tumors of the hand by: prof. dr. hussein abdel fattah
DESCRIPTION
Tumors of the Hand By: Prof. Dr. Hussein Abdel Fattah. The hand is the site of a great variety of benign lesions and a few malignant lesions but benign ones predominates . Malignant skin tumors squamous cell carcinoma, basal cell carc. & malignant melanoma are not included in this survey - PowerPoint PPT PresentationTRANSCRIPT
Tumors of the HandBy: Prof. Dr. Hussein Abdel
Fattah
The hand is the site of a great variety of benign lesions and a few malignant lesions but benign ones predominates .
Malignant skin tumors squamous cell carcinoma, basal cell carc. & malignant melanoma are not included in this survey
Tumor like conditions are mentioned
Patients seek advice early because of simplicity of recognition and the disability that attends a small lesion in the hand.
Benign lesions in the hand are first noticed as a palpable mass, an enlarged digit, or a mechanical dysfunction .
Pain may be the presenting symptom in glomus tumor,osteoid osteoma osteoblastoma
Many metabolic and degenerative processes are seen in the hand as radiolucent areas, subchondral degenerative cysts in arthropathies and in gout.
Parathyroid adenoma
DiagnosisStandard X-ray of the hand of excellent quality and definition are essential
C.T. & M.R.I. & Bone scanClinical photo prior to surgery
Angiography in the hand is a useful technique for determining the anatomical extent of the lesion and its relationship to intricate system. Particularly in vascular tumors.
Many lesions in the hand are part of systemic processes. Radioactive isotope scan serves as a total skeletal survey. Any area of increased activity must be judged in light of the over all clinical picture.
Planning Treatment for Hand Tumours
For benign lesions of the digits incisions should be placed in such a way that they do not subsequently interfere with function.
Types of Surgical Approach
Marginal excision. Curettage & graft. Wide resection and
intercalary reconstruction.
Wide ray resection.
In many instances ray resection may be a cosmetically and functionally superior method of reconstruction than composite tissue grafting.
Caution is needed against overenthusiastic reconstruction with potential loss of the remaining function of the hand.
Enchondroma:
Solitary and Multiple
The small bones of the hand and have a marked predilection
to proximal and middle phalanx and to metacarpal
Cartilagenous tumors
ECCHONDROMA ENCHONROMA
Common painless unless pathological fracture
Enchondroma fifth metacarpal
Curettage & graft after path. fracture.
Multiple chondromata
Curettage & collapse of the
wall
Preoperative
Postoperative
Ollier,s disease
Multiple chondromata
Maffuci syndrome With cavernous haemangimata showing calcified
thrombi
Big benign enchondroma distal Ulna
Bone tumorsOsteochndrma
Osteoid osteomaGiant cell tumorOsteosarcomaSecondary deposit
OSTOID OSTEOMAPAINFUL SMALL LESION
HOT IN BONE SCAN
BENIGN OSTEOBLASTOM
A
PAINFULL DENSE TUMOR
WITH TENDECY
TO RECURREN
CE
B. OSTEOBLASTOMA
REURRENCE AFTER
CURETTAGE
RADICAL EXCISION & ILIAC BONE GRAFT
OSTEOCHONDROMA
MULTIPLE HEREDITARY
EXOSTOSIS
ANEURYSMAL BONE CYST
G.C.T. OF SECOND
METACARPAL
PARATHYROID BROWN
TUMOR HEALS AFTER
EXCISON OF ADENOMA
DIFF. DIAGNOSIS
G.C.T. INDEX CURETTAGE & GRAFT POSSIBILTY OF
RECURRENCE HIGH
RAY RESECTION IS MORE RADICAL
G.C.T. DISTAL RADIUS
EXCISION & FIBUALR GRAFT
In contrast, many sarcomas in the hand and particularly on the dorsum tend to mimic an inflammatory process with diffuse swelling, local heat and erythema rather than appear as a discrete swelling.
Fibrous Tissue Tumors
Fibroma, localised well differeniated
Palmar fscia contracture, hereditary slowly growing nodules over years
Fibrous tissue localised fibroma
DUPUYTREN,S CONTRACTURE
Subcutaneous fibrosis in palmar
Facia with with progressive contracure& flexion deformity
Rt hand operated 3 months ago
Lt. hand operated 10
years ago at age of 53
Age 63 now
Fibrous Tissue Tumors Diffuse Fibromatosis
Diffuse Fibromatosis is a soft tissue tumour of neurolemmal sheath ,muscular fibrous sheath that has a nasty habit of many local recurrences if not completely excised. These tumors can be very painful and disfiguring. They show tendency to malignant destructive recurrence.
