Bone and soft tissue tumors Flashcards
What does CT assess in upper extremity tumors?
It evaluates bone destruction and calcified lesions.
How does clonality distinguish neoplasms from benign growths like Dupuytren’s?
Benign conditions (e.g., Dupuytren’s) are polyclonal; neoplasms are monoclonal.
Is a tourniquet safe for upper extremity neoplasm surgery, and how should it be applied?
Yes, use it with gravity exsanguination (arm elevation), not an Esmarch bandage.
How should an incision be oriented for an upper extremity mass biopsy?
Longitudinally, to incorporate into the final excision or amputation.
Should you dissect around or split the muscle during an upper extremity biopsy?
Split the muscle sharply to avoid seeding other compartments.
Are drains recommended after an open biopsy of an upper extremity mass?
No, they can seed tumor cells along tracts; use diligent hemostasis instead.
What causes an epidermal inclusion cyst?
Epidermal cells embed in the dermis, usually due to trauma.
Where do epidermal inclusion cysts typically occur, and how are they treated?
In glabrous skin of the palms and fingertips (often perionychium); treat with complete excision including the punctum.
What is a glomus tumor?
A benign hamartoma from the thermoregulatory neuromyoarterial apparatus in the stratum reticulare.
What symptoms indicate a subungual glomus tumor, and how is it treated?
Severe pain, cold sensitivity, tenderness, nail deformity, and discoloration; treat by removing the nail plate and excising the tumor completely.
What is a pyogenic granuloma, and who does it most commonly affect?
A rapidly growing, vascular, friable nodule, often on fingertips; most common in young adults, especially post-pregnancy.
What are the two most common hand tumors or masses?
- Ganglions; 2. Giant cell tumors.
What is the predominant cell type in giant cell tumors of the hand?
Histiocytes.
Where do giant cell tumors of the hand typically originate?
Flexor tendon sheath.
How are giant cell tumors of the hand treated?
Complete excision, including the stalk if present.
How do neurofibromas and neurilemmomas differ?
Neurofibromas arise within nerve fascicles; neurilemmomas (schwannomas) arise from Schwann cells on the nerve surface.
How are neurofibromas and neurilemmomas treated surgically?
Neurofibromas require fascicle transection; neurilemmomas can be shelled out.
What is the most common benign nerve tumor of the upper extremity?
Neurilemmoma (schwannoma).
What condition is suggested by multiple upper extremity neurofibromas and café-au-lait spots?
Neurofibromatosis type 1 (NF1, von Recklinghausen disease).
What condition is likely in a patient with bilateral acoustic schwannomas?
Neurofibromatosis type 2 (NF2), rarely with neurofibromas.
What studies differentiate neurofibromas from neurilemmomas?
MRI and nerve conduction studies.
How are fibromatosis and juvenile aponeurotic fibromas treated?
Wide excision with skin grafting or free tissue transfer; high recurrence risk.
What is infantile digital fibromatosis, and when does it present?
A benign condition in children (5 months–6 years) with firm, nontender nodules on the dorsal/lateral fingers.
What histologic features characterize infantile digital fibromatosis?
Interlacing fibroblasts with intracytoplasmic eosinophilic inclusion bodies.
How is infantile digital fibromatosis treated?
Wide excision with full-thickness skin grafting if needed.
What is the main challenge with desmoid tumors?
High recurrence rate, especially in females.
How are upper extremity AVMs treated?
Ligation of feeding vessels and complete excision, often with preoperative embolization.
Which benign bone tumor is most common in the hand?
Enchondroma.
Where do enchondromas commonly occur in the hand?
Proximal phalanx, metacarpal, and middle phalanx.
What is Ollier’s disease?
A nonhereditary condition of multiple unilateral enchondromas.
What defines Maffucci syndrome?
Multiple enchondromas with hemangiomas.
What is the lifetime risk of malignant transformation for a solitary enchondroma?
Less than 5%.
What malignancy can enchondromas transform into?
Chondrosarcoma.
How do enchondromas typically present?
Often as pathologic fractures causing pain.
How are enchondromas treated?
Curettage and bone grafting; allow fractures to heal first if present.
What is a periosteal chondroma?
A benign cartilaginous tumor at the metaphyseal-diaphyseal junction of the phalanx, similar to enchondroma.
What age group is most affected by unicameral bone cysts, and are they exclusive to this group?
5–10 years, almost exclusively in children.
How do unicameral bone cysts typically present?
As incidental radiographic findings or pathologic fractures.
What is the nonsurgical treatment for unicameral bone cysts?
Intralesional corticosteroid injection.
What are aneurysmal bone cysts, and where do they occur?
Blood-filled cysts in the metacarpal metaphysis growing toward the physis.
What age group is most affected by aneurysmal bone cysts, and what are the symptoms?
Second decade of life; swelling and pain, often post-injury.
How are aneurysmal bone cysts treated?
Curettage and bone grafting due to their erosive nature.
What is the structure of an osteochondroma?
A bone stalk with a cartilaginous cap growing from the metaphysis in skeletally immature patients.
When is excision necessary for osteochondromas?
Only if symptomatic, as malignant transformation is rare.
What symptoms characterize osteoid osteomas?
Nighttime pain relieved by NSAIDs.
How do osteoid osteomas appear on imaging?
A sclerotic nidus with a lucent halo, less than 1 cm in diameter.
What histologic features define osteoid osteomas?
A hypervascular nidus of osteoblasts with surrounding cortical reactive bone.
How are osteoid osteomas treated?
Curettage and bone grafting.
What is an osteoblastoma, and how does it differ from an osteoid osteoma on imaging?
A hypervascular nidus of osteoblasts with reactive bone; imaging shows a sclerotic nidus with a lucent halo, greater than 1 cm.
What are the clinical features of a giant cell tumor of bone in the hand?
Gradual swelling, pain, and sometimes pathologic fracture, often in the distal radius.
Do giant cell tumors of bone have malignant potential?
Yes, they can metastasize, most commonly to the lung.
How do giant cell tumors of bone appear on radiographs?
Lytic lesions without new bone formation, encroaching on but not penetrating the joint surface.
How are giant cell tumors of bone surgically treated?
Wide excision with joint reconstruction if needed.
What is the most common malignant hand tumor?
Squamous cell carcinoma (SCC).
Which benign peripheral nerve sheath tumor is more prevalent in the hand and wrist: neurofibromas or Schwannomas?
Schwannomas
(Angelini et al., 2018)
Are neurofibromas typically solitary or multiple when presenting in the upper limb?
Neurofibromas are typically solitary, though multiple presentations are often linked to neurofibromatosis type 1 (NF1), which occurs in less than 5% of cases.
(Woodruff et al., 1997)
On which side of the forearm are Schwannomas most commonly located: flexor or extensor?
Schwannomas are most commonly located on** the flexor side of the forearm,** correlating with the distribution of major nerves like the median and ulnar.
(Kim et al., 2003)
Why is neurological deficit more frequent after neurofibroma resection compared to Schwannoma resection?
Neurofibromas are intraneural and infiltrative, often necessitating nerve sacrifice with a 45% deficit rate, while Schwannomas are eccentric and encapsulated, enabling enucleation with a 5% deficit risk.
(Kim et al., 2007)
Does current evidence support malignant degeneration as a significant risk in Schwannomas?
Malignant degeneration in Schwannomas is extremely rare and not well-established, with most malignant peripheral nerve sheath tumors arising de novo or from neurofibromas in NF1.
(Farid et al., 2014)
What is the most commonly affected bone in the hand by enchondromas?
The proximal phalanx is the most commonly affected, not the metacarpal bone. Studies indicate that 69.7% of hand tumors, including enchondromas, occur in the phalanges, with the proximal phalanx being the most frequent site.
Does delaying treatment of an enchondroma until after an undisplaced pathological fracture heals affect clinical outcomes?
No, outcomes are similar whether treatment occurs immediately or after healing. Research shows no significant differences in consolidation time, recurrence rate, or functional outcomes based on timing.
Do bone grafts reduce the local recurrence rate of hand enchondromas after curettage?
No, bone grafts do not influence recurrence rates. Evidence highlights that the thoroughness of curettage, not the use of grafts, is the key factor in preventing recurrence.
What is the estimated risk of malignant transformation in a patient with Ollier’s disease?
**The risk is approximately 25-30%, **not 10%. Clinical studies consistently report this higher range, emphasizing the need for vigilant monitoring.
Are multiple enchondromas with phleboliths on radiographs indicative of Ollier’s disease or Maffucci’s syndrome?
These findings indicate Maffucci’s syndrome, not Ollier’s disease. Research confirms that Maffucci’s syndrome features both enchondromas and hemangiomas (marked by phleboliths), while Ollier’s disease involves only enchondromas.
