Malignant tumours of the hand and wrist

Top 75 most-cited articles in hand microsurgery: A bibliometric and visualised analysis

Introduction

Hand microsurgery is an important advancement of the speciality that has improved outcomes in hand trauma and hand surgical conditions. This bibliometric analysis aims to identify the 75 most cited hand microsurgery articles and explore their relevance to contemporary practice.

Methods

The Web of Science core collection database was used to screen and identify the top 75 most-cited articles relevant to hand microsurgery. VOSviewer 1.6.18 and CiteSpace 6.2.R4 software were used to analyse and visualise occurrences, authorship, countries, institutions, journals, keywords, and Evidence Level (Oxford Centre for Evidence-Based Medicine).

Results

The initial search identified 3024 articles. The top 75 most-cited articles were published between 1980 and 2018, with contributions from 291 authors. Professor Fu Chang Wei from Chang Gung Memorial Hospital, Taiwan, was the most prolific author. Articles originated from 14 countries, with the United States leading (29.3 %), followed by Taiwan (14.6 %), Italy (8.0 %), and Germany (8.0 %). The 75 most-cited articles were published in 22 journals, led by Plastic and Reconstructive Surgery, followed by the Journal of Hand Surgery (American Volume) and Microsurgery. A total of 345 keywords were analysed, with "Hand," "Defects," "Reconstruction," and "Regeneration" being the most frequent. Level of Evidence 4 was most common (40 %), followed by Levels 3 (25 %) and 5 (24 %).

Conclusions

The top 75 most-cited hand microsurgery articles influence current surgical practice and teaching material. Understanding specific surgical techniques in hand microsurgery and examining their outcomes will benefit patients, surgeons, researchers and policymakers alike.

A multivariate analysis on characteristics of hand and wrist tumours: a multiethnic study

INTRODUCTION

Hand tumours are frequently encountered in clinical practice. However, large-scale epidemiological data of soft tissue tumours in the hand are infrequently published. Epidemiological data provide diagnostic cues to guide the workup and management of hand tumours. Assessing significant independent demographic factors and tumour characteristics associated with hand tumours is essential in health care.

METHODS

A retrospective review of patients who underwent excision of hand tumours in Singapore General Hospital between 2004 and 2015 was conducted. The data collected included age, gender, ethnicity, histological diagnosis, malignancy and location of tumour. Generalised linear latent and mixed models (GLLAMM) analyses were performed.

RESULTS

A total of 4476 tumours were identified from 4226 patients with a mean age of 51.3 (range 8-101) years and male to female ratio of 1 to 1.15. Most patients were Chinese (75%), followed by Malay (9%), Indian (8%) and others (8%). The most common hand tumours excised were ganglions (43%) (majority in the wrist), followed by giant cell tumours (9%) (commonly in the digits). Most soft tissue tumours were benign (97%), with only 3% of malignant cases. The GLLAMM analyses revealed further potential factors on the status of malignancy, tumour origin and tumour location.

CONCLUSION

Most soft tissue tumours in the hand and wrist are benign. This can guide workup and counselling of patients before the operation. While malignant tumours are uncommon, they have the potential for significant morbidity and mortality if not appropriately evaluated or treated. The application of GLLAMM analyses showed that age, ethnicity and gender were significant predictors of malignancy.

Soft Tissue Sarcomas Mimicking Benign Inflammatory Processes: A Diagnostic Dilemma

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.

Secondary Chondrosarcoma Arising in Synovial Chondromatosis of Wrist Joint

Introduction

Chondrosarcoma of the synovium is a rare and malignant form of cartilaginous tumor that originates in synovial tissue. There have only been a limited number of reported cases of malignant transformation of synovial chondromatosis (SC) into secondary chondrosarcoma (SCH), primarily in the hip and knee, in patients with resistant illness. The occurrence of chondrosarcoma in SC of the wrist is highly uncommon, as evidenced by only a single previous case study that has been documented in the literature.

Case Report

This study presents a case series of two patients with primary SC who developed SCH at the wrist joint.

Conclusion

Clinicians treating localized swellings of the hand and wrist should be alert to the likelihood of a sarcoma diagnosis to minimize delays to definitive therapy.

Differential Diagnoses of Pediatric Upper Limb Masses

PURPOSE

Upper limb masses are one of the most common presentations in the outpatient setting. However, there is a paucity of information in the literature regarding the epidemiology of upper-extremity masses in the pediatric population. The aim of this study was to determine the differential diagnoses and clinical characteristics in children aged ≤18 years presenting with upper limb masses.

