Tumours of the hand Flashcards
What is this?
Ganglion cyst
A Mucin filled synovial cyst.
What is a ganglion’s aetiology
Trauma
Mucoid degeneration
Synovial herniation
What is the epidemiology of ganglion cysts?
Most common hand mass 60-70%
Dorsal (70%) orginate over SL ligament
Volar carpal (20%)- Radiocarpal or STT joint
Volar retinacular- dorsal DIPJ- MUCOID cyst assoc with Heberden’s nodes
What are the signs and symptoms of a ganglion?
Symptoms= Painless lump
Signs= Firm
Well circumscribed
Often fixed to deep tissue but not to overlying skin
Translucent with illumination
Allen’s test to ensure radial/ ulna artery
What investigations are useful in identifying a ganglion?
XRays normal
Mri - not normally indicated but show a well cicrumscibed homogenous fluid signal intensity
Increased signal intensity on T2-weighted MRI images
What is the treatment for a ganglion?
Observation- first line in adults
79% in children resolve in a year.
Aspiration- 2nd line in adult, avoid on volar aspect of wrist due to radial artery
50% chance of reoccurrance cf surgical resection but less risks
Biopsy would show mucin-filled synovial cell lined sac
Surgery if severe symptoms or neurovascular manifestations
adequate exposure to ensure entire resection of cyst including stalk and adjacent capsule.
Volar ganglions higher rate of reoccurrance cf dorsal post surgery (15-20%)
What is this?
Epidermal inclusion cyst
this is Benign, slow growing soft tissue tumour
DD: Tophus gout
Foreign body granuloma
Sebaceous cyst
GCT
Ganglioncyst
Enchondroma
Glomus tumour
What is the incidence and epidemiology of epidermal inclusion cyst?
Occurs months to years post trauma
Third most common hand tumour
Men > females
3rd to 4th decade
Distal phalanx most common location
What is the Pathophysiology of epidermal inclusion cysts?
Results from penetrating trauma that drives Keratinised epithelial into subcutaneous tissue
Cells grow slowly to -> epithelial lined cyst filled with keratin
What is the prognosis of epidermal inclusion cyst?
Marginal Excision is curative, low reocurrance rates
What are the symptoms and signs of epithelial inclusion cyst?
Symptoms:
Painless swelling frequently occuring in the fingertip
Well circumscribed slightly mobile lesion with white/yellow/flesh coloured in appearance
What investigations can be useful in epithelial inclusion cyst?
Xrays- ap, lateral and oblique
soft tissue swelling may be evident
A lytic erosion in distal phalanx
Biopsy- to confirm not infection/ neoplasm
What is the histology of the epidermal inclusion cyst?
Cysts containing keratin lined with epithelial cells
What is the Tx of epidermal inclusion cyst?
Non operative- not recommended
Operative- Marginal Excision
Careful to remove Entire capsule
**Currettage and bone graft if **bone erosion/ lesions
What are the complications of epidermal inclusion cysts?
Wound complications
Infection
Digital neuropraxia
Recurrance
What is the differential diagnosis on this mass?
Giant cell tumour of tendon sheath ( Pigmented villonodular tumour of tendon sheath)
Ganglion cyst
Desmoid tumour
Fibroma/Fibrosarcoma
Pigmented villonodular synovitis- involves larger joints
What is the epidemiology of giant cell tumour of tendon sheath?
3rd-5th decade
2nd most common tumour of hand after ganglion
most common on PALMAR surface of RADIAL 3 digits near the DIPJ
No reports of mets in literature
What investigations would be helpful for diagnosisng GCT of tendon sheath?
Xray- pressure type bony erosions ( see picture)
USS- homogenously hypoechoic
MRI-decreased signal on T1 and T2 images
What do you see on histology with GCT of the tendon sheath?
Proliferating histiocytes, moderately cellular (sheets of rounded or polygonal cells)
Multinucleated giant cells are common
What is this ?
Glomus tumour
A Rare benign tumor of the glomus body, often occurring in the subungual region
What investigations can be used to diagnose a glomus tumour?
Xray- pressure erosions-> deformity of bone cortex
MRI - helpful= T1 low, T2 high signal
What is seen on histology of glomus tumour?
Well-defined lesion lacking cellular atypia or mitotic activity
small round cells with dark nuclei
Associated small vessels in a hyaline/myxoid stroma
What is this?
Melanoma of the hand
specifically- acral lentiginous melanoma
DDX could also be
trauma
subungual hematoma
onychomycosis
for a nevus
seborrheic keratosis
basal cell carcinoma
What is the prognosis of melanoma?
Name the poor prognostic factors?
DEPTH of naevus most important prognostic factor
< 0.7mm survical is 94%
> 4.0mm survival is 46%
Poor prognostic factors
Deep lesion
Male
Lesion on scalp or neck
Positive lymph nodes and metastasis
Ulceration
Subungual melanoma has poor prognosis overall with 5yr survival 40-60%
What are the signs and symptoms of melanoma?
Symptoms:
Recent change in size or shape
itchy or bleeding
Signs:
Brown-black pigmented lesion, may ulcerate
Hutchinson sign= Extension of brown-black pigment of the nail bed or nail plate to the cuticle and nail folds( see pic)
Note (ABCDE)- Asymmetry
Border irregularity
Colour variation
Diameter (<6mm benign)
Elevation
Enlargement
