hansel
- Academic Teaching Hospital Dresden, Department of Dermatology and Allergology, Dresden, Germany
| | - Birgit Heinig
- Center for Physical and Rehabilitative Medicine, Städtisches Klinikum Dresden, Dresden, Germany
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40
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Use of Routine Pathologic Evaluation of Nonmalignant Lesions in Hand Surgery: A National Study. Plast Reconstr Surg 2019; 142:160e-168e. [PMID: 30045180 DOI: 10.1097/prs.0000000000004592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most lesions of the upper extremity are common and benign, and many have questioned the need for routine pathologic evaluation of these specimens. The authors aim to examine the national use of routine pathologic examination of nonmalignant hand lesions to help guide health care policy and practice patterns. METHODS The authors used a national level MarketScan database to form a cohort of adult patients who underwent excision of nonmalignant upper extremity lesions. The authors calculated the rate of submission for each surgical procedure and separately for each diagnosis. The authors also investigated demographic and clinical characteristics associated with the submission of surgical specimens using a multivariable logistic regression model. The authors calculated the total cost of routine pathologic evaluation. RESULTS The final study cohort included 222,947 patients and 182,962 specimens from 153,518 cases. The mean rate of submission was 69 percent. Older age, Northeast region, and high comorbidity scores showed significant correlation with the odds of having a specimen submitted for pathologic evaluation. Excision of primary wrist ganglion was the most performed procedure, and benign lesions larger than 4.0 cm were most frequently submitted for pathologic evaluation. The mean cost of routine pathologic examination was $133 per specimen, and the annual expenditure was $5 million. CONCLUSIONS The routine pathologic examination of benign hand lesions is used frequently but provides limited clinical benefit at a cost. To increase efficiency and improve quality of care, surgeons should be aware of the low value of routine pathologic evaluation and be more selective for cases for which diagnostic testing will change management.
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41
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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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42
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Mizuno S, Ochi K, Miyauchi J, Watanabe I, Hotta H, Anazawa U. A Well-Differentiated Liposarcoma in the Digit: A Case Report of the 5-Year Post-Surgical Follow-Up. J Hand Surg Asian Pac Vol 2018; 23:415-418. [PMID: 30282536 DOI: 10.1142/s242483551872027x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A liposarcoma is extremely rare in the digits. A 73-year-old woman was diagnosed with a lipoma in her middle finger 10 years ago. As this tumor increased in size and presented with imaging findings that were atypical of lipomas, careful marginal resection biopsy outside the pseudo-capsule was performed, and the tumor was diagnosed as a well-differentiated liposarcoma. At the 5-year follow-up, the patient showed no evidence of local recurrence or metastasis, with no loss of hand function. The findings from this case suggest that even for a lipomatous tumor in the digits, further imaging examination and resection biopsy should be considered if the tumor presents with features that are atypical of lipomas.
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Affiliation(s)
- Sakiko Mizuno
- * Department of Orthopaedic Surgery, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
| | - Kensuke Ochi
- * Department of Orthopaedic Surgery, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
| | - Jun Miyauchi
- † Department of Pathology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
| | - Itsuo Watanabe
- * Department of Orthopaedic Surgery, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
| | - Hiraku Hotta
- † Department of Pathology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
| | - Ukei Anazawa
- * Department of Orthopaedic Surgery, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
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Goyal A, Pathak P, Sharma P, Sharma S. Role of FNAC in diagnosing lesions of hand and wrist. Diagn Cytopathol 2018; 46:853-858. [PMID: 30144350 DOI: 10.1002/dc.24050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/28/2018] [Accepted: 07/18/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Swellings in the hand and wrist are frequently encountered in clinical practice and fine needle aspiration cytology (FNAC) is used as a primary diagnostic modality in most of them. A wide spectrum of lesions can be encountered at these sites. The aim of this study was to report the prevalence and spectrum of hand and wrist lesions and evaluate the diagnostic role of FNAC. METHODS All the patients who presented with palpable lesions in the hand or wrist between January 2011 and July 2016 were reviewed, retrospectively. RESULTS 1312 cases were subjected to FNAC of hand and wrist swellings, of which 1136 (86.6%) cases were satisfactory. Age ranged from 5 months to 90 years with M: F = 0.7:1. 138 (12.1%) were diagnosed as inflammatory lesions, 875 (77.0%) as benign, non-neoplastic (tumor-like) lesions and 123 (10.8%) were neoplastic lesions. The inflammatory lesions included 75 cases of synovitis, 30 cases of tuberculosis, 28 cases of abscess, one case of cysticercosis, two cases of gout, and fat necrosis each. In the benign, non-neoplastic (tumor-like) lesions, the most common lesion was ganglion (775 cases). The neoplastic lesions included 78 benign lesions with the most common being giant cell tumor of tendon sheath (61 cases). There were 40 cases of mesenchymal lesions, four cases of appendageal tumors and one case of malignancy (squamous cell carcinoma). Mesenchymal lesions accounted for 3.5% (40/1136) cases. CONCLUSION FNAC is very useful and simple investigation for early diagnosis of lesions of hand and wrist. The lesions encountered at these sites most commonly are benign.
