Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Plastic Surgery - HAND > Chapter 31- Hand Tumors > Flashcards

Chapter 31- Hand Tumors Flashcards

1
Q

What is the role of CT in assessing upper extremity tumors?

A

CT is used to evaluate the extent of the bone destruction as well as calcified lesions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the role of MRI in assessing upper extremity tumors?

A

Evaluation of lesions involving bone and soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is clonality used to differentiate between neoplasms and benign tissue growths (Dupuytren’s)?

A

Benign and inflammatory conditions are typical polyclonal, whereas neoplasms are monoclonal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In which direction should the incision be oriented when obtaining a biopsy of an upper extremity mass?

A

Longitudinal, rather than transverse or zigzag, to incorporate the incision in the final excision/amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When performing a biopsy, should one dissect around the muscle plane or split the muscle sharply?

A

Split the muscle sharply to avoid seeding other compartments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Should drains be placed after performing an open biopsy?

A

No. Drains can seed tumor cells along tracts. Use diligent hemostasis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Should a tourniquet be used when operating on a neoplasm of the upper extremity?

A

Yes, but exsanguinate by gravity (elevation of the arm), do not use an Esmarch bandage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the usual etiology of an epidermal inclusion cyst?

A

Epidermal cells become embedded in the dermis, which is usually the result of trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where do epidermal inclusion cysts usually occur and what is the treatment?

A

In glabrous, non-hair-bearing skin of the palms and fingertips (usually perinychium). Treatment is complete excision including punctum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a glomus tumor?

A

A benign, hamartomatous neoplasm formed from the thermoregulatory neuromyoarterial apparatus in the stratum reticulare.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical findings seen with a subungal glomus tumor? What is the treatment?

A

Severe pain, cold sensitivity, tenderness, nail deformity, discoloration. Treatment is removal of the nail plate and complete excision of the tumor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most likely diagnosis in a patient with a subcutaneous elevation just proximal to the eponychial fold and associated nail grooving? Treatment?

A

Mucous cyst. Mucous cysts are fluid-filled ganglia of the distal interphalangeal joint associated with bony spurs and nail grooving. Treatment is cyst excision and removal of bone spurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a pyogenic granuloma? What demographic does it affect most commonly?

A

Pyogenic granuloma is a rapidly growing vascular, friable nodule. It is frequently seen on the fingertips in young adults, and notably most common after pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a keratoacanthoma?

A

A lesion found most commonly on the dorsum of the hand (elderly patients), round, elevated, with a central crater. Can spontaneously regress or progress to SCC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the natural history of a keratoacanthoma?

A

1: Proliferation - rapid growth of a pre-existing lesion
2: Maturation
3: Involution - gradually gets smaller as central crater expels keratin plug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the recommended treatment for keratoacanthoma?

A

Surgical excision or intralesional 5FU or methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the first and second most common tumors or masses of the hand?

A

1: Ganglions
2: Giant cell tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the predominant cell type in giant cell tumors (aka localized nodular synovitis)?

A

Histiocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the usual site of origin of giant cell tumors?

A

Flexor tendon sheath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment of giant cell tumors?

A

Complete excision along with the stalk (if present)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the difference between a neurofibroma and a neurilemmoma?

A

Neurofibroma; tumor arising within the nerve fascicles

Neurilemmoma (schwannoma); tumor of schwann cells on the nerve surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the treatment of a neurofibroma and a neurilemmoma?

A

neurofibroma; requires transection of the proximal and distal fasicles
neurilemmoma; can be shelled out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the most common benign NERVE tumors of the upper extremity?

A

neurilemmoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A patient presents with multiple neurofibromas of the upper extremity and cutaneous cafe-au-lait spots, what is the diagnosis?

A

NF1, Von Rechlinghausen disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

A patient presents with bilateral acoustic schwannomas, what is the likely diagnosis?

A

NF2 (these patients rarely have neurofibromas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What diagnostic studies can be used to differentiate between neurofibroma and a neurilemmoma?

A

MRI and nerve conduction studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the treatment of fibromatosis and juvenile aponeurotic fibromas?

