Hand Tumors Flashcards
What is the role of computed tomography in assessing upper extremity tumors?
Used to evaluate extent of bone destruction as well as calcified lesions.
What is the role of magnetic resonance imaging in assessing upper extremity tumors?
Used for evaluation of lesions involving bone and soft tissue.
How is clonality used to differentiate between neoplasms and benign tissue growths (ie, Dupuytren disease)?
Benign and inflammatory conditions are typically polyclonal, whereas neoplasms are monoclonal.
In which direction should the incision be oriented when obtaining a biopsy of an upper extremity mass?
Longitudinal (rather than transverse or zigzag) so as to incorporate the biopsy site within the definitive excision or
amputation.
When performing a biopsy on a lesion, should one dissect around muscle planes or split the muscle sharply?
Split sharply (to avoid seeding other muscle compartments).
When performing an open biopsy, should drains be placed?
No, drains can seed tumor cells along their tracts. Simply obtain hemostasis.
Should a tourniquet be used when operating on a neoplasm of the upper extremity?
Yes, but exsanguination of the arm should be done through elevation, not Esmarch bandage.
What is the staging system for musculoskeletal tumors?
Stage Grade
IA Low (G1)
IB Low
IIA High (G2)
IIB High
Site
Intracompartmental Extracompartmental Intracompartmental Extracompartmental
What is the usual etiology of epidermal inclusion cysts?
Trauma that causes epidermal cells to become embedded in the dermis.
Where do epidermal inclusion cysts usually occur?
In the glabrous, non–hair-bearing skin of the palms and fingertips (especially perionychium).
What is the treatment of epidermal inclusion cysts?
Complete excision along with the skin puncture wound (or punctum, if present
What are the clinical findings seen with a subungual glomus tumor?
Severe pain, cold sensitivity, tenderness, nail deformity, or discoloration.
What is the treatment of a subungual glomus tumor?
Removal of nail, excision of tumor.
What is the likely diagnosis of a patient with a subcutaneous elevation just proximal to the eponychial fold and nail grooving?
A mucous cyst, or fluid-filled ganglion of the distal interphalangeal joint associated with bony spurs and nail grooving.
What is the treatment of mucous cysts?
Cyst excision and removal of bone spurs.
What is the name of a rapidly growing vascular, friable nodule frequently seen on fingertips in young adults, more common after pregnancy?
Pyogenic granuloma.
What is the name of the lesion that is commonly found on the dorsal hand that is round, elevated, and usually has a central crater? This lesion usually resolves spontaneously, and only occasionally progresses to squamous cell carcinoma.
Keratoacanthoma.
What is the natural history of keratoacanthomas?
They undergo three phases:
1. proliferation
2. maturation
3. involution
The clinical story will usually include the rapid growth of a preexisting lesion that then gradually gets smaller as the
central crater expels a keratin plug.
What is the recommended treatment for keratoacanthomas?
Surgical excision or intralesional injection with 5-fluorouracil (5-FU) or methotrexate.
What are the first and second most common tumors or masses of the hand?
Ganglions and giant cell tumors (GCTs), respectively.
What is the predominant cell type in GCTs (aka localized nodular synovitis)?
Histiocytes.
What is the usual site of origin of GCTs?
Flexor tendon sheath.
What is the treatment of GCTs?
Excision along with stalk (if present).
What is the difference between a neurofibroma and a neurilemmoma?
Neurofibroma: in the substance of the nerve. Neurilemmoma (also known as schwannoma): on the nerve surface.
How does this difference impact treatment?
Neurilemmoma can be “shelled out” easily, while neurofibroma requires transection at the proximal and distal
fascicles.
Are these common tumors?
Neurilemmomas are the most common benign nerve tumors in the upper extremity.
A patient presents with multiple neurofibromas of the upper extremity and cutaneous cafe ́-au-lait spots. What is your diagnosis?
Von Recklinghausen disease or neurofibromatosis type 1.
A patient presents with bilateral acoustic schwannomas. What is the likely diagnosis?
Neurofibromatosis type 2. Note that these patients rarely have neurofibromas.
What diagnostic studies can be used to differentiate between neurofibroma and neurilemmoma?
Magnetic resonance (MR) and nerve conduction studies.
What is the treatment of fibromatosis and juvenile aponeurotic fibromas?
Wide excision with skin grafting or free tissue transfer, which still has a high potential for recurrence
What is the chief problem seen with desmoid tumors?
High rate of recurrence (especially in female patients).
In general, what is the treatment of upper extremity arteriovenous malformations?
Ligation of feeding vessels, complete excision.
Are vascular malformations really neoplasms?
No, they are simply an abnormal collection of blood vessels.
What is the most common benign bone tumor?
Enchondroma.
What are the common locations of enchondromas?
Metacarpals (most common) and phalanges. Carpal bones are rarely involved.
What is Ollier disease?
Multiple enchondromatosis.