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Hand exam > tumors > Flashcards

tumors Flashcards

1
Q

ganglion cyst

A
  • most originate SL ligament
  • dorsal 30% success with steroid and aspiration
    5-8% recurrence with surgical resection
  • volar cysts originate STT or radiocarpal joint.
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2
Q

epidermal inclusion cyst

A

originate from follicular infundibulum, usually from trauma

- cottage cheese consistency.

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3
Q

desmoid tumor

A
  • benign soft tissue
  • wide excision
  • 24-65% recurrence
  • can respond to tamoxifen
  • xray may help
  • widely infiltrative
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4
Q

neurilemmoma

A
  • schwann cell tumor
  • cellular component = antoni A
  • matrix component = antoni B
  • 4% neurologic complication
  • compact spindle cells and hypocellular myxoid stroma
  • age 20-50
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5
Q

neurofibroma

A
  • tumor of the nerve fascicles
  • slow growing and painless
  • associated with neurofibromatosis
  • fast growth associated with malignant transformation
  • must sacrifice nerve to remove
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6
Q

giant cell (soft tissue)

A
  • recurrence 44-50%
  • multinucleated giant cells and xanthoma cells
  • may erode phalanx from pressure
  • higher incidence of recurrence if involve extensor and flexor tendons or joint capsule
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7
Q

glomus tumor

A
  • smooth muscle of glomus

- recurrence rate 10%, can be painful

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8
Q

pyogenic granuloma

A
  • disorder of angiogenesis
  • can bleed
  • endothelial cells and mast cells
  • silver nitrate or excise with cuff of normal tissue
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9
Q

lipoma

A

MRI appear similar to fat on T1 and T2

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10
Q

enchondroma

A

most common benign bone tumor

  • multiple in Ollier’s disease and Muffuci syndrome (hemangiomas) - more likely malignant degeneration
  • may have calcific stripping on xray
  • popcorn calficiations
  • no cortical involvement
  • no periosteal reaction
  • treat with curettage and bone graft
  • pathologic fractures
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11
Q

aneurysmal bone cyst

A
  • female, <20 years old most common
  • cystic with fibrous tissue with foam cells/giant cells
  • pain and swelling
  • may get worse with pregnancy
  • rapid expansion, distort joint surface
  • occurs in the medullary canal of metaphysis and rarely penetrates the articular surface or growth plate.
  • fluid/fluid level on CT/MRI from blood on bottom and serum on top
  • multinucleated giant cells and blood (hemosiderin staining)
  • curettage and bone graft 60% recurrence
  • can xray treat if not resectable (vertebral body)
  • excision and graft best treatment but still high recurrence
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12
Q

giant cell (bone)

A
  • metaphysis of mature long bones, most likely radius in upper extremity
  • young (2nd-4th decade)
  • gradual onset of pain and swelling
  • locally aggressive, but benign, however can metastasize to lung, especially if radius involved
  • bisphosphonates and denosumab may suppress
  • excise and bone graft
  • multinucleated giant cells, foamy histiocytes and stromal cells
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13
Q

osteoid osteoma

A
  • lytic with central spot on xray
  • NSIADS help with pain
  • curettage or excision
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14
Q

osteochondroma

A
  • growth stops at puberty
  • cortical and medullary continuity with cartilage cap near physis
  • if >2cm then concern for malignancy
  • sessile or pedunculated
  • multiple in multiple hereditary exostosis (MHE)
  • most common proximal phalanx
  • if asymptomatic can observe, marginal excision 2% recurrence
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15
Q

multiple hereditary exostosis (MHE)

A
  • autosomal dominant
  • multiple osteochondromas
  • leg length discrepancies, joint deformity
  • malignant transformation to chondrosarcoma <5%
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16
Q

benign parosteal osteochondromatous proliferation (BPOP)

“noras” lesion

A
  • 20-30 years old
  • no periosteal reaction, well circumscribed, not communicate with normal bone
  • local recurrence 50%
  • proliferation bizarre fibroblasts
  • biopsy to rule out malignancy
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17
Q

hemangiomas

A

female to male 4:1
high flow
rapid growth after appear to 12 months then involute
50% by age 5 and 70% by at 7 involute

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18
Q

kasabach-merrirt syndrome

A

coagulopathy due to platelet trapping

can be fatal

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19
Q

keratoacanthoma

A
  • rapidly growing
  • keratin filled central scale
  • may regress spontaneously
  • histology can resemble SCC
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20
Q

solar lentigo

A
  • brown spot from sun exposure
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21
Q

cutaneous horn (cornu cutaneum)

