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Neder AT, da Costa AC, de Barros RSM, Nakachima LR, Rodrigues MP, de Souza SCA, de Oliveira RK, da Gama SAM, Sabongi RG, Hirakawa CK. Hand tumors. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S108. [PMID: 38865528 PMCID: PMC11164264 DOI: 10.1590/1806-9282.2024s108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/11/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Antonio Tufi Neder
- Universidade de São Paulo/Faculty of Medicine of Ribeirão Preto - Hand Surgery at Rede Mater Dei de Saúde and Instituto Orizonti – Belo Horizonte (MG), Brazil
| | - Antonio Carlos da Costa
- Medical School of Santa Casa de São Paulo, Hand Surgery and Microsurgery Group at Santa Casa de São Paulo – Belo Horizonte (MG), Brazil
| | | | - Luis Renato Nakachima
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology – Belo Horizonte (MG), Brazil
| | - Mauricio Pinto Rodrigues
- Universidade de São Paulo, Institute of Orthopedics and Traumatology, Clinical Hospital, Faculty of Medicine – Belo Horizonte (MG), Brazil
| | | | | | - Sérgio Augusto Machado da Gama
- Universidade de São Paulo, Clinical Hospital, Faculty of Medicine, Pontifícia Universidade Católica de Campinas Hand Group – Belo Horizonte (MG), Brazil
| | - Rodrigo Guerra Sabongi
- Universidade Federal de São Paulo, Paulista School of Medicine – Belo Horizonte (MG), Brazil
| | - Celso Kiyoshi Hirakawa
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology – Belo Horizonte (MG), Brazil
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El Ghoneimy A, Zaky I, Zamzam M, Kamel A, Mounir N, El Kenaey N. Wide Resection of Primary Malignant Bone Tumors of the Hand in Children and Reconstruction Using Nonvascularized Fibular Bone Graft: Case Series and Literature Review. J Hand Surg Am 2022; 47:1017.e1-1017.e7. [PMID: 34600792 DOI: 10.1016/j.jhsa.2021.08.007] [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] [Received: 01/01/2021] [Revised: 06/09/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Primary malignant bone tumors of the hand are rare in children. Resection and reconstruction of the digit are challenging and have been described in case reports. This retrospective study describes the functional and oncologic outcomes of resection and reconstruction using a nonvascularized fibular bone graft in a cohort of children. METHODS A total of 5 children were included. The mean age at diagnosis was 7.6 years (range, 1.6-12 years). Histologic diagnosis showed Ewing sarcoma in 3 and osteosarcoma in 2 patients. Four tumors were located in the metacarpal bones of the fingers, and 1 was located in the thumb. Four patients were treated with chemotherapy. All the patients were treated with wide resection and a cement spacer. This was followed by second stage reconstruction using a nonvascularized fibular bone graft. In tumors of the fingers, carpometacarpal joint fusion with a neighboring carpal bone was performed, whereas a pseudoarthrosis was created between the graft and the base of the proximal phalanx. In the thumb's case, the opposite was done, with fusion at the metacarpophalangeal joint and a pseudoarthrosis at the carpometacarpal joint. RESULTS The mean follow-up duration was 5.5 years (range, 2-9 years). Surgical margins were negative in all the patients. At their latest follow-up visit, none of the patients developed systemic or local recurrence. Two complications required a revision surgery, one due to graft subluxation and the other due to nonunion. At their final follow-up examination, the mean total arc of movement was 80° (range, 60°-100°), and all the patients were able to resume their grasping and writing capabilities. CONCLUSIONS The resection and reconstruction of primary malignant bone tumors of the metacarpals using a nonvascularized fibular bone graft in children can preserve the cosmesis and function of the digit without jeopardizing oncologic outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Ahmed El Ghoneimy
- Children Cancer Hospital 57357, Cairo, Egypt; Cairo University, Cairo, Egypt.
| | - Imane Zaky
- Children Cancer Hospital 57357, Cairo, Egypt; National Cancer Institute, Cairo, Egypt
| | - Manal Zamzam
- Children Cancer Hospital 57357, Cairo, Egypt; National Cancer Institute, Cairo, Egypt
| | - Ahmed Kamel
- Children Cancer Hospital 57357, Cairo, Egypt; National Cancer Institute, Cairo, Egypt
| | - Nada Mounir
- Children Cancer Hospital 57357, Cairo, Egypt
| | - Naglaa El Kenaey
- Children Cancer Hospital 57357, Cairo, Egypt; National Cancer Institute, Cairo, Egypt
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Mathew R, Sethi A, Flint AT, Omman R, House J. A Case of Undifferentiated Pleomorphic Sarcoma. Cureus 2022; 14:e26153. [PMID: 35747109 PMCID: PMC9211378 DOI: 10.7759/cureus.26153] [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: 06/21/2022] [Indexed: 12/01/2022] Open
Abstract
Suspicion for soft tissue malignancy of the hand is usually low because most tumors of the hand are small and benign. We present a case of an elderly female who presented with a rapidly enlarging, ulcerating hand mass over a few months. She was diagnosed with undifferentiated pleomorphic sarcoma (UPS), a high-grade, aggressive soft-tissue sarcoma. Computed tomography (CT) of the chest was conducted for staging purposes. It showed multiple subcentimeter pulmonary nodules, findings that were initially worrisome for metastatic disease but later proved to be newly and incidentally diagnosed granulomatous disease of the lungs. This case highlights the importance of early recognition of potential malignancy in soft-tissue tumors of the hand to facilitate proper referral and initiation of appropriate oncologic therapies. Due to early diagnosis and intervention, our patient had locally advanced disease without metastasis, a type of cancer known to have a high degree of metastatic potential.
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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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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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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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[Fibro-osseous Pseudotumor of the Digits - a Chameleon among generally rare Hand Tumors]. HANDCHIR MIKROCHIR P 2022; 54:74-76. [PMID: 35168271 DOI: 10.1055/a-1690-7420] [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
EinleitungDer fibro-ossäre Pseudotumor der Finger (FOPD = fibro-osseous pseudotumor of the digits) ist unter den Handtumoren insgesamt als auch unter den benignen Handtumoren eine seltene Entität. FOPD können sowohl klinisch als auch radiologisch eine maligne Neoplasie nachahmen. Hauptsächlich tritt dieser Tumor bei jüngeren Erwachsenen, vorwiegend Frauen, auf. Bis dato ist eine maligne Transformation nicht beschrieben. Allerdings führen klinische und histologische Befunde fälschlicherweise immer wieder zur Diagnose eines bösartigen Tumors.
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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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SOFULU Ö. Primary bone tumors and tumor-like lesions of the wrist: a single-center experience. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.991321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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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Li Q, Kim J, Kim SY, Baek GH. Early Surgical Treatment of Both Tumor and Fracture in Patients With Enchondroma of the Hand Combined With Pathologic Fracture. Ann Plast Surg 2021; 87:260-264. [PMID: 33661226 DOI: 10.1097/sap.0000000000002776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to evaluate the degree of cortical thinning and the tumor area in simple radiographs in patients with enchondroma of the hand combined with pathologic fracture and to determine the surgical outcome of simultaneous tumor curettage and internal fixation of fracture. METHODS We enrolled 23 bone lesions of 21 patients diagnosed with enchondroma of the hand. Of them, 9 bone lesions of 8 patients had pathologic fracture. We evaluated the degree of cortical thinning and tumor area in simple radiographs and compared them between patients with and without pathologic fracture. For patients with pathologic fracture, we performed curettage of the tumor through the fracture site and fixed the fracture using K-wires. We then evaluated the clinical outcome of these patients using the visual analog scale to measure pain intensity and Takigawa's criteria 1 year after surgery. RESULTS There was a significant difference in the degree of cortical thinning between the 2 groups (P < 0.001); however, there was no significant difference in the percentage of tumor area (P = 0.259). The average time from surgery to bony union was 8.5 weeks in patients with pathologic fracture. The patients reported that they could return to their previous activities of daily living within 12 weeks of surgery. The average visual analog scale score was 0.6 at 1 year after surgery, and 6 patients were graded as excellent and 2 as good according to Takigawa's criteria. CONCLUSIONS Cortical thinning seems to be related to pathologic fracture. Our scoring system for cortical thinning may be helpful in evaluating the risk for pathologic fracture. Early 1-stage surgical treatment for pathologic hand fracture with enchondroma is a very useful method with satisfactory outcomes that could shorten the treatment period.
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Affiliation(s)
- Qingyuan Li
- From the Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul National University College of Medicine, Seoul, Korea
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Jones HB, Murphree J, Suryavanshi JR, Osemwengie BO, Rosqvist S, Cox CT, MacKay BJ. Multifocal chondrosarcoma of the hand: Case report and review of the literature. Clin Case Rep 2021; 9:e04352. [PMID: 34136252 PMCID: PMC8190542 DOI: 10.1002/ccr3.4352] [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: 09/15/2020] [Revised: 02/10/2021] [Accepted: 04/28/2021] [Indexed: 11/12/2022] Open
Abstract
Few multifocal hand chondrosarcomas have been reported. To our knowledge, this report is the first to describe multifocal hand chondrosarcoma in a patient with no evidence of prior enchondroma, Ollier's disease, or Maffucci syndrome.
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Affiliation(s)
| | - Jacob Murphree
- Texas Tech University Health Sciences CenterLubbockTXUSA
| | | | | | | | - Cameron T. Cox
- Texas Tech University Health Sciences CenterLubbockTXUSA
| | - Brendan J. MacKay
- Texas Tech University Health Sciences CenterLubbockTXUSA
- University Medical CenterLubbockTXUSA
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The surgical management of the cavity and bone defects in enchondroma cases: A prospective randomized trial. Surg Oncol 2021; 37:101565. [PMID: 33848764 DOI: 10.1016/j.suronc.2021.101565] [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: 07/12/2020] [Revised: 09/10/2020] [Accepted: 03/28/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND We compared the curettage/bone grafting and the curettage/bone graft substitutes surgical techniques in their relation to functional outcomes, oncologic outcome (recurrence, malignant transformation), the rate of postsurgical complications, durations of surgery and of postsurgical immobilization for hand-localized cases of solitary and multiple enchondromas. METHODS The current prospective randomized trial analyzed 200 adult patients (2012-2017) with enchondroma who underwent surgical intervention. The cases were randomly divided into Group 1 (n = 100; F 56, M 44) for surgeries with curettage and autogenous bone grafting, and Group 2 (n = 100; F 55, M 45) for surgeries with curettage and bone graft substitutes. The placebo control Group 3 consisted of cases operated by curettage only (n = 56; F 31, M 25). The follow-up period was set at 30 months. RESULTS The duration of surgery was 51 ± 4 min in Group 1 and 27 ± 1 min in Group 2 (p = 0.008). In Group 1, the rate of recurrence was 6% against 1% in Group 2 (p = 0.005). No other statistically significant differences in postsurgical outcomes between three involved groups were noted. CONCLUSION In cases of enchondroma of the hand, postsurgical functional outcomes, the rate of postsurgical complications, the duration of immobilization, and the time to complete recovery are not influenced by the type of chosen grafting material. The implementation of HAp-collagen bone substitutes in granules instead of autogenous bone grafting reduces the duration of surgery. The implementation of autogenous bone grafting may increase the rate of tumor recurrence.
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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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Soft-tissue Sarcoma of the Hand: Patient Characteristics, Treatment, and Oncologic Outcomes. J Am Acad Orthop Surg 2021; 29:e297-e307. [PMID: 32932303 DOI: 10.5435/jaaos-d-20-00434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/28/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The aim of this study was to describe patient characteristics, treatment, and oncologic outcomes of soft-tissue sarcomas (STSs) of the hand. METHODS Sixty-nine STSs of the hand in adult patients treated at a tertiary referral center were retrospectively included. We describe patient and tumor characteristics along with oncologic outcomes. RESULTS Epithelioid sarcoma (23%) was the most common histologic subtype, followed by synovial sarcoma (15%). Of all tumors, 17 (25%) were grade I, 22 (32%) were grade II, and 30 (44%) were grade III. The 5-year disease-free survival for epithelioid sarcomas was 75% with a disease survival of 100%, along with a metastatic rate of 15%. Of the patients with a synovial sarcoma, 40% developed metastases, and the 5-year disease-free survival was 68% and the 5-year disease survival was 73%. CONCLUSION Hand STSs are aggressive tumors with a high metastatic potential. Even with adequate oncologic treatment, long-term clinical follow-up (10 years) in these tumors is advised. The treating surgical oncologist should not be deceived by their smaller size.
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Clinical and Radiographic Outcomes Following Management of Benign Bone Lesions of the Hand With Calcium Phosphate Bone Cement. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Hu X, Liu Z, Zhou H, Fang J, Lu H. Deep HT: A deep neural network for diagnose on MR images of tumors of the hand. PLoS One 2020; 15:e0237606. [PMID: 32797089 PMCID: PMC7428075 DOI: 10.1371/journal.pone.0237606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Xianliang Hu
- School of Mathematical Sciences, Zhejiang Univeristy, Hangzhou, Zhejiang Province, P. R. China
| | - Zongyu Liu
- School of Mathematical Sciences, Zhejiang Univeristy, Hangzhou, Zhejiang Province, P. R. China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
| | - Jianyong Fang
- Suzhou Warrior Pioneer Software Co., Ltd., Suzhou, Jiangsu Province, P. R. China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
- * E-mail:
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The distribution of chondromas: Why the hand? Med Hypotheses 2020; 143:110132. [PMID: 32759011 DOI: 10.1016/j.mehy.2020.110132] [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: 04/24/2020] [Revised: 06/18/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
Chondroma is a benign hyaline cartilage tumor and is a relatively common skeletal neoplasm. Uneven distribution of this tumor among the various bones and regions of the skeleton is known but no explanation of this phenomenon followed. The current research aimed to document the exact chondroma distribution in the body. We hypothesized that the cases of all subtypes of chondroma have to be investigated in complex and that obtaining combined data from a large cohort of cases may explain the logic of chondroma distribution and may answer the question of why the hand is the main target of the tumor. We retrospectively analyzed 1529 cases of various subtypes of chondroma. Enchondroma was the most frequent type (65.4%) and the hand was the main target location (49.8% of all cases). The right side of the body was affected in 900 cases (58.9%) and in 629 cases (41.1%) the left side was affected (p = 0.03). The general results for tumor distribution are as follows: head and extremities - 92.8%; head, hands, and feet - 71.8%; and hands and feet - 62.8%. In the hand and the feet, multiple chondromas were distributed along the same digital ray in all cases. The anatomical distribution of various subtypes of chondroma follows "the periphery of the being", the uneven lateral distribution, and the "same digital ray" patterns that permits to suggest that genetic mutations affecting the development of the body during the embryonic period are the main etiological component for this tumor.
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García-Jiménez A, Chanes-Puiggrós C, Trullols-Tarragó L, Pulido-García MC. Chondrosarcoma of the Hand Bones: A Report of 6 Cases and Review of the Literature. J Hand Surg Asian Pac Vol 2019; 24:45-49. [PMID: 30760143 DOI: 10.1142/s2424835519500085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Primary malignant tumours of the hand are extremely rare, with chondrosarcoma being the most common. We describe six consecutive cases of chondrosarcoma (CS) of the hand, with a follow-up of 12 months to 10 years after surgical intervention. METHODS Five cases were primary tumors and one was secondary to Ollier's disease. Mean age at diagnosis was 67.5 years (range 46 to 85 years) and three patients were males. The bone most commonly affected was the proximal phalanx (in 4 patients), followed by the metacarpal bone (3 cases in the other 2 patients). The first symptom was an increase in volume in five cases and a pathological fracture in one. The x-ray study showed signs of malignancy in two cases only. In the other four cases, CT and MRI studies were necessary to complete the diagnosis. RESULTS Primary amputation was performed in two cases and intralesional curettage and cancellous bone autograft in four. Primary amputation was performed in two cases and intralesional curettage and cancellous bone autograft in four. We found three grade I/III CS and three grade II/III CS in the histological study. Local recurrences occurred in three patients, two being grade II/III CS. One of the three had undergone an initial amputation and underwent re-amputation, another had had curettage of the lesion and was amputated, and the third patient decided not to undergo the procedure due to her age. A pulmonary nodule was suspected at the most recent follow up in a fourth patient, who had been diagnosed with a grade II/III CS. CONCLUSIONS Although CS of the hand bones behaves as a locally aggressive lesion, it rarely metastasizes. Intralesional curettage with a cancellous bone autograft appears to be a good option in low-grade CS to preserve the function, keeping in mind the high rate of recurrence. Wide excision or amputation is recommended when severe joint deformity or soft tissue involvement interferes with hand function.
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Affiliation(s)
- Antonio García-Jiménez
- * Department of Orthopedic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Camila Chanes-Puiggrós
- * Department of Orthopedic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Trullols-Tarragó
- † Division of Orthopedic Oncology, Department of Orthopedic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María-Carmen Pulido-García
- ‡ Division of Trauma, Department of Orthopedic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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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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Bowen CM, Landau MJ, Badash I, Gould DJ, Patel KM. Primary tumors of the hand: Functional and restorative management. J Surg Oncol 2018; 118:873-882. [DOI: 10.1002/jso.25202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/23/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Chase M. Bowen
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Mark J. Landau
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Ido Badash
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Daniel J. Gould
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Ketan M. Patel
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
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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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Parosteal extra-axial chordoma of the second metacarpal bone: a case report with literature review. Skeletal Radiol 2018; 47:579-585. [PMID: 29151144 DOI: 10.1007/s00256-017-2818-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 09/20/2017] [Accepted: 10/31/2017] [Indexed: 02/02/2023]
Abstract
Extra-axial chordoma is a chordoma that occurs in non-axial locations. It is a very rare tumor, with 20 cases reported to date; 14 in bone and six in soft tissue. Of the 14 skeletal extra-axial chordomas, ten were intramedullary and four were intracortical. We report the first case of parosteal extra-axial chordoma arising in the second metacarpal bone, expressing brachyury on immunohistochemical analysis, and describe the pathologic and radiologic findings. We suggest that extra-axial chordoma can occur in parosteal bone lesions or the hand, without features of bone distribution or bone-specific sites.
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Kuyumcu G, Sundaram M, Schils JP, Ilaslan H. Osteoid osteoma of the hand and foot in children successfully treated with radiofrequency neurotomy probes. Skeletal Radiol 2017; 46:1561-1565. [PMID: 28689337 DOI: 10.1007/s00256-017-2702-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 02/02/2023]
Abstract
Osteoid osteoma is a common benign tumor that is typically found in young adults and children, usually in the long bones of the lower extremity. Radiofrequency ablation (RFA) under computed tomography guidance is the standard of care for symptomatic osteoid osteomas. However, patients with osteoid osteoma of the hand or foot are often treated with open surgery because of the risk of injury to vascular and neural structures from RFA. This risk is more pronounced in pediatric patients because of the small lesion size and proximity of lesions to important neurovascular structures. Here, we present 2 pediatric patients, one with an osteoid osteoma in the hand and the other with an osteoid osteoma in the foot. In both patients, a 22-gauge, 2.5-mm active tip ablation probe was used. The smaller ablation volume achieved with this probe protected neighboring neurovascular structures while effectively ablating the osteoid osteoma nidus. Based on our success in these cases, we recommend the application of this method for cases in which neurovascular proximity to the osteoid osteoma lesion makes ablation challenging.
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Affiliation(s)
- Gokhan Kuyumcu
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Murali Sundaram
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jean P Schils
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Hakan Ilaslan
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
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Jubbal KT, D'Souza G, Abrams RA, Kulidjian AA. Management of soft tissue tumors of the upper extremity: a review. SICOT J 2017; 3:47. [PMID: 28664843 PMCID: PMC5492789 DOI: 10.1051/sicotj/2017001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/28/2016] [Indexed: 11/14/2022] Open
Abstract
Introduction: Management of malignant tumors of the hand and wrist is challenging and is generally approached by limb salvage or amputation. With advances in care, amputation has been superseded by limb salvage as the treatment of choice. Methods: A narrative literature review was performed to identify articles on the topic of management of soft tissue tumors of the upper extremity, including surgical management, adjuvant radiation therapy, and chemotherapy. Results: A total of 29 articles were selected. Earlier reports favored radical tumor resection, which often led to amputation, whereas later articles demonstrated limb salvage as the preferential treatment modality. Conclusions: Given the detrimental effects on function and psychologic outcomes, amputation has been superseded by limb salvage in most cases, although it can occasionally be the only option. A variety of adjuvant therapies have been described, including radiation or brachytherapy, chemotherapy, and regional hyperthermia. Radiation treatment, and specifically brachytherapy, is beneficial to select patients. Controversy surrounds chemotherapy in certain subtypes, and regional hyperthermia requires further investigation.
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Affiliation(s)
- Kevin T Jubbal
- University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Gehaan D'Souza
- Division of Plastic Surgery, University of California, San Diego, 200 W Arbor Drive, San Diego, CA 92103, USA
| | - Reid A Abrams
- Department of Orthopedic Surgery, University of California, San Diego, 200 W Arbor Drive, San Diego, CA 92103, USA
| | - Anna A Kulidjian
- Department of Orthopedic Surgery, University of California, San Diego, 200 W Arbor Drive, San Diego, CA 92103, USA
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Tumors of the hand. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:747-762. [DOI: 10.1007/s00590-017-1984-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/30/2017] [Indexed: 12/15/2022]
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Mahan MC, Frisch N, Durrant B, Parsons T, Woods T, Mott M. Ewing Sarcoma in the Fifth Metacarpal of an Adult Woman: A Case Report. JBJS Case Connect 2016; 6:e95. [PMID: 29252749 DOI: 10.2106/jbjs.cc.16.00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Atypical presentations of Ewing sarcoma (ES) can lead to misdiagnosis and delays in treatment. We present a rare case of ES in the hand of an adult woman who underwent multiple interventions prior to referral to our institution. At 22 months after definitive treatment, the patient remained pleased with the result and had no evidence of recurrence. CONCLUSION To our knowledge, ES of the hand in an adult woman has not yet been reported in the literature, and a lack of recognition of this condition might be secondary to the absence of features traditionally associated with malignant bone neoplasms. A broader differential diagnosis after intervention failures offers the opportunity for diagnosis and appropriate treatment.
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Affiliation(s)
- M Chad Mahan
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
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Knaus WJ, Alluri R, Bakri K, Iorio ML. Oncologic reconstruction of the hand and upper extremity: Maximizing functional outcomes. J Surg Oncol 2016; 113:946-54. [DOI: 10.1002/jso.24196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 01/21/2016] [Indexed: 11/08/2022]
Affiliation(s)
- William J. Knaus
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Ram Alluri
- Department of Orthopaedic Surgery, University of Southern California; Keck School of Medicine; Los Angeles California
| | - Karim Bakri
- Division of Plastic Surgery; Mayo Clinic; Rochester Minnesota
| | - Matthew L. Iorio
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
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The Importance of Hand Appearance as a Patient-Reported Outcome in Hand Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e552. [PMID: 26893977 PMCID: PMC4727704 DOI: 10.1097/gox.0000000000000550] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
Abstract
Hand appearance is meaningful to patients because hands are an essential part of human interactions, communication, and social integration. Recent literature indicates that hand aesthetics is an important, measurable patient-reported outcome. In hand surgery, several outcome instruments exist that accurately measure functional outcomes, but aesthetics is often overlooked or imprecisely measured. This makes comparison of disease burden and effectiveness of therapies, as they pertain to aesthetics, difficult. This special topic article outlines the aesthetic features of the hand, how literature is evaluating the appearance of the hand in outcomes research, and proposes a novel approach to assessing hand aesthetics.
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Imaging Diagnosis of Solitary Tumors of the Phalanges and Metacarpals of the Hand. AJR Am J Roentgenol 2015; 205:106-15. [PMID: 26102388 DOI: 10.2214/ajr.14.13340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Tumors and tumorlike lesions of the tubular bones of the hand, often incidentally discovered lesions, present a unique but challenging differential diagnosis. CONCLUSION Imaging, including both radiography and cross-sectional imaging, can allow the radiologist to generate a clinically useful differential diagnosis based on the distinguishing features of these entities. Recognition of these lesions is important because clinical management and treatment by orthopedic oncologists vary depending on the diagnosis.
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Longhurst WD, Khachemoune A. An unknown mass: the differential diagnosis of digit tumors. Int J Dermatol 2015; 54:1214-25. [DOI: 10.1111/ijd.12980] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/03/2014] [Accepted: 01/17/2015] [Indexed: 12/23/2022]
Affiliation(s)
- William D. Longhurst
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
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Arthozoul M, Brun C, Laffosse JM, Martinel V, Grolleau JL, André A. Avulsion of flexor digitorum profundus secondary to enchondroma of the distal phalanx. Case report and literature review. ACTA ACUST UNITED AC 2015. [PMID: 26204827 DOI: 10.1016/j.main.2015.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report an unusual case of avulsion of the flexor digitorum profundus tendon of the ring finger at its insertion, in combination with a pathological fracture of the distal phalanx due to enchondroma. The bone lesion was curetted and grafted using autogenous bone. The FDP tendon was reattached to the distal phalanx using the pullout technique. We describe this case in detail and discuss the surgical management through a review of literature.
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Affiliation(s)
- M Arthozoul
- Unité de chirurgie de la main et chirurgie réparatrice des membres, institut de l'appareil locomoteur, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France
| | - C Brun
- Service de radiologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France
| | - J-M Laffosse
- Unité de chirurgie de la main et chirurgie réparatrice des membres, institut de l'appareil locomoteur, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France
| | - V Martinel
- Polyclinique de l'Ormeau, 12, chemin de l'Ormeau, 65000 Tarbes, France
| | - J-L Grolleau
- Unité de chirurgie de la main et chirurgie réparatrice des membres, institut de l'appareil locomoteur, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France
| | - A André
- Unité de chirurgie de la main et chirurgie réparatrice des membres, institut de l'appareil locomoteur, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France.
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Zyluk A, Mazur A. Statistical and histological analysis of tumors of the upper extremity. ACTA ACUST UNITED AC 2015; 10:252-257. [PMID: 28868084 PMCID: PMC5579472 DOI: 10.1007/s11678-015-0314-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/09/2015] [Indexed: 02/01/2023]
Abstract
Background Tumors of the upper extremity are common and usually benign. The most commonly diagnosed are ganglion cysts: specific, non-neoplastic swellings localized mostly around the wrist. Objective The objective of this retrospective study was to determine the proportion of various types of nonganglionic hand tumors operated on at the authors’ institution in 2014. Methods A total of 246 patients, 141 women (57 %) and 105 men (43 %), with a mean age of 53 years and with tumorsof the upper extremity, were identified and treated in the authors’ institution in 2014. Results Almost half of the lesions were localized in the fingers (n = 119, 48 %), followed by the wrist (n=49, 20 %), metacarpus (n = 40, 16 %), and more proximal parts (n = 38, 16 %). The time between the patients noticing the lesion and surgery was a mean of 4 years (range, 1 month to 30 years). The most common lesion was giant cell tumor of the tendon sheath (n = 58, 23 %), followed by lipoma (n = 40, 16 %), epidermal cyst (n = 23, 9 %), enchondroma (n=16, 6 %), hemangioma (n = 14, 6 %), fibroma (n = 11, (4 %), glomus tumor (n = 10, (4 %), and rheumatoid nodule (n = 10, (4 %). Two cases of malignant fibrosarcoma were identified incidentally. Conclusion A brief review of the literature is made referring to the data presented here.
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Affiliation(s)
- Andrzej Zyluk
- Department of General and Hand Surgery, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Agnieszka Mazur
- Department of General and Hand Surgery, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland
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