A

Treatment involves wide excision with skin grafting or free tissue transfer. High recurrence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is infantile digital fibromatosis?

A

Benign condition presenting in children 5mo-6yrs in which a broad-based, firm, non-tender nodule(s) develops on the dorsal or lateral aspects of the fingers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the histologic findings of infantile digital fibromatosis?

A

Interlacing fibroblasts and intracytoplasmic eosinophilic inclusion bodies. The inclusion bodies distinguish from other fibromatoses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the treatment for infantile digital fibromatosis?

A

Wide excision of the lesion(s) with full-thickness skin grafting if defect warrants.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the chief problem seen with desmoid tumors?

A

High rate of recurrence (esp in females)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the treatment for an upper extremity AVM?

A

Ligation of feeding vessels, complete excision of the malformation. Preoperative embolization may be performed prior to excision.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the most common benign bone tumor?

A

Enchondroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the common locations for echondroma?

A

Proximal phalanx, metacarpal, middle phalanx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is Ollier’s disease?

A

Non-hereditary disease of multiple enchondromas that usually present unilaterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is Maffucci syndrome?

A

A condition characterized by multiple endochondromas and hemangiomas

37
Q

What is the lifetime chance of a solitary enchondroma undergoing malignant transformation?

A

<5%

38
Q

What to enchondromas degenerate into?

A

Chondrosarcomas

39
Q

How do enchondromas typically present?

A

Often discovered as the cause of a pathologic fracture presenting with pain

40
Q

What is the treatment for enchondromas?

A

Curettage and bone grafting. Allow fracture to heal prior to definitive resection if present.

41
Q

What is a periosteal chondroma?

A

Benign cartilaginous tumor that is similar to an enchondroma and most commonly found at the metaphyseal-diaphaseal junction of the phalanx.

42
Q

What is the peak age range of unicameral bone cysts?

A

5-10 years, seen almost exclusively in children

43
Q

What is the typical presentation of unicameral bone cysts?

A

Incidental finding on radiography or pathologic fracture

44
Q

What is the nonsurgical treatment for unicameral bone cysts?

A

Intralesional corticosteroid injection

45
Q

What is the name of the blood-filled cysts that typically occurs in the metaphysis of a metacarpal and then grows towards the physis?

A

Aneurysmal bone cyst

46
Q

What is the peak age range and what are the symptoms for aneurysmal bone cyst?

A

Second decade of life; swelling and pain, often following an injury

47
Q

What is the treatment for aneurysmal bone cyst?

A

Curettage and bone grafting is recommended as they are erosive, although benign, they must be removed.

48
Q

What is the usual structure of an osteochondroma?

A

Bone stalk and cartilaginous cap growing from the metaphysis in skeletally immature patients

49
Q

Is excision necessary for osteochondromas?

A

Excision is not necessary unless they are symptomatic, as they rarely undergo malignant transformation

50
Q

What are the symptoms of an osteoid osteoma?

A

Pain at night that is generally resolved be NSAIDs

51
Q

How do osteoid osteomas present on imaging?

A

Sclerotic nidus with lucent halo, LESS than 1 cm in diameter

52
Q

What is the histology of osteoid osteomas?

A

Hypervascular nidus of osteoblasts with surrounding cortical reactive bone formation

53
Q

What is the treatment for osteoid osteomas?

A

Curettage and bone grafting

54
Q

What is an osteoblastoma, how do they present on imaging?

A

Hypervascular nidus of osteoblasts with surrounding cortical reactive bone formation; Sclerotic nidus with lucent halo, GREATER than 1 cm in diameter

55
Q

What is the clinical presentation of a giant cell tumor of bone?

A

Gradual swelling, pain, sometimes with pathologic fracture, most often in distal radius

56
Q

Do giant cell tumors have malignant potential?

A

yes, they are capable of metastasizing (Most commonly to lung)

57
Q

How do giant cell tumors of bone appear on radiographs?

A

Lytic lesion without new bone formation; the lesion encroaches on, but does not penetrate the joint surface

58
Q

What is the surgical treatment of giant cell tumors?

A

Wide excision and joint reconstruction if necessary

59
Q

What is the pathophysiology of fibrous dysplasia?

