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Flashcards in Hand Tumors Deck (55)
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31

what are imaging findings with glomus tumour?

  • radiolucent on XR
  • scalloping over DP on lateral XR (bone remodelling, not always present)
  • doppler US shows flow
  • MRI visible T1, bright T2

32

what does pathology say for glomus tumour?

  • encapsulated structure
  • polyhedral cells
  • fibrous stroma
  • endotherlial pericytes
  • numerous non-myelinated nerve fibres

33

what is classic triad for glomus tumour?

what are 2 eponymous findings on physical exam?

  • triad: paroxysmal pain, pinpoint tenderness, cold hypersensitivity
  • Love test: exquisite pain w tip of pencil
  • Hildreth sign: resolution of pain w/ application of tourniequet

34

compare schwannoma and neurofibroma

 

SCHWANNOMA

NEUROFIBROMA

Definition

Benign PNST arising from Schwann cells and located at periphery of nerve

Benign PNST arising from Schwann cells that involves entire x-section of nerve

History

Slowly growing mobile nodule, rarely associated w pain or motor/sensory findings; can have tinel

Similar to schwannoma; also rarely pain/motor/sensory findings, but plausibly more common than w schwannoma; can have tinel

Investigations (MRI)

Fusiform w tapered ends, low-intermed T1, high T2, target sign (lower in centre), split fat sign (fat splits around tumour)

- eccentric

Fusiform w tapered ends, low-intermed T1, high T2, target sign (lower in centre), split fat sign (fat splits around tumour)

- centric

Treatment

Active surveillance w regular phys exam/MRI

Vs excision (shell out of epineurium)

Active surveillance

Exicision if symptomatic, especially if primary coaptation and distal/non-critical nerve (sens)

Malignant transformation

Rare << 1%

Rare < 1%; w NF1 2-15%

Associations

NF2, (NF3 = “multiple schwannomatosis”)

NF1

35

what are syndromes associated w enchondroma?

  • ollier's disease
    • spontaneous disease of childhood - multiple enchondromatosis of long/short bones of hands/feet/extremities
    • 30% malignant transformation rate to chrondrosarcoma
  • Mafuccie sydrome
    • spontaneous condition of multiple enchondromas and hemangioma's hands and feet
    • also 5-55% spontanteous malignant transformation to chrondrosarcoma, osteosarcoma, soft tissue sarcoma

36

what features suggest malignant transformation of enchondroma?

  • rapid change in size
  • pain
  • irregular surface
  • extension of tumour into soft tissue
  • cortical erosion

37

what are xr findings of enchondroma

  • lesion of metaphysis/diaphysis
  • demonstrating cortical thinning and expansion
  • pathologic fracture
  • flecks of calcification / stipling

38

what are treatment principles of enchondroma

  • obtain history/physical to rule out red flags for malignant transformation
  • if pathologic fracture - treat closed, allow fracture to unite, then excise
  • if symptomatic, or old pathologic fracture, then corticotomy, marginal debridement of all cartilaginous tumour material within the cortex, and pack with cancellous bone graft or alloplast bone substitute
  • if asymptomic incidental finding in area not prone to fracture - could consider serial examinations and excision as needed

39

define osteochondroma; contrast to definition for enchondroma

  • osteochondroma is a benign cartilage tumour characterized by 2ary bone formation through endochondral ossification and a hyaline cartilage cap, commonly at bony metaphysis
  • enchondroma is a benign cartilage tumour characterized by aberrant cartilage formation  at diaphyseal / metaphyseal bone regions

40

what is the radiologic features of osteochroma?

  • solitary or multiple exostoses
  • projection of cortex is continuous w normal cortex
  • hallmark is medullary continuity

41

pathologic finding in osteochrondroma

  • normal bone cortex, lesion has a hyaline cartilage cap

42

list 2 characteristic features of osteoid osteoma

  • on history, pain is relieved by NSAID or ASA
  • on imaging, there is a dense, reactive, eccentric cortical sclerosis surrounding a radiolucent nidus

43

what is an osteoid osteoma?

painful bone forming tumour, rare in upper extremity, small

44

how does GCT of bone differ from GCT tendon sheath

  • completely different entities w similar name
  • GCT bone is technically a benign lesion, but is locally aggressive and has the potential to metastasize (mostly to lungs) and has an associated mortality (therefore in many ways behaves like a malignant tumour)

45

what are radiologic features of GCT bone?

  • #3 site is distal radius, also metaphyseal lesion of metacarpal / phalanges
  • see metaphyseal lesion w expansion into epiphysis, lytic , no matrix, indistinct borders, pseudotrabeculation

46

what are treatment principles of GCT bone?

  • establish diagnosis via open incisional biopsy following appropriate "sarcoma" protocol
  • then work up w CT chest +/- bone scan
  • then consider curretage and marginal excision for benign lesions (not usually recommended due to recurrence)
  • vs. wide excision or (ray) amputation with primary/delayed reconstruction

47

what is most common malignancy of hand?

What is most common malignancy of nailbed?

scc for both

48

what is the etiology/primary for metastatic lesions to bones in hand?

what is the most common site in the hand/wrist for a bony met?

  • Lung (40%) > kidney (14%)  > breast (10%) > colon (5%); also thyroid, prostate, multiple myeloma, melanoma
  • distal phalanx

49

which soft tissue sarcoma metastasize via lymphatics (and therefore a SLNB) may be indicated

  • SCARE
  • synovial sarcoma
  • clear cell sarcoma
  • angiosarcoma
  • rhabdomyosarcoma
  • epithelioid sarcoma

50

what is the most common soft tissue sarcoma of upper extremity? how does it present?

  • epithelioid carcinoma
  • slow growing mass / nodule(s) in volar aspect digits, hand, forearm
  • often painless, can ulcerate & drain

51

what is the second most common soft tissue sarcoma, and how does it present

  • synovial sarcoma
  • slow growing solid mass x mos-year, adjacent to bursa or joints (for u/e, most commonly adjacent to carpus)

52

what is the most common bone malignancy of hand? How does it present?

  • chrondrosarcoma
  • slow growing, firm, painful mass proximal phalanx or metacarpal

53

what are xray features of chrondrosarcoma?

  • tumour matrix w stippled calcifications
  • lysis
  • poorly defined margins
  • extreme cortical expansion
  • perforation of  cortical margin
  • extension to surrounding

54

what type of special canal is the abnormality of the AV shunt in Glomus Tumour

Suquet-Hoyer canal

55