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Flashcards in Hand Tumors Deck (55)
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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


what does pathology say for glomus tumour?

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


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


compare schwannoma and neurofibroma





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


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


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%


NF2, (NF3 = “multiple schwannomatosis”)



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


what features suggest malignant transformation of enchondroma?

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


what are xr findings of enchondroma

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


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


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


what is the radiologic features of osteochroma?

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


pathologic finding in osteochrondroma

  • normal bone cortex, lesion has a hyaline cartilage cap


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


what is an osteoid osteoma?

painful bone forming tumour, rare in upper extremity, small


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)


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


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


what is most common malignancy of hand?

What is most common malignancy of nailbed?

scc for both


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


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

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


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


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)


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

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


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


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

Suquet-Hoyer canal