Tumors

Question 0

Glomus Tumor

1. What percentage are in the hand?
2. What percentage are under the nail?
3. What percentage have multiple lesions?
4. What is the recurrence rate?
5. What would prompt re-exploration?
6. Useful clinical test?
7. Findings on MRI?
8. Describe two more tests used to make this diagnosis and their specificity and sensitivity.

Answer 0

1. 75%
2. 65%
3. 25%
4. 20%
5. Symptoms that continue longer than three months after initial excision
6. Ethyl chloride spray, bluish
7. Dark on T1, light on T2
8. A. Love test. Localize maximum tenderness with head of a pin. Sensitivity 100%, accuracy 78%.
   B. Hildreth test. With inflation a tourniquet ischemia causes love test to become negative and relieves pain. When tourniquet is deflated pain returns rapidly. Sensitivity 92%, specificity 91%.

Question 1

Giant Cell Tumor of Tendon Sheath

1. AKA?
2. How common?
3. Surgical treatment?
4. Risk of recurrence?
5. What about recurrence treatment?
6. Higher risk recurrence with…?
7. Are there cases of malignant transformation?
8. What is the main pathological entity?
9. Describe the two most common types.

Answer 1

1. Pigmented villonodular tenosynovitis, fibrous xanthoma, localized nodular synovitis
2. Second most common after ganglion cysts.
3. Marginal excision
4. 30%
5. Adjuvant radiation
6. A. Satellite lesions
   B. Incomplete excision
   C. DIP joint
   D. Deep to volar plate
   E. DJD
   F. Actual bone invasion (not just pressure)
   G. Involvement of flexor or extensor tendons
7. No
8. Lipid laden foam cell
9. A. Localized nodular (less likely to recur, most common form in the hand)
   B. Multilobululated

Question 2

What is Stuart-Treves syndrome?

1. Formal name?
2. History?
3. Presentation?
4. Location?
5. 5 year survival?
6. Avg survival?
7. Treatment?

Answer 2

Lymphangiosarcoma

Occurs rapidly in pts with previous lymph node dissection and chronic lymphedema

Purple papules, or bruise

Frequency: Arm, forearm, elbow, chest wall

9%

50% mortality at 19 mo

High amputation or forequarter amp may be life saving. Consider adjuvant chemo.

Question 3

What is tumor lysis syndrome?

Answer 3

After chemotherapy the rapid breakdown of tumor cells results and hyperphosphatemia, hypocalcemia, hyperuricemia and possibly gout attack.

Treat with indomethacin.

Question 4

Metastatic cancer in the hand?

1. What primary tumor is most common?
2. More common in which hand? 
3. More common in which digit?
4. More common in men or women?
5. Which phalanx?

Answer 4

1. Lung, kidney, breast
2. Right
3. Middle
4. Men
5. P3

Question 5

Recite the MSTS Tumor staging system.

What is the other name for this system?

Answer 5

Enneking Classification:

Stage Grade Location

IA Low Intracompartmental
IB Low Extra
IIA High Intra
IIB High Extra
III Any mets. Regional or distant