Tumors and pseudotumors of the hand: The role of imaging

Diagnostic and therapeutic management of a left forearm tumor in a violinist: Clinical case and literature review

INTRODUCTION

The management of forearm tumors requires a precise clinical examination and the performance of further examinations before considering possible surgical management is necessary, particularly in the case of professional musicians. In this specific population, certain differential diagnoses may fail to identify an organic cause for a painful symptomatology. Among the known causes is musician's focal dystonia (https://pubmed.ncbi.nlm.nih.gov/20590806/, n.d.; Rozanski et al., 2015).

CASE

65-year-old patient, professional violinist, who consulted for a tumor of the forearm, with involuntary tremor-like movements which recently made it impossible to play the violin. Tumor removal was performed and anatomopathological analysis revealed a schwannoma. The patient was able to play the violin from the first week after surgery and the tremors disappeared.

DISCUSSION

Musician's dystonia could be envisaged here, given the presence of discomfort only during instrumental practice. The management of this tumor required a precise clinical examination, with the musician's instrument. Musician's dystonia must remain a diagnosis of elimination.

CONCLUSION

We report a misleading case of a nerve tumor in a musician that could easily be mistaken for dystonia at first glance.

Soft tissue pseudotumors of the hand and wrist mimicking malignancy: Two case reports

RATIONALE

Most soft-tissue lesions in the hand and wrist have a benign etiology, and malignant tumors, such as soft-tissue sarcomas, are rare. Mimickers of soft tissue tumors in the hand and wrist are more common than true neoplastic lesions; however, soft tissue pseudotumors that mimic malignancy are very rare.

PATIENT CONCERNS

This study describes 2 patients with soft tissue pseudotumors of the hand and wrist. Both patients presented with rapidly growing soft-tissue masses. Magnetic resonance imaging (MRI) revealed ill-defined margins and an aggressive appearance in both cases, leading to a strong suspicion of malignant soft tissue tumors.

DIAGNOSIS

Both patients underwent incisional biopsies, and the final diagnoses were inflammation due to IgG4-related disease in the first case and chronic granulomatous inflammation in the second case.

INTERVENTIONS

The first patient was administered oral steroids, while the second patient was treated with anti-inflammatory drugs.

OUTCOMES

Both patients showed a reduction in swelling of the hand and wrist.

LESSONS

Although the imaging approach for pseudotumorous lesions is similar to that for true soft tissue tumors, the management of these lesions is different. Biopsies should only be performed when the diagnosis is unclear.

[Fibro-osseous Pseudotumor of the first Web Space - an interesting Case]

Ein 52-jähriger Patient stellte sich nach Zuweisung durch seinen Hausarzt aufgrund einer schmerzhaften, größenprogredienten Schwellung in der ersten Kommissur seiner linken adominanten Hand in der handchirurgischen Sprechstunde vor. Er gab an, die Schwellung vor fünf Wochen erstmals bemerkt zu haben und dass sie zunehmend schmerzhaft und funktionell einschränkend sei. Ein aktuell auslösendes Trauma wurde verneint; allerdings habe er sich vor drei Jahren bei einem Fahrradsturz im Bereich der betroffenen 1. Kommissur verletzt. Die Familienanamnese war bzgl. maligner Erkrankungen blande.

Imaging Features of Primary Tumors of the Hand

Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues, ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences, data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis, prognosis and therapy. The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.

Imaging for Dupuytren disease: a systematic review of the literature

BACKGROUND

As treatment of Dupuytren disease (DD) is expected to shift towards prevention of progression, the use of imaging in patients with DD becomes more important. In this systematic review an overview is given of the different methods for and applications of imaging for DD that have been described.

METHODS

The MEDLINE and EMBASE databases were searched for articles reporting the use of imaging in patients with DD, published before May 17, 2018. Studies were systematically examined in two rounds by two observers according to the PRISMA systematic. All studies containing original data on imaging for DD were considered for inclusion.

RESULTS

Three hundred and seven unique studies were identified, of which 23 were included in the study. Only studies on the use of ultrasound (US) and magnetic resonance imaging (MRI) were identified. Broadly, articles could be divided into 5 categories. Seven studies were found on diagnosis, two on measurement of disease extent, four on measurement of disease activity, seven on guidance of minimally invasive procedures and five studies on evaluation of treatment. According to the Oxford CEBM, the levels of evidence were low, ranging from level 3 to 5.

CONCLUSIONS

A variety of applications for US and MRI for patients with DD has been described. Based on the results of this review, the largest value for imaging lies in the measurement of disease activity and the follow-up of treatment of patients with early stage disease. Unfortunately, the overall level of evidence of the available literature was low. Future research is necessary to define the exact value of US and MRI in the management of patients with DD.