HAND TUMORS
Mohamed Ahmed Fawzy EL Abbasy;
Abstract
SUMMARY AND CONCLUSION
H
and neoplasms are usually classified in two categories: benign and malignant; in musculoskeletal tissues, malignancies may also be subdivided into low grade and high grade. Cellular growth in benign neoplasms usually proceeds at a much slower rate than in malignant tumors. Benign lesions may be expansile and sometimes encapsulated. Distant spread usually does not occur, and local recurrence is less common in benign than in malignant lesions.
Malignant neoplasia is characterized by a rapid growth rate, atypical cellularity, and poor cell differentiation. Local growth is aggressive and infiltrative; there are only “pseudocapsules” through which the tumor extends with satellite lesions. Such tumors are likely to spread as blood-borne metastases, and local recurrence rates are high after excision unless a wide margin of normal tissue is included in the resection. Low-grade malignancies grow more slowly and infiltrate early but are less likely to metastasize than to recur locally.
Many benign tumors of the hand or forearm require no treatment, can be diagnosed clinically, and are asymptomatic. However, if a lesion increases in size or becomes symptomatic, or if the physical or radiographic appearance suggests an aggressive process, appropriate staging studies, including obtaining tissue for diagnosis, must be done.† Unfortunately, lumps and growths that look innocent may not necessarily be so; every tumor ought to be considered a potential impediment to function, if not to survival.
Ganglions and giant cell tumors of tendon sheaths are the first and second most common soft-tissue tumors in the hand, respectively.
Schwannomas are the most common nerve tumors in the upper extremity and they most commonly occur on the flexor surfaces.
Enchondromas are the most common primary bone tumors in the hand.
With Maffucci syndrome, multiple enchondromas and hemangiomas are seen on radiographs; risk of sarcoma is high.
Epithelioid sarcomas are the most common soft-tissue sarcomas arising in the hand.
Chondrosarcomas are the most common primary malignant bone tumors arising in the hand.
There are well-documented instances of malignant transformation of enchondromas to chondrosarcomas.
Soft-tissue calcifications may be seen in synovial sarcomas.
The most common acral metastases are seen in the setting of lung or breast cancer.
Metastasis to hand is very rare, about 0.1%. of metastatic lesions, they are usually from primary lung cancer.
Tumor workup should include a chest CT, bone scan, pelvic CT, and laboratory work if a malignancy is suspected. The biopsy is the single most important step in patients' staging workup, having a direct bearing on the outcome. The biopsy should, in most circumstances, be performed in the same institution where the definitive tumor surgery will be accomplished. The tumor is appropriately staged based on the criteria of Enneking staging system. Depending on the surgical stage of the tumor, an intralesional, marginal, wide, or radical excision should be performed.
H
and neoplasms are usually classified in two categories: benign and malignant; in musculoskeletal tissues, malignancies may also be subdivided into low grade and high grade. Cellular growth in benign neoplasms usually proceeds at a much slower rate than in malignant tumors. Benign lesions may be expansile and sometimes encapsulated. Distant spread usually does not occur, and local recurrence is less common in benign than in malignant lesions.
Malignant neoplasia is characterized by a rapid growth rate, atypical cellularity, and poor cell differentiation. Local growth is aggressive and infiltrative; there are only “pseudocapsules” through which the tumor extends with satellite lesions. Such tumors are likely to spread as blood-borne metastases, and local recurrence rates are high after excision unless a wide margin of normal tissue is included in the resection. Low-grade malignancies grow more slowly and infiltrate early but are less likely to metastasize than to recur locally.
Many benign tumors of the hand or forearm require no treatment, can be diagnosed clinically, and are asymptomatic. However, if a lesion increases in size or becomes symptomatic, or if the physical or radiographic appearance suggests an aggressive process, appropriate staging studies, including obtaining tissue for diagnosis, must be done.† Unfortunately, lumps and growths that look innocent may not necessarily be so; every tumor ought to be considered a potential impediment to function, if not to survival.
Ganglions and giant cell tumors of tendon sheaths are the first and second most common soft-tissue tumors in the hand, respectively.
Schwannomas are the most common nerve tumors in the upper extremity and they most commonly occur on the flexor surfaces.
Enchondromas are the most common primary bone tumors in the hand.
With Maffucci syndrome, multiple enchondromas and hemangiomas are seen on radiographs; risk of sarcoma is high.
Epithelioid sarcomas are the most common soft-tissue sarcomas arising in the hand.
Chondrosarcomas are the most common primary malignant bone tumors arising in the hand.
There are well-documented instances of malignant transformation of enchondromas to chondrosarcomas.
Soft-tissue calcifications may be seen in synovial sarcomas.
The most common acral metastases are seen in the setting of lung or breast cancer.
Metastasis to hand is very rare, about 0.1%. of metastatic lesions, they are usually from primary lung cancer.
Tumor workup should include a chest CT, bone scan, pelvic CT, and laboratory work if a malignancy is suspected. The biopsy is the single most important step in patients' staging workup, having a direct bearing on the outcome. The biopsy should, in most circumstances, be performed in the same institution where the definitive tumor surgery will be accomplished. The tumor is appropriately staged based on the criteria of Enneking staging system. Depending on the surgical stage of the tumor, an intralesional, marginal, wide, or radical excision should be performed.
Other data
| Title | HAND TUMORS | Other Titles | أورام اليد | Authors | Mohamed Ahmed Fawzy EL Abbasy | Issue Date | 2014 |
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