M.R.I. coronal section
M.R.I. AXIAL CUTS
Ray resection of the medial two RAYS to save good
function of the hand
AFTER THREE YEARS
FIBROMATOSIS OF SECOND RAY FOR
RESECTION
Recurrent malignant Triton tumor
Diffuse fibromatosis
M.R.I.showing extensive infiltration in the sole of
the foot
Symes amputation was mandatory after four
previous excisions
Synovial TumorsPigmented villonodular
synovitisA REACTIVE LESION OF
TENDON SHEATH USUALLY ON THE PALMAR ASPECT OF DIGIT SLOWLY GROWING 20% SHOWS
BONE EROSION, 2O% LOCAL RECURENCE
Pigmented villonodular synovitis
in the index
MARGINAL EXCISION
Longstanding tumor with pressure
bone atrophy
P.V.N.S. THUMB
Flap incision
Tendons nerves,
vessels intact
PVNS in the
SECOND
toe
Chondromatosis Synovii
Unique case in the radial and ulner synovial
bursa in the distal forearm and palm of the
hand
SLOWLY DEVELOPING HARD NODULES
WITH SLIGHT PAIN & CREPITUS ON MOVING THE FINGERS
Excision of chondromatous masses
Nerve tumorsNeurofibroma
Glomus tumorElephantiasis nurofibromatosis
Nerve sheath tumor in dorsal
digital nerve of little finger
Dorsal digital nerve
neurofibroma painful
excision
Nerve sheath tumor fo median nerve presenting as C.T.S. simple
decompression Unique case
Multiple neurofibromatosis tender sheath tumor for
excision preserving the nerve trunk
Tumor Like Conditions
Simple ganglion Inclusion dermoid Megalodactylia Vascualar anomalies Lymphatic obstruction anomalous Gouty arhropathy,tophi Rheumatoid tenosynovitis T.B. tenosynovitis & spina ventosa
Simple dorsal Palmer ganglion
Muscinous filled cyst adjacent to joint caopsule or tendon sheath, with an outer
fibrous wall and inner synovial lyning filled with clear colorless gelatenous
fluid
Implantation Dermoid
Skin epithelial cells implanted through a small skin puncture
MegalodactyliaIn the Hands and Feet
Hyperplastic, giant overgrowth of one or more digit usually the middle, index, or thumb, including the phalanges.
Some are due to bony overgrowth with normal appearing soft tissue parts, others from excess fat, lymphatic and fibrous tissue.
Large neurofibromata with trophic effect on the overgrowth may be associated with angiomata and lymphomata
Elephantiasis neurofibromatosis
Megalodactylia
Child two years Middle and ring fingers
Second and third Toes
Ring finger
Megalodactylia ray-resection
Megalodactylia ring finger ray resection
short
Short metacar
pal
Elephantisis neurofibromatosis good function leave alone
MEGALODATYL second &
third ray
MEGALODATYLIA
RESECTED BIG TOE , SECOND & THIRD RAYS
MEDIAL LATERAL
Three months postoperative
Vascular TumorsHaemangioma
Arterial aneurysmArteriovenous aneurysm
Lymphatic obstruion
TRAUMATIC ARTERIAL ANEURYSM
ANGIOGRAM FOR ANEURYSM ULNER
ARTERY
Artriovenous fistula in forearm
veins were arterialized, with distal
ischemia loss of distal end of
the index
Cavernous Haemangio
ma
Congenital lymphatic obstruction with elephantiasis
Congenital Lymphatic Obstruction
Neonatal
Adult lymphoede
ma
Chronic Gouty Tophi Eroding I.P.
Joints
Gouty Tophi in Hands and Feet
Rheumatoid Tenosynovitis Melon
Seed Bodies
Rheumatoid Tenosynovitis around Extensor Tendons
Tuberculous Dactylitis age 2 yrs
T.B.
TENOSYNOVITIS in tendon sheath of flexor group
Early Leprotic Late Nerve Palsy
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