A
  • acellular corneal protrusion
  • may be associated with HPV
  • larger width-height ratio -> increase risk of malignancy and nearly half premalignant so should biopsy
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22
Q

verruca vulgaris

A
  • HPV associated
  • from stratum granulosum of epidermis
  • include basophilic inclusion bodies (viral origin) and hyperkeratosis
  • most regress spontaneously within 2 years
  • treat with cryotherapy
  • if fail then excision
  • lidocaine injection may help regress
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23
Q

BCC

A
  • 5mm margin
  • Mohs if morpheaform as may spread beyond the visible boards and be more aggressive
  • may treat with intralesional interferon
  • associated with gorlins, gardenirs, and xeroderma pigmentosa.
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24
Q

gorlins syndrome

A
  • PTCH gene mutation (patched 1 protein)
  • multiple BCC
  • jaw cysts, bifid ribs, palmar pits, calcified falx cerebri
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25
Q

xeroderma pigmentosa

A
  • autosomal recessive

- faulty DNA repair

26
Q

gardener syndrome

A
  • BCC
  • GI polyps
  • epidermoid cysts
  • jaw osteomas
  • supernumerary teeth
27
Q

SSC

A

most common skin cancer of the hand

  • 5-10mm margins
  • 5-FU for pre-malignant lesions (AK)
28
Q

pleomorphic sarcoma - high grade (Malignant Fibrous Histiocytoma)

A
  • most common sarcoma, 19% upper extremity
  • mets to lungs
  • wide excision and radiation
  • spindle and histiocytic cells are arranged in a storiform (cartwheel) pattern
29
Q

synovial sarcoma

A
  • associated with tendons/bursae/joints
  • most common at wrist
  • calcification on xray
  • young adults
  • lung and lymph node metastasis
  • resection, chemotherapy and rads
  • X:18 translocation
30
Q

clear cell sarcoma

A
  • soft tissue sarcoma, does not involve epidermis
  • round “clear” cells bordered by fibrous network
  • recurrence and mets common
  • wide excision and radiation
31
Q

liposarcoma

A
  • shoulder, arm/forearm
  • > 50 years old
  • large, painful mass
  • mets to lung and recurrance common
  • 12:16 translocation
  • spindle cells with mitoses without an adipocytic component
  • wide local excision and radiation
32
Q

rhabdomyosarcoma

A
  • skeletal muscle tumor
  • mets to lungs and LN
  • most common sarcoma in childhood
  • wide excision, chemo and rads
  • 2:13 translocation
33
Q

angiosarcoma

A
  • rare but poor prognosis
  • skin and subq involved
  • chronic lymphedema causes it
  • angiosarcoma following breast cancer mastectomy = lymphangiosarcoma or stewart-treves syndrome
34
Q

radiation fibrosis

A

can present with late ulcers

35
Q

dermatofibrosarcoma protuberans

A
  • low grade dermal sarcoma
  • raised hard nodule, painless
  • forearm most common
  • high local recurrence
36
Q

merkel cell

A
  • pressure nerve ending
  • neuroendocrine cell derived
  • caused by merkel cell polyomavirus
  • rapid growing with frequent mets
  • need lymphadenectomy
  • may need rads and chemo
37
Q

melanoma

A 
in situ -> 5mm margin
< 1mm -> 1cm margin
1-4mm -> 1-2cm margin and SLNB
> 4mm -> 2cm margin
lymph node dissection not improve survival.
38
Q

general management of soft tissue malignancy

A

> 2-5cm bad prognosis
chest CT to assess lung mets (most common for sarcomas)
bone scintigraphy detects osteoblastic response to tumor and may miss early mets
- biopsy longitudinal and stay within 1 muscle compartment

39
Q

epithelial sarcoma

A
  • most common soft tissue malignancy in hand
  • painless, slow growing, firm nodule.
  • can have draining ulcer
  • spreads to LN
  • radiation and brachytherapy
  • epithelial membrane antigen (EMA) + on histology
  • average age 33
  • average time to diagnosis 18 months
40
Q

myodesis

A

residual muscle and fascia suture to bone (decreased bursa formation)

41
Q

myoplasty

A

suture residual muscle agonist to antagonist over end of bone for physiologic tension