A

Bone marrow involved bone(s) filled with noncalcified collagen

60
Q

What is the xray appearance of fibrous dysplasia?

A

ground-glass opacity

61
Q

What is the treatment of fibrous dysplasia of the hands?

A

No treatment required, only if there is a pathologic fracture or “impending” fracture

62
Q

What is the staging system for malignant musculoskeletal tumors?

A

Stage 1A - Low (G1) - Intracompartmental (T1) - M0
Stage 1B - Low (G1) - Extracompartmental (T2) - M0
Stage IIA - High (G2) - Intracompartmental (T1) - M0
Stage IIB - High (G2) - Extracompartmental (T2) - M0
Stage III - Any - Any - M1 (regional or distant)

63
Q

What is the most common malignant tumor of the hand?

A

SCC

64
Q

What is the most common type of melanoma in African Americans and Asians?

A

Acral lentiginous, generally presenting on hands and feet

65
Q

When treating melanoma of the hand, how is the level of amputation determined?

A

Amputate proximal to the nearest joint

66
Q

What role does sentinel lymph node biopsy play in the treatment of subungal melanoma?

A

Helpful because the depth of the tumor is difficult to determine in the nail bed

67
Q

What is dermatofibrosis protuberans?

A

Soft tissue neoplasm arising in the dermis that presents as a purple-red plaque or nodule - can be treated with Mohs

68
Q

What is a strong risk factor associated with malignant peripheral nerve sheath tumor?

A

NF1

69
Q

What is synovial cell sarcoma?

A

High grade sarcoma that grows in proximity to (but not in) joints. Size of the lesion is proportional to the mortality.

70
Q

What is the treatment for synovial cell sarcoma?

A

Wide excision with lymph node sampling (and dissection if nodes are positive), consider adjuvant radiation therapy

71
Q

What other sarcoma is similar to synovial cell sarcoma and usually arises from the muscle?

A

Epitheloid sarcoma

72
Q

What pattern of spread does epitheloid sarcoma demonstrate?

A

Spreads proximally along fascial planes, tendons, and lymphatics

73
Q

Where is malignant fibrohistiocytoma usually found in the upper extremities?

A

Deep muscle mass of the adductor pollicis or within the flexor muscles

74
Q

What is the most common malignant primary bone tumor of the hand seen in children and teens?

A

Osteogenic sarcoma

75
Q

How does osteogenic sarcoma look on plain radiograph?

A

Bone growth outside the normal skeletal boundaries with laze “cloud-like” bone formation into soft tissues

76
Q

What is the adjuvant treatment regimen for osteogenic sarcoma

A

Chemotherapy improves limb salvage and survival, no role for external beam radiation

77
Q

What is the most common malignant primary bone tumor of the hand in adults?

A

Chondrosarcoma

78
Q

Is chondrosarcoma sensitive to chemotherapy or radiation?

A

No

79
Q

What is the benign predecessor that can rarely degenerate into a chondrosarcoma?

A

Enchondroma

80
Q

What is a rare bone tumor of the metacarpals and phalanges that consists of abnormal endothelial cells?

A

Angiosarcoma

81
Q

What is the typical presentation of a Ewing sarcoma of the hand?

A

Pain, swelling, soft-tissue mass; generalized symptoms such as fever, elevated WBCs or ESR

82
Q

Whats it the radiographic presentation of a Ewing sarcoma?

A

Lytic lesion of the bone with a soft tissue component

83
Q

What is the periosteal reaction called in the Ewing sarcoma?

A

“Onion skin” appearance or “sunburst” pattern

84
Q

What are the common sites of Ewing sarcoma of the hand?

A

Metacarpals, phalanges

85
Q

What is the treatment of Ewing sarcoma?

A

Surgical excision, chemotherapy, and/or external beam radiation

86
Q

What percentage of patients with primary cancers in other parts of the body will develop a metastasis to the hands or feet?

A

0.3%

87
Q

What is the most common primary carcinoma that metastasizes to hand?

A

Bronchogenic carcinoma, followed by breast and kidney

88
Q

When primary carcinoma mestastasizes to the hand what location does it go to?

A

Distal phalanx

Plastic Surgery - HAND (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions