Enchondroma in the distal phalanx of the finger: An observational study of 34 cases in a single institution

Surgical Management of Enchondromas of the Hand: A 12-Year Experience

Objective Enchondromas are benign tumours of hyaline cartilage most frequently arising in the bones of the hand and the optimum surgical management strategy for these is debated. We present an audit of the surgical management of 57 enchondromas referred to our tertiary hand surgery department over a period of 12 years (2008–2020) and describe our surgical technique for this procedure as well as a comparison with other studies in the literature.

Materials and Methods Retrospective audit of our practice. Data were extracted from our institutional operative database to identify all patients undergoing surgical management of enchondromas during the time period. The individual electronic patient records were then evaluated to extract demographics and outcome data.

Results Our results demonstrate excellent clearance of enchondroma (74% Tordai group 1 radiological resolution) with very low complication rates and no recurrence. Our results also emphasize the importance of surgical management of enchondromas to allow diagnosis of rare chondrosarcoma (3.5% in this study).

Conclusion A larger randomized controlled trial is still required to adequately determine the differences between the surgical options available and determine the best possible surgical approach to these cases. Level of evidence is III.

Deep HT: A deep neural network for diagnose on MR images of tumors of the hand

Background

There are many types of hand tumors, and it is often difficult for imaging diagnosticians to make a correct diagnosis, which can easily lead to misdiagnosis and delay in treatment. Thus in this paper, we propose a deep neural network for diagnose on MR Images of tumors of the hand in order to better define preoperative diagnosis and standardize surgical treatment.

Methods

We collected MRI figures of 221 patients with hand tumors from one medical center from 2016 to 2019, invited medical experts to annotate the images to form the annotation data set. Then the original image is preprocessed to get the image data set. The data set is randomly divided into ten parts, nine for training and one for test. Next, the data set is input into the neural network system for testing. Finally, average the results of ten experiments as an estimate of the accuracy of the algorithm.

Results

This research uses 221 images as dataset and the system shows an average confidence level of 71.6% in segmentation of hand tumors. The segmented tumor regions are validated through ground truth analysis and manual analysis by a radiologist.

Conclusions

With the recent advances in convolutional neural networks, vast improvements have been made for image segmentation, mainly based on the skip-connection-linked encoder decoder deep architectures. Therefore, in this paper, we propose an automatic segmentation method based on DeepLab v3+ and achieved a good diagnostic accuracy rate.

A bent needle tip during irrigation for enchondroma of the distal phalanx: a new curettage tool

BACKGROUND

We employed a novel curettage tool, a bent needle tip, during irrigation for enchondroma of the distal phalanx. This study aimed to evaluate our new curettage tool for treating enchondroma of the distal phalanx.

METHODS

Seven distal phalanx enchondromas were pathologically diagnosed at our institute. We evaluated age, gender, tumor location, affected side, clinical symptoms, Takigawa classification, size, recurrence, complications, residual pain, Tordai score, and follow-up period. We bent an 18G needle tip connected to an extension tube and syringe. The bent needle was inserted through the small hole, and the cavity for bone grafting was adequately filled with injectable calcium phosphate cement through the small hole.

RESULTS

There were five centric-type and two giant-type tumors, with a mean size of 52.7%. All patients had clinical symptoms at the initial presentation. All patients showed complete bone healing within 3 months on post-radiological examinations and were Grade 1 according to the Tordai score.

CONCLUSIONS

This tool is extremely simple, and both the incision and the cortical window can be small. We recommend a bent needle tip, easily devised in any hospital, as a curettage tool for treating enchondroma in small bones, especially of the distal phalanx.

Squamous cell carcinoma of the nail bed: A case report

BACKGROUND

Squamous cell carcinoma (SCC) of the nail bed is a poorly reported malignant subungual tumor. Because it presents with nonspecific symptoms and signs, it is frequently misdiagnosed by dermatologists or surgeons. A delay in diagnosis and/or wrong treatment might increase the possibility of disease progression. Thus, new perspectives are needed to assist dermatologists and surgeons with diagnosing and treating SCC. This rare case presented with a 2-year delay in the diagnosis of SCC teaches a valuable lesson.

CASE SUMMARY

A 62-year-old female presented with a non-healing subungual growth in the nail bed of the right middle finger for 2 years. The lesion was first medicated with iodine by the patient herself without any relief. Twenty months later, a dermatologist diagnosed the lesion as paronychia and treated it with nail avulsions repeatedly with no obvious alleviation. A lesionectomy confirmed the lesion was SCC. An extended excision of the tumor with amputation of the distal interphalangeal joint was subsequently performed. A biopsy of sentinel lymph nodes was negative. Due to the result of preoperative positron emission tomography-computed tomography scanning, sweeping of axillary lymph nodes was considered dispensable and was skipped. At the 2-year follow-up, the patient showed a quick recovery and no sign of recurrence.

CONCLUSION

Our successful diagnosis and treatment of the case highlights the need for additional attention to long-standing non-healing lesions of the nail bed and the necessity for discreet evaluation and customization of surgical interventions.

Multiple intraneural glomus tumors in different digital nerve fascicles

Background

Glomus tumors in the digital nerve are extremely rare. Multiple intraneural glomus tumors in different digital nerve fascicles have not been previously reported.

Case presentation

We report the case of a 54-year-old male with a 1-year history of progressive numbness of the middle finger with point tenderness at the level of the middle phalanx. Surgical incision revealed the presence of two glomus tumors within different fascicles of the ulnar digital nerve of the middle finger.

One tumor was excised along with surrounding fascicle, the other was removed leaving the fascicle intact. Subsequently, the patient regained function of the finger and no tumors have recurred.

Conclusions

Patients and physicians should be aware of the properties of intraneural glomus tumors so that early diagnosis and treatment can be sought.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-6098-y) contains supplementary material, which is available to authorized users.

Mallet Finger Fracture through Enchondroma of the Distal Phalanx

A 46-year-old man injured his ring finger and developed a mallet deformity. Radiographs showed a mallet finger fracture through an osteolytic lesion of the distal phalanx. Magnetic resonance imaging showed low intensity on T1-weighted imaging and high intensity on T2-weighted imaging, which suggested the clinical diagnosis of enchondroma. The bone tumor was excised, and osteosynthesis was performed using Ishiguro's extension block pinning, and a flexion block pin was added to prevent flexor tendon avulsion fracture through the enchondroma, followed by an autologous iliac cancellous bone graft. One year after surgery, the patient had no pain or extension lag of the affected ring finger, and his quickDASH score was 0 points. Radiographs showed no recurrence and minimal arthritic change of the distal interphalangeal joint. One-stage treatment of a mallet finger fracture through an enchondroma using Ishiguro's method was effective.

Rupture of a subungual glomus tumor of the finger

BACKGROUND

Glomus tumor is a rare benign neoplasm, which most frequently occurs in the subungual regions of digits. Tumor rupture and infection occurred in one patient with a glomus tumor have never been reported.

CASE PRESENTATION

We report a 59-year-old female presented to our hospital with a five-year history of progressively sharp pain and severe tenderness in the tip of her right middle finger. The treatment was surgical excision through a lateral incision accompanied with removal of the nail. After the surgery, the patient gained a functional recovery of her previously afflicted finger.

CONCLUSIONS

To the best of our knowledge, this is the first case of finger infection caused by a ruptured subungual glomus tumor. Patients and physicians should be aware of the properties of glomus tumor so that early diagnosis and treatment of subungual glomus tumor as well as avoidance of tumor rupture and infection can be achieved.