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Incidence, histopathologic analysis and distribution of tumours of the hand.

Simon MJ, Pogoda P, Hövelborn F, Krause M, Zustin J, Amling M, Barvencik F - BMC Musculoskelet Disord (2014)

Bottom Line: The dominant tissue type found in phalanges and metacarpals was of cartilage origin.Osteogenic tumours were predominant in carpal bones.All primary skeletal tumours can be found in the hand and are most often of cartilage origin followed by bone cysts and osteogenic tumours.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistr, 52, 20246 Hamburg, Germany. amling@uke.de.

ABSTRACT

Background: The aim of this large collective and meticulous study of primary bone tumours and tumourous lesions of the hand was to enhance the knowledge about findings of traumatological radiographs and improve differential diagnosis.

Methods: This retrospective study reviewed data collected from 1976 until 2006 in our Bone Tumour Registry. The following data was documented: age, sex, radiological investigations, tumour location, histopathological features including type and dignity of the tumour, and diagnosis.

Results: The retrospective analysis yielded 631 patients with a mean age of 35.9 ± 19.2 years. The majority of primary hand tumours were found in the phalanges (69.7%) followed by 24.7% in metacarpals and 5.6% in the carpals. Only 10.6% of all cases were malignant. The major lesion type was cartilage derived at 69.1%, followed by bone cysts 11.3% and osteogenic tumours 8.7%. The dominant tissue type found in phalanges and metacarpals was of cartilage origin. Osteogenic tumours were predominant in carpal bones. Enchondroma was the most commonly detected tumour in the hand (47.1%).

Conclusions: All primary skeletal tumours can be found in the hand and are most often of cartilage origin followed by bone cysts and osteogenic tumours. This study furthermore raises awareness about uncommon or rare tumours and helps clinicians to establish proper differential diagnosis, as the majority of detected tumours of the hand are asymptomatic and accidental findings on radiographs.

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Anatomical site distribution of the six tumour categories. Cartilage tumours dominate in the phalanges and metacarpals. Carpals are mostly affected by tumours of osteogenic origin.
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Figure 2: Anatomical site distribution of the six tumour categories. Cartilage tumours dominate in the phalanges and metacarpals. Carpals are mostly affected by tumours of osteogenic origin.

Mentions: Table 1 clearly illustrates that cartilage tumours were the most commonly found tumour in the hand (69.1%) followed by bone cysts with 71 cases (11.3%) in this study. Osteogenic tumours were only detected in 8.7% (n = 55). Vascular tumours appeared 14 times (2.2%), followed by fibrogenic tumours in 6 cases (0.9%). Forty-nine cases of different tumour entities were grouped together under “other” tumours (7.8%). Significance was calculated with the global chi-square test for enchondromas and giant cell tumours.The majority of hand tumours were found in the phalanges (69.7%); of these 10.2% were not benign. Metacarpal bones were affected in 24.7%. Malignancy in metacarpals was found in 12.2%. The carpal bones were affected by primary tumours in 5.5% of cases and of these 8.6% were malignant (Figure 1E). Another distribution perspective of the three skeletal parts of the hand is illustrated in Figure 2. Cartilage tumours in the phalanges and the metacarpal bones were the most often registered tumour type, 74.5% and 64.7% respectively. Osteogenic tumours (34.3%) were the highest in the carpal bones, but these were closely followed by bone cysts (28.5%) and cartilage tumours (20.0%). There were no fibrogenic tumours detected in the metacarpals or carpals.The following Figures 3, 4 and 5 illustrate the most often-occurring tumour types in the hand which surpassed the 5% margin of all bone tumours of the hand in the current dataset. Each of the following six tumour types is presented with a radiographic and a histological image. Additionally, the tumour distributions in the three anatomical sites of the hand as well as the occurrence of this particular tumour across life decades are demonstrated. In Figure 3A-D, enchondroma is presented which is the most frequently occurring tumour of the hand. The radiograph shows a medullary lesion with sharp margins in the proximal phalangeal bone (Figure 3A). Histologically, one identifies at low magnification a typical hypocellular area with a blue-gray taint in the cartilaginous matrix. There is hardly any manifestation of enchondromas in the carpal region (Figure 3C). The peak occurrence is identified for the fourth and fifth decade (Figure 3D). The second most often-occurring tumour type of the hand is the chondrosarcoma (Figure 3E-H). It appears only in the phalangeal and metacarpal region of the hand (Figure 3G). The tumour has a greater occurrence in later stages of life (Figure 3H). A typical ballooned cystic expansion is demonstrated in the metacarpal bone, which is very representative in appearance for an aneurysmal bone cyst (ABC) (Figure 4A). ABCs predominately manifest in the first 40 years of life (Figure 4D). The osteoid osteoma is more often present in the first 4 decades of life and in approximately 60% in the phalangeal bones (Figure 4G-H