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Furtado C, Zeitoun R, Wilkes J, Sumathi V, Tony G. Soft Tissue Sarcomas Mimicking Benign Inflammatory Processes: A Diagnostic Dilemma. Mediterr J Rheumatol 2023; 34:531-536. [PMID: 38282941 PMCID: PMC10815534 DOI: 10.31138/mjr.270823.sts] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 01/30/2024] Open
Abstract
Background Soft tissue sarcomas are rare and often go undetected until a later stage, particularly when they present as intra-articular or tenosynovial lesions mimicking benign synovial pathologies. The failure to distinguish between malignant and benign synovial disease can have a significant impact on patient outcomes and limit alternatives for local control surgery and limb salvage. Case Description In this case series, we present two cases of soft tissue sarcomas, one being an intraarticular synovial chondrosarcoma, and the other a pleomorphic spindle cell sarcoma centred along tendon sheaths. Radiologically, the initial clinical presentation of these cases resembled benign synovial pathologies, leading to a delay in diagnosis and treatment. Conclusion Our study underscores the importance of maintaining a low threshold of suspicion for surveillance, a multidisciplinary approach, and early histological diagnosis to ensure appropriate timely treatment and a favourable prognosis for patients with soft tissue sarcomas.
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Affiliation(s)
- Cleofina Furtado
- Department of Diagnostic and Interventional Radiology, University Hospitals of North, Midlands NHS Trust, Stoke on Trent, United Kingdom
| | - Rania Zeitoun
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jonathan Wilkes
- Department of Musculoskeletal Pathology, The Royal Orthopaedic Hospital NHS Foundation Trust, Robert Aitken Institute for Clinical Research (Level 3), University of Birmingham, Birmingham, United Kingdom
| | - Vaiyapuri Sumathi
- Department of Musculoskeletal Pathology, The Royal Orthopaedic Hospital NHS Foundation Trust, Robert Aitken Institute for Clinical Research (Level 3), University of Birmingham, Birmingham, United Kingdom
| | - George Tony
- Department of Diagnostic and Interventional Radiology, University Hospitals of North, Midlands NHS Trust, Stoke on Trent, United Kingdom
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Samargandi R. Integra® Dermal Regeneration Matrix: A Versatile Solution for Complex Soft Tissue Sarcoma Reconstruction in the Hand. Cureus 2023; 15:e40553. [PMID: 37333040 PMCID: PMC10276311 DOI: 10.7759/cureus.40553] [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: 06/16/2023] [Indexed: 06/20/2023] Open
Abstract
This case report describes the successful use of Integra® (Integra LifeSciences Corporation, Plainsboro, New Jersey, United States), an artificial skin substitute, for the reconstruction of soft tissue defects following soft tissue sarcoma resection. We present a case of a 75-year-old female presented with a progressively enlarging lesion on her right hand. Imaging revealed tumor involvement in the extensor tendons and adjacent to the index finger tendon. A percutaneous biopsy confirmed an undifferentiated pleomorphic sarcoma. The patient underwent neoadjuvant radiotherapy followed by wide excision of the tumor. Integra® dermal regeneration matrix was utilized to cover the exposed bone during the surgical procedure. This allowed for wound closure and provided a favorable environment for tissue regeneration and subsequent split-thickness skin graft. Complete wound healing was obtained. Regular follow-up examinations showed no evidence of local recurrence or secondary lesions after one year. The successful use of Integra®, in this case, demonstrates its efficacy as a reconstructive option for complex hand sarcomas. It offers immediate wound coverage and promotes tissue regeneration, thereby avoiding the need for more extensive treatment modalities with associated donor-site morbidity. The utilization of Integra® resulted in high patient satisfaction and excellent recovery. This case highlights the importance of utilizing innovative techniques and materials in achieving optimal outcomes in challenging hand sarcoma reconstructions.
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Affiliation(s)
- Ramy Samargandi
- Orthopedic Surgery Department, Faculty of Medicine, University of Jeddah, Jeddah, SAU
- Orthopedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, FRA
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3
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AbuMoussa S, Roshan MP, Souza FF, Daley D, Rosenberg A, Pretell J, Fullerton N, Subhawong T. Soft Tissue Masses of the Hand: A Review of Clinical Presentation and Imaging Features. Curr Oncol 2023; 30:2032-2048. [PMID: 36826119 PMCID: PMC9955517 DOI: 10.3390/curroncol30020158] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 02/11/2023] Open
Abstract
More than 15% of all soft-tissue tumors arise in the hand. Because of the location of these tumors, even small abnormalities may be alarming to patients on presentation. Although the majority of lesions are benign and can be diagnosed solely by history and physical examination, additional imaging workup may be required to confirm a diagnosis or define anatomic extent of involvement. This paper aims to review the basic epidemiology, clinical presentation, imaging findings, and treatment options of the more common soft-tissue tumors of the hand.
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Affiliation(s)
- Samuel AbuMoussa
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Mona Pari Roshan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Felipe Ferreira Souza
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Dane Daley
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Andrew Rosenberg
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Juan Pretell
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Natalia Fullerton
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Ty Subhawong
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Correspondence: ; Tel.: +1-(305)-585-7500
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Kim M, Policherla RK, Linhares SM, Hui-Chou HG. Low-Grade Fibromyxoid Sarcoma of the Distal Upper Extremity: A Systematic Review. Hand (N Y) 2023:15589447221150523. [PMID: 36692100 DOI: 10.1177/15589447221150523] [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: 01/25/2023]
Abstract
BACKGROUND Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft-tissue tumor that usually occurs in the proximal extremities and trunk. The purpose of this systematic review was to assess patient demographics, treatment approach, and outcomes for patients with LGFMS of the distal upper extremity. METHODS We performed a literature review of case reports and patient reports of LGFMS using Medical Literature Analysis and Retrieval System Online (MEDLINE) and PubMed. Inclusion criteria included case reports and case series of patients with LGFMS of the distal upper extremity. Animal studies, comments, and non-English publications were excluded. Data on available patient demographics, treatment regimen, recurrence, and metastasis were collected. RESULTS A total of 365 publications were reviewed. After applying the inclusion and exclusion criteria, 19 articles were included. There were 24 unique patients with LGFMS of the distal upper extremity. The median age was 32 years, and most patients were treated with a surgical excision. Of the 15 reported outcomes, 4 patients had local recurrences, and no patient had metastases or died due to the tumor. CONCLUSIONS Although LGFMS of the distal upper extremity is less common, it is critical for surgeons to consider it as a differential. The current approach is a wide excision with negative margins, and chemotherapy or radiotherapy may not be necessary. We found decreased proportions of local recurrence and metastases in the distal upper extremity compared with other anatomical regions. We recommend that surgeons follow up with their patients indefinitely given the slow mitotic rate of LGFMS.
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Affiliation(s)
- Minji Kim
- University of Miami Miller School of Medicine, FL, USA
| | | | | | - Helen G Hui-Chou
- University of Miami Miller School of Medicine, FL, USA
- DeWitt Daughtry Family Department of Surgery, Miami, FL, USA
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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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Serinelli S, Gitto L, Zaccarini DJ. Synovial sarcoma of the hand-wrist: a case report and review of the literature. J Med Case Rep 2021; 15:12. [PMID: 33453728 PMCID: PMC7811743 DOI: 10.1186/s13256-020-02613-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023] Open
Abstract
Background Synovial sarcomas are infrequent malignant tumors occurring mostly in adolescents and young adults. The occurrence of synovial sarcoma in the hand-wrist area is rare (4 to 8.5% of all synovial sarcomas in different studies). Case presentation This report documents an uncommon case of synovial sarcoma occurring in the hand-wrist of a 69-year-old Caucasian woman. She was subsequently treated with surgical excision and radiotherapy without recurrence after follow up. Conclusions This paper aims to characterize the demographic, pathologic, and clinical features with a literature review. The present literature review confirms that hand-wrist synovial sarcomas are more frequent among males and subjects 10 to 40 years old. Most cases in this location are usually not larger than 5 cm in size. The five-year survival rate is higher than that reported in a previous review on hand synovial sarcomas, and this suggests an improved survival in recent decades.
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Affiliation(s)
- Serenella Serinelli
- Department of Pathology, State University of New York - Upstate Medical University, 750 E. Adams St, Syracuse, NY, 13210, USA.
| | - Lorenzo Gitto
- Department of Pathology, State University of New York - Upstate Medical University, 750 E. Adams St, Syracuse, NY, 13210, USA
| | - Daniel J Zaccarini
- Department of Pathology, State University of New York - Upstate Medical University, 750 E. Adams St, Syracuse, NY, 13210, USA
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Surgical Management of Upper Limb Sarcomas. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Persitz J, Beit Ner E, Chechik I, Keren T, Avisar E. Epithelioid sarcoma of the hand: a wolf in sheep's clothing. J Plast Surg Hand Surg 2020; 55:96-104. [PMID: 33176534 DOI: 10.1080/2000656x.2020.1838914] [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: 02/07/2023]
Abstract
Epithelioid sarcoma (ES) of the hand is a rare, aggressive cutaneous malignancy with high rates of recurrence, metastases and mortality. With an incidence rate of 0.4 cases/y per one million population, which compromise for approximately 1-1.4% of all soft tissue sarcoma, ES accounts for 10% of soft tissues sarcomas of the hand and foot. Its aggressiveness and propensity to spread and metastases without being noticed, makes it unique and potentially lethal. Missed or delayed diagnosis are often encountered as this tumor can mimic variety of different entities and due to the infrequent nature of this lesion, treatment options are still controversial. The authors provide systemic review of the current literature on epidemiology, etiology, pathogenesis, management and outcomes of this disease as well as a case presentation and a proposed treatment algorithm. The choice of treatment option depends on disease characteristics, staging at presentation, regional lymph node involvement, comorbidities and performance status of the patient. Emphasis on a multidisciplinary coordinated care is crucial as early diagnosis and treatment can decrease morbidity and mortality rates.
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Affiliation(s)
- Jonathan Persitz
- The Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
| | - Eran Beit Ner
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
| | - Igal Chechik
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
| | - Timoret Keren
- The Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
| | - Erez Avisar
- The Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tzrifin, Israel
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Claudi C, Andreisek G, Vrugt B, Ganser J. A Juxta-Articular Myxoma of the Thumb. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:171-174. [PMID: 32313878 PMCID: PMC7167580 DOI: 10.1016/j.jhsg.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/09/2020] [Indexed: 11/22/2022] Open
Abstract
Juxta-articular myxomata are benign tumors that are mostly encountered in the vicinity of larger joints. Few cases in the hand have been reported. We present a case of a juxta-articular myxoma at the metacarpophalangeal joint of the thumb in a 40-year-old man. The preoperative diagnostic work-up included 4-dimensional magnetic resonance angiography and ultrasound. The histochemical examination of the resected tumor established the diagnosis definitively. Follow-up magnetic resonance imaging scheduled with no clinical suspicion of tumor recurrence 9 months after surgery revealed no obvious recurrence. At 14 months, the patient had full motion without pain and declined further imaging.
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Affiliation(s)
- Carolin Claudi
- Department of Orthopedic Surgery, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
| | - Gustav Andreisek
- Department of Radiology, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
| | - Bart Vrugt
- Department of Pathology, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
| | - Joachim Ganser
- Department of Hand and Plastic Surgery, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
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