Hand Tumors

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What is the most common primary tumor of bone in the hand?: Enchondroma
What are the typical radiographic features of an enchondroma?: A scalloped lytic lesion
What conditions are associated with enchondromas?: Ollier Disease (multiple enchondromas) and Maffucci syndrome (mult enchondromas associated with subcutaneous hemangiomas
What is the management of enchondromas?: Curettage of lesion. May require bone grafting.
What are the typical presenting symptoms of an enchondroma?: Usually asymptomatic, incidental finding on X-ray. May present as a pathologic fracture.
In what disease do you find an increase in the risk of malignant transformation of an enchondroma to a chondrosarcoma: Ollier's disease
Conditions associated with Ollier's disease include . . .: Multiple enchondromas, axial skeletal deformities, increased transformation of enchondromas to malignant chondrosarcomas
What is the most frequent malignancy of the hand?: Squamous cell carcinoma
How do you treat squamous cell carcinoma of the thumb?: Amputation of thumb at IP joint. Selective lymph node sampling may be beneficial.
What is a glomus tumor?: Benign hamartoma of neuromyoarterial receptors
What is the typical location of a glomus tumor?: Subungual
What are the symptoms typically associated with glomus tumors: Exquisite pain, pinpoint tenderness, and cold intolerance
How do you diagnose a glomus tumor?: MRI, H&P
How are glomus tumors treated?: Simple excision - removal of nail plate. If subungual, make a longitudinal incision in nail plate.
What is the recurrence rate of glomus tumors after excision?: 20%
On which surface of the hand do epidermal inclusion cysts occur?: palmar
What is the treatment for epidermal inclusion cysts?: excision
What are epidermal inclusion cysts?: Mobile, non-tender masses formed after trauma
What are the typical radiographic findings of a mucous cyst?: osteoarthritis with osteophytes
What is the treatment for a mucous cyst?: excision of the cyst and osteophyte
What physical findings are associated with mucous cysts?: Swelling and nail deformities (nail grooving and skin thinning) +/- pain.
What is the 2nd most common tumor of the hand?: Giant cell tumor of tendon sheath (pigmented villonodular tenosynovitis)
What physical findings are associated with giant cell tumors of the tendon sheath?: firm, indolent, painless volar mass on the surface of the finger or hand
What is the treatment for giant cell tumors of the tendon sheath?: Ray resection or en bloc removal combined with bone grafting
What is the local recurrence rate of giant cell tumors of the tendon sheath after total surgical excision?: 50%
What hand tumor starts as a red papule that expands?: keratoacanthoma
Keratoacanthoma is a variant of what malignancy?: Squamous cell carcinoma
What is the treatment of keratoacanthoma?: Excisional biopsy
What hand tumor is associated with immunosuppressed patients?: keratoacanthoma
What is the most common benign tumor of the hand?: Ganglion cyst
How do you treat ganglion cysts of DIP?: Debride osteophyte, not ganglion.
What are the radiographic findings of a chondromyxoid fibroma?: Radiolucent lesion with small sclerotic rims
What is the most common solitary hand tumor of neural cell origin?: Neurilemmoma
What is the most common source of metastatic tumors to the hand?: Bronchogenic carcinoma of the lung
What hand tumor presents with pain at night that is relieved by NSAIDs?: osteoid osteoma
Osteoid osteoms typically occur in what age group?: under 40
What are the radiographic findings associated with osteoid osteomas?: Radiolucent zone with dense nidus surrounded by a distinctive area of cortical sclerosis
What is the treatment of osteoid osteomas?: Complete excision
Whatmors is the inheritance pattern of osteochondromas?: Autosomal dominant
What is the treatment for osteochondromas?: Resection of all tumors with reconstructive surgery to repair any bone or joint malalignment

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