METHODS

A retrospective review of patients aged ≤18 years managed at our institution over a 5-year period was performed. We obtained information on patient demographics, clinical features, radiological investigations, intraoperative features, and histology. We also evaluated the correlation between the clinical and histopathological diagnoses in patients who underwent surgery.

RESULTS

There were 141 upper limb masses in our series. The mean age at presentation was 12 years (SD, 5 years). The most common presenting complaints were asymptomatic swelling, pain, and paresthesia. The majority (128; 91%) of tumors were benign; there were 5 locally aggressive tumors and 6 malignant tumors. The dominant hand was involved in 60 patients. Of 140 patients, 43 (31%) patients had surgery. The procedures included incisional biopsy, excisional biopsy, wide resection, and reconstruction. One patient required a below elbow amputation for an osteosarcoma.

CONCLUSIONS

Ten percent of cases represented malignant or locally aggressive disease. We have used our observations to develop a clinical algorithm that can assist clinicians in evaluating and managing children and adolescents presenting with upper-extremity masses.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Unusual Location of Bone Tumor Easily Misdiagnosed: Distal Radius Osteosarcoma Treated as Osteomyelitis

Despite being the most common primary malignant bone tumor in children and adolescents, the presence of osteosarcoma at the wrist is infrequent; only less than 1% of osteosarcomas arise in the distal radius. The clinical presentation may mimic common musculoskeletal problems or benign lesions such as osteomyelitis, and a high index of suspicion is necessary so that the treating surgeon does not miss such lesions. We reported a case treated initially as osteomyelitis before being diagnosed as distal radius osteosarcoma. We conclude that an unusual location of osteosarcoma may be easily misdiagnosed, and therefore, osteosarcoma should be considered one of the main differential diagnosis in such cases until proven otherwise.

Cytomorphological spectrum of hand, wrist, and foot lesions at tertiary care center in central India

BACKGROUND

Fine-needle aspiration cytology (FNAC) being a fast technique is used as a primary investigation to diagnose wide spectrum of hand, wrist, and foot lesions. These sites are prone to trauma, reparative, and infectious process, which forms mass lesions mimicking neoplasia. Our study highlighted the importance of FNAC with the chance of reduction in biopsy or excision.

AIMS AND OBJECTIVES

To report the prevalence and cytomorphological spectrum of hand and foot lesions with the aim of consolidating the diagnostic potential and also correlate the cytological evaluation with histopathology.

MATERIALS AND METHODS

This retrospective observational study was done in central India for the period of 5.5 years. The archive cytology slides of patients with palpable lesions at these sites are reviewed and analyzed.

RESULTS

Of the total 6512 FNAC cases, 115 cases presented as swelling in the hand, wrist, and foot are reviewed. Age ranged from 4 months to 80 years with M:F = 1.25:1. Of the 111 satisfactory smears (96.7%), 21 cases (18.9%) diagnosed as inflammatory lesion, including synovitis, tuberculosis, gout, and fat necrosis. Sixty cases as benign non-neoplastic (tumor-like) lesions with the most common being ganglion (29). Of the 30 neoplastic lesions, 26 were benign tumor with the most common being mesenchymal neoplasms (19), followed by giant cell tumor of tendon sheath. Malignant tumors included malignant melanoma, small round cell tumor, and squamous-cell carcinoma.

CONCLUSION

FNAC is useful investigation for early diagnosis of hand and foot lesions. These lesions are benign mostly with less malignancy occurrence (<2%), compared with other soft tissue lesions.

Recurrent myxoid liposarcoma of the hand

Malignant hand tumors are rarely observed in clinical practice which makes distinguishing them from benign soft tissue masses particularly challenging. A 41-year-old male presented with joint pain and swelling of his left index metacarpophalangeal joint. Radiological studies showed pronounced swelling around the affected joint with no bony abnormality, but incision and drainage of the site yielded negative cultures. Subsequent gross total resection confirmed the diagnosis of myxoid liposarcomas after cytogenetic pathology examination. Recurrence occurred after 1 year, followed by second resection and adjuvant radiotherapy. At 2 years follow-up, the patient was recurrence free. In conclusion, myxoid liposarcoma should be in the differential diagnosis of an older patient with erythema and swelling surrounding a subfascial mass of the hand.

