Soft Tissue Tumors of the Hand. 2. Malignant

Hand tumors: A review of 186 patients at a single institute

PURPOSE

The spectrum of diagnoses and clinical features of hand tumors differ from those of tumors in other body parts. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study aimed to elucidate the diagnostic distribution and the clinical features of hand tumors undergone surgery in our institute.

PATIENTS AND METHODS

A total of 235 lesions in 186 patients diagnosed with hand tumors between 1978 and 2020 were reviewed. Age at surgery, gender, chief complaint, tumor location, and pathological diagnosis were analyzed.

RESULTS

There were 121 benign bone tumors, 98 benign soft tissue tumors, and 16 malignant tumors. Chondroma and tenosynovial giant cell tumor were common benign bone and soft tissue tumors at the proximal phalanx of the ring finger and the palm, respectively. Meanwhile, chondrosarcoma and synovial sarcoma were common malignant tumors at the dorsal part of the hand. Local pain and painless mass were the chief complaints in patients with benign bone and soft tissue tumors, respectively. Most patients with malignant tumors were referred after unplanned resection. When patients were classified into two categories by tumor size according to maximal diameter, tumors larger than 19 mm had a significantly higher risk of malignant (p = 0.031) despite being smaller than other tumors in different body parts.

CONCLUSION

When a tumor malignancy is suspected, the patient should be referred to a specialist to avoid unplanned resection or delayed diagnosis due to misdiagnosis. Knowing the distribution and clinical features should help in diagnosing hand tumors.

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.

Use of Routine Pathologic Evaluation of Nonmalignant Lesions in Hand Surgery: A National Study

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.

A very unusual complication of amniocentesis

The uses of amniocentesis are numerous, including determination of chromosomal abnormalities, lung maturity, and infections. A common complication of amniocentesis is loss of the pregnancy, but rare complications should be considered. The role of patient history and clinical observation of uncommon presentations are critical in the management of the patient.

Moderately differentiated squamous cell carcinoma of the palm: an extremely infrequent tumour

Squamous cell carcinoma of the palm is a very infrequent malignancy. Its unusual presentation can produce a delay in the final diagnosis with serious consequences as far as morbidity and mortality are concerned. This article summarises the case of a patient who was referred to our department presenting a squamous cell carcinoma on his left palm and a clinically positive axillar lymphadenopathy. He had previously been wrongly diagnosed on several occasions.

Squamous cell carcinoma of the hand: a 20-year review

PURPOSE

Squamous cell carcinoma (SCC) is a common malignancy of the hand; yet, recurrence rates, metastatic rates, and long-term survival rates have not been well defined. This study evaluated the risk factors for local and regional recurrence for this diagnosis.

METHODS

Records of patients treated for SCC of the hand over a 20-year period in a single institution were reviewed. Data collected included patient demographics, tumor characteristics, and preoperative and postoperative care received. Overall survival, recurrence-free survival, and survival free of SCC in the same upper extremity were analyzed.

RESULTS

A total of 86 patients were identified. Mean age at the time of initial presentation was 69 years (range, 39-89 y). Mean follow-up was 6.4 years (range, 1-15 y). Overall survival was 88% and 57% at 5 and 10 years, respectively. Recurrence-free survival was 67% and 50% at 5 and 10 years, respectively. Rate of metastasis was 4%. Lymph node biopsy was performed in 4 patients who had clinical lymphadenopathy; 2 patients had positive nodes. Average time to first recurrence was 4.1 years (range, 0.5-11 y). Web space location, bilateral tumors, multiple tumors, and prior history of SCC were associated with an increased risk of recurrence. Survival free of SCC in the same upper extremity was 72% and 54% at 5 and 10 years, respectively. Younger age, history of transplantation, multiple tumors, and use of flap or skin graft for closure were associated with an increased risk of another SCC developing in the same extremity. No benefit was noted with wide, Mohs, or shave resection in terms of overall survival, recurrence-free survival, or SCC occurrence in the ipsilateral upper extremity.

CONCLUSIONS

Squamous cell carcinoma tumors of the hand have a high tendency for local recurrence but a low rate of metastasis. Specific characteristics of the tumor may increase chances of recurrence. The technique of tumor excision did not have a major role in outcome.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Merkel cell carcinoma of the hand and upper extremity: current trends and outcomes

Merkel cell carcinomas represent an uncommon yet aggressive skin cancer. We sought to identify changes in incidence and predictors of outcomes and survival of patients with Merkel cell carcinomas of the hand and upper extremity. The Surveillance, Epidemiology and End Results database was used to identify all patients with Merkel cell carcinomas of the skin located specifically in the hand and upper extremity. Overall, 5211 cases were identified in the period from 1986 through 2009. The age-adjusted incidence of Merkel cell carcinoma of the hand and upper extremity increased from 0.02 cases per 100,000 in 1986 to 0.14 cases per 100,000 in 2009. The mean age of these patients was 75 years and positive regional lymph nodes were identified in 33%. Rate of metastasis was 4.1%. Overall survival for the study cohort was 49%. Multivariate analysis identified tumor size >5 cm, positive regional lymph nodes and metastasis at diagnosis as independent predictors of mortality. The incidence of Merkel cell carcinomas has increased substantially over the study period. Overall survival for Merkel cell carcinomas of the body and hand and upper extremity is related to tumor size and extent of disease at time of clinical presentation. Merkel cell carcinomas of the hand and upper extremity tend to be diagnosed at an earlier stage with lower rates of regional and systemic spread, and subsequently have a higher overall survival rate.

Fine-needle aspiration biopsy of the distal extremities: a study of 141 cases

We reviewed our cytopathology databases for an 11-year period to identify all fine-needle aspiration biopsy (FNAB) cases of palpable masses of the hand, wrist, ankle, or foot. Cases were included only if there was a subsequent tissue biopsy or a minimum 1-year clinical follow-up. Of 141 aspirates, 41, 23, 34, and 43 were from the hand, wrist, ankle, and foot, respectively. Specific benign or malignant diagnoses were achievable in 71.6% of cases, whereas the remaining cases were given a descriptive diagnosis (26.2%) or, infrequently, a "suspicious for" diagnosis (2.1%). Overall sensitivity and specificity for distinguishing a benign from malignant entity from all 4 sites were 100% and 96%, respectively, whereas positive and negative predictive values were 88% and 100%, respectively. The most common lesion was a ganglion. Of the benign neoplasms, giant cell tumor of tendon sheath (17) and desmoid-type fibromatosis (7) were most common. Of 31 malignancies, 24 were sarcomas: sarcoma not otherwise specified (6), high-grade pleomorphic sarcoma (5), and Ewing sarcoma (3) were most common. Seven nonsarcomas included melanoma (3), metastatic squamous carcinoma (2), and malignant lymphoma (2). An FNAB-procured cytopathologic diagnosis is clinically reliable in a high percentage of distal extremity mass lesions.