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Affiliation(s)
- Aditi Goyal
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Priya Pathak
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Pooja Sharma
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
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44
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Characteristics, Management Techniques, and Outcomes of the Most Common Soft-Tissue Hand Tumors: A Literature Review and Our Experience. Ann Plast Surg 2018; 79:558-565. [PMID: 28570445 DOI: 10.1097/sap.0000000000001148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Diagnosis of the hand's soft-tissue tumors is often difficult because of the different anatomic structures present in this region and yet clinicians must be able to distinguish typical benign entities from life-threatening or limb-threatening malignant diseases. MATERIALS AND METHODS At the Department of Plastic and Reconstructive Surgery at the University of Palermo, 629 patients with hand tumors were studied. Treatment was surgical for all of them; also radiotherapy and chemotherapy were necessary based on the histological diagnosis. CONCLUSIONS Our retrospective study with a literature review aims to present the most commonly observed soft-tissue hand lesions, analyzing their causes, their objective and instrumental evaluation, and their treatments.
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45
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Lechmiannandan S, Aida N, Paul AG, Thevarajah S. "Thumb's off" for acrometastasis of renal cell carcinoma: Is there a role for acrometastasectomy in the era of targeted therapy? Asian J Urol 2018; 5:199-201. [PMID: 29988877 PMCID: PMC6033195 DOI: 10.1016/j.ajur.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/15/2017] [Accepted: 07/03/2017] [Indexed: 10/31/2022] Open
Affiliation(s)
- Sivaneswaran Lechmiannandan
- Urology Unit, Department of General Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.,Department of Orthopaedics, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.,Urology Unit, Department of General Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Nurbaiti Aida
- Urology Unit, Department of General Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.,Department of Orthopaedics, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.,Urology Unit, Department of General Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Aaron Gerrard Paul
- Department of Orthopaedics, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.,Urology Unit, Department of General Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Shankaran Thevarajah
- Urology Unit, Department of General Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
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Odom C, Ficke B, Dahlgren N, Patel HA, Buddemeyer K, Farnell C, Shah A, Chaudhari N. Extradigital Glomus Tumor with Atypical Neuritis Presentation. Cureus 2018; 10:e2794. [PMID: 30116673 PMCID: PMC6089704 DOI: 10.7759/cureus.2794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Glomus tumors are rare tumors of the arteriovenous junction that play a role in temperature regulation. They are most commonly found in the subungual finger. We present the case of a 77-year-old female with a chief complaint of a painful mass in her ulnar wrist. The differential diagnosis at the time was broad. Following a detailed history and physical exam, the etiology was believed to be that of a peripheral nerve sheath tumor. The patient was taken to the operating room for resection and biopsy of the mass. Histological evaluation confirmed that the mass was a glomus tumor. Our patient’s symptoms had completely resolved and functional status had improved to baseline by the time of her two-week postoperative clinic visit. This case report demonstrates the many complexities in the diagnosis of a glomus tumor and the important role of surgical treatment in obtaining relief from extradigital glomus tumors.
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Affiliation(s)
- Christopher Odom
- Orthopaedic Surgery, University of Alabama at Birmimgham, Birmingham, USA
| | - Brooks Ficke
- Orthopaedic Surgery, Resurgens Orthopaedics, Atlanta, USA
| | - Nicholas Dahlgren
- School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | | | | | - Chason Farnell
- School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Ashish Shah
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
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47
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Wang Z, Li S, Li Y, Lin N, Huang X, Liu M, Pan W, Yan X, Sun L, Li H, Li B, Qu H, Wu Y, Lin P, Ye Z. Prognostic factors for survival among patients with primary bone sarcomas of small bones. Cancer Manag Res 2018; 10:1191-1199. [PMID: 29795990 PMCID: PMC5958943 DOI: 10.2147/cmar.s163229] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Primary bone sarcomas of the hands or feet are rare lesions and poorly documented. Moreover, the prognostic determinants of bone sarcomas of the hands or feet have not been reported. Materials and methods The Surveillance, Epidemiology, and End Results (SEER) program database was used to screen patients with bone sarcomas of the hands or feet from 1973 to 2013, with attention paid to chondrosarcoma, Ewing sarcoma, and osteosarcoma. The prognostic values of overall survival (OS) and cancer-specific survival (CSS) were assessed using Cox proportional hazards regression model with univariate and multivariate analyses. The Kaplan–Meier method was used to obtain OS and CSS curves. Results A total of 457 cases were selected from the SEER database. Chondrosarcoma was the most common form of lesion in hands or feet or both, followed by Ewing sarcoma and osteosarcoma. The 5- and 10-year OS rates of the entire group were 75.7% and 66.1%, respectively. The 5- and 10-year CSS rates were 78.7% and 73.7%, respectively. Multivariate analysis revealed that age under 40 years, localized stage, low grade, surgical treatment, and first primary tumor were associated with improved OS, and decade of diagnosis, stage, grade, and surgery were independent predictors of CSS. However, no significant differences were observed in OS and CSS among patients with different primary tumor locations and tumor subtypes. Additionally, the most significant prognostic factor was whether metastasis had occurred at the time of initial diagnosis. Conclusion Among patients with primary bone sarcomas of the hands or feet, younger age (<40 years), localized stage, low grade, surgical treatment, and first primary tumor are favorable factors for prolonging survival.
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Affiliation(s)
- Zhan Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Shu Li
- Key Laboratory of Cancer Prevention and Intervention, Key Laboratory of Molecular Biology in Medical Sciences, National Ministry of Education, Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Cancer Institute, Hangzhou, China
| | - Yong Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Nong Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xin Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Meng Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Weibo Pan
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xiaobo Yan
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Lingling Sun
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Hengyuan Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Binghao Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Hao Qu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Yan Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Peng Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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Lichon S, Khachemoune A. Clinical presentation, diagnostic approach, and treatment of hand lipomas: a review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ito H, Horie H, Sadatomo A, Naoi D, Tahara M, Kono Y, Inoue Y, Koinuma K, Lefor AK, Sata N. Metachronous solitary metacarpal bone metastasis from rectal cancer. J Surg Case Rep 2017; 2017:rjx247. [PMID: 29255589 PMCID: PMC5730931 DOI: 10.1093/jscr/rjx247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/31/2017] [Accepted: 11/18/2017] [Indexed: 11/12/2022] Open
Abstract
Metachronous solitary metacarpal bone metastasis from rectal cancer has not been reported previously. Here, we describe a 54-year-old woman who underwent abdominoperineal resection for rectal cancer following neoadjuvant chemoradiotherapy. The resected specimen contained adenocarcinoma with no lymph node metastases (Stage II, T3N0M0); no adjuvant chemotherapy was administered. Fifteen months after surgery, the patient presented with pain and swelling of the right thumb. Radiography revealed metacarpal bone destruction, and fluorine-18 fluorodeoxyglucose positron emission tomography showed uptake only in the metacarpal bone. Open biopsy revealed an adenocarcinoma, and a right thumb resection was performed. Histological examination indicated features of adenocarcinoma similar to the findings of a rectal lesion, leading to a diagnosis of metachronous solitary metacarpal bone metastasis from rectal cancer. The patient remains free of disease after 6 years of follow-up. Our findings suggest that surgical resection may lead to favorable outcomes in patients with resectable solitary bone metastases.
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Affiliation(s)
- Homare Ito
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Hisanaga Horie
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Ai Sadatomo
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Daishi Naoi
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Makiko Tahara
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Yoshihiko Kono
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Yoshiyuki Inoue
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Koji Koinuma
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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50
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Morris G, Evans S, Stevenson J, Kotecha A, Parry M, Jeys L, Grimer R. Bone metastases of the hand. Ann R Coll Surg Engl 2017; 99:563-567. [PMID: 28853594 DOI: 10.1308/rcsann.2017.0096] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction The aim of this study was to identify patients with malignant hand lesions, establish the proportions of those that were metastases and review their clinical course. Methods A retrospective search of a prospective tumour database was carried out to identify all patients treated at our unit with hand metastases. Patient demographics were recorded including site of primary malignancy, region of the hand involved, management of their metastasis and clinical outcome. Results Overall, 149 patients were identified with a malignant tumour of the hand. Ten had a metastatic lesion. There were 3 women and 7 men with a median age of 68 years (range: 28-91 years) at presentation. All presented with non-mechanical hand pain while four had pain and swelling. The median interval from symptom onset to diagnosis was eight weeks. The minimum follow-up duration was four months. Three patients had no history of malignancy. Of the remaining seven patients, three had other known metastases. Six patients underwent solely palliative radiotherapy. Three patients had amputation. One was treated with surgical excision and radiotherapy. One had an amputation and axillary node clearance. All but one patient had died by the time of the latest follow-up appointment. The median time to death following identification of acrometastases was 18 months. Sites of primary disease were skin (n=4), lung (n=3), kidney (n=2) and neuroendocrine system (n=1). The thumb was the most commonly affected location. Conclusions This study demonstrates that patients presenting with non-mechanical hand pain should be considered to have a malignant process until proved otherwise, particularly in patients with thumb symptoms and a history of prior malignancy.
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Affiliation(s)
- G Morris
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - S Evans
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - J Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - A Kotecha
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - M Parry
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - L Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - R Grimer
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
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