Role of FNAC in diagnosing lesions of hand and wrist

BACKGROUND

Swellings in the hand and wrist are frequently encountered in clinical practice and fine needle aspiration cytology (FNAC) is used as a primary diagnostic modality in most of them. A wide spectrum of lesions can be encountered at these sites. The aim of this study was to report the prevalence and spectrum of hand and wrist lesions and evaluate the diagnostic role of FNAC.

METHODS

All the patients who presented with palpable lesions in the hand or wrist between January 2011 and July 2016 were reviewed, retrospectively.

RESULTS

1312 cases were subjected to FNAC of hand and wrist swellings, of which 1136 (86.6%) cases were satisfactory. Age ranged from 5 months to 90 years with M: F = 0.7:1. 138 (12.1%) were diagnosed as inflammatory lesions, 875 (77.0%) as benign, non-neoplastic (tumor-like) lesions and 123 (10.8%) were neoplastic lesions. The inflammatory lesions included 75 cases of synovitis, 30 cases of tuberculosis, 28 cases of abscess, one case of cysticercosis, two cases of gout, and fat necrosis each. In the benign, non-neoplastic (tumor-like) lesions, the most common lesion was ganglion (775 cases). The neoplastic lesions included 78 benign lesions with the most common being giant cell tumor of tendon sheath (61 cases). There were 40 cases of mesenchymal lesions, four cases of appendageal tumors and one case of malignancy (squamous cell carcinoma). Mesenchymal lesions accounted for 3.5% (40/1136) cases.

CONCLUSION

FNAC is very useful and simple investigation for early diagnosis of lesions of hand and wrist. The lesions encountered at these sites most commonly are benign.

Squamous Cell Carcinoma of the Palm in Nigeria

OBJECTIVE

To document six cases of squamous cell carcinoma (SCC) of the palm.

MATERIALS AND METHODS

A review of patients' records seen from 1986 to 1998, at the Plastic Surgical Unit of the National Orthopaedic Hospital, Enugu was undertaken. The accumulated data were analyzed with the reference to those diagnosed as SCCs.

RESULTS

Four males and two females with a mean age of 61.3 years were afflicted with SCC of the palm. All but one of these patients farmed. There were long delays before presentation, and extents of the lesions reflected that.

CONCLUSION

The Public health education is indicated in our community, if the patients are to recognize the nature of this lesion and report early.

Myxoid liposarcoma of the hand - A rare entity

Hand liposarcomas are not well recognized in common practice, which leads to erroneous diagnostics and delayed proper treatment. We reported a case of a myxoid liposarcoma classified as stage IIb, and developed in the palmar side of the left hand in a 38-year-old man. There was an initial tumor reduction by a sclerosing agent injection that proved to be a failure. An open excisional biopsy confirmed the diagnostic after pathology examination. Recurrence occurred after 2 years, followed by a second resection and an adjunctive radiotherapy. At 5 years follow-up, the patient was recurrence free. Although myxoid liposarcoma is rare in the hand, it should be considered in the differential diagnosis of a painless soft tissue mass in this region.

Lung Metastasis Mimicking Fingertip Infection

Metastasis fingers (acral metastasis) are finding a poor prognosis. Past medical history should be questioned and metastasis from primary tumor should be kept in mind in patients with pain, swelling, and hyperemia in fingers. Successful surgical treatment on acral metastasis does not extend the life expectancy; however, it reduces the patient's pain during his terminal period, saves the functions of the limb, and increases life comfort.

Ewing's sarcoma of proximal phalanx of the hand with skip metastases to metacarpals

Ewing's sarcoma is the second most common malignant primary bone tumor of childhood and adolescence affecting mainly the diaphysis of long bones and flat bones. This tumor is extraordinarily rare in small bones of the hand and presents as a swelling with atypical radiological features of cystic and lytic lesion with scant periosteal reaction. The common differential diagnosis include osteomyelitis, tuberculosis, enchondroma and benign tumors. Moreover, skip metastasis to adjacent bones is even rarer. The prognosis of this condition is greatly influenced by the presence of metastasis at presentation, further emphasizing the importance of early diagnosis. Multimodality treatment using surgery, radiotherapy and chemotherapy is currently recommended though no consensus exists. We report a case of Ewing's sarcoma of the little finger proximal phalanx which was initially missed and developed skip metastasis to several metacarpals within 4 months.