42
Q

transradial amputation

A

need 5cm distal to elbow to allow prosthesis

- can interpose PQ to prevent impingement

43
Q

elbow disarticulation

A

decrease boney overgrowth

44
Q

marquardt angular osteotomy

A

distal transhumeral amputation osteotomy 70-110 degrees for better rotational control

45
Q

transhumeral amputation

A

keep 5-7cm to fit prosthesis

46
Q

forequarter amputation

A

resect scapula and possibly portion of clavicle

47
Q

malignant bone tumor treatment

A

chemotherapy often indicated

48
Q

chondrosarcoma

A
  • most common malignant bone tumor of the hand
  • slow growing, painless
  • usually do not metastasize
  • 40-50 years
  • diffuse, expansile, lytic, poorly marginated
  • binucleated cells, nuclear crowding, mitosis, pleomorphism
  • treat surgery (chemo and rads not help)
49
Q

osteosarcoma

A
  • most common proximal humerus
  • met to lung
  • suburst, periosteal elevation (codman’s triangle), osteoblastic or osteolytic on xray
  • osteoid produced in stroma
  • neoadjuvant chemotherapy then surgery (no rads)
50
Q

Ewing sarcoma

A
  • pain, swelling, erythema (mistake for infection)
  • translocation 11-22
  • round cell lesions/blue cell tumor
  • large, lytic destructive
  • chemo and wide excision
51
Q

metastatic disease

A
  • lung 40% primary to hand
  • lytic expansive, destructive
  • palliative (life expectancy <6months)
52
Q

fibrokeratoma

A
  • type of angiofibroma that occurs on fingers and toes
  • hyperkeratosis, thickened dermal collagen, increased blood vessels
  • treat with surgical excision
  • benign
53
Q

porokeratoses

A
  • autosomal dominant
  • flat or pitted with keratotic marginal rim
  • malignant transformation 3-19% so recommend cryotherapy or topical agent
54
Q

histology trigger finger

A

fibrocartilaginous metaplasia of A1 pulley

55
Q

histology of lateral epicondylitis

A

angiofibroblastic hyperplasia within the extensor carpi radialis brevis

56
Q

MRI

A

T2 (think H2O) water is bright
T1 water is dark
fat bright on both
cartilage and ligaments dark on both

57
Q

Acquired periungual fibrokeratoma (APF)

A

solitary, painless lesion arising from the proximal germinal matrix area. The lesion puts pressure on the nail plate, resulting in nail deformity. The treatment is surgical excision. Histopathology typically demonstrates hyperkeratosis, acanthosis, focal hypergranulosis of the epidermis, widened capillaries, and the presence of thick bundles of collagen in lines oriented longitudinally.

58
Q

stewart-treves syndrome

A
  • lymphangiosarcoma with long-standing lymphedema
  • subcutaneous red nodular lesions with purplish discoloration
  • wide local excision or amputation
  • poor survival (20 months)
59
Q

Malignant peripheral nerve sheath tumor

A
  • occur with neurofibromatosis
  • arise in major nerves and cause dysfunction
  • enlarging painful mass
  • spindle shaped Schwann cells
  • invade individual nerve fascicles and spread along nerve sheath lymphatics
  • high recurrance
  • radical excision or amputation
  • 5 year survival <50%
60
Q

acute calcific periarthritis

A
  • acute calcium deposition
  • benign, self limited
  • women > men, usually around 45 years
  • rapid onset swelling, erythema, pain and limited ROM
  • xray with dense, amorphous, homogenous, cloud-like, round or oval calcific deposits with no cortical or trabecular pattern
  • treat with NSIADS, steroid injection, splinting and rest
61
Q

sarcoidosis

A
  • idiopathic multisystem granulomatous disease
  • lungs and perihilar lymph nodes, skin, joints, and bone affected
  • more common in women, age 45-65, African
  • non-caseating granulomas
  • angiotensin converting enzyme elevated, calcium elevated
  • treat with steroids
  • bone honeycomb appearance due to replacement of medullary cavity with granulation tissue
  • night sweatesand weight loss
62
Q

granuloma annulare

A
  • first 3 decades of life
  • sun, insect bites, trauma initiated
  • localized or generalized, flesh or pink with non-scaly plaque with firm rope-like border
  • 50% spontaneously resolved in 2 years
  • topical or intralesional steroids

Hand exam (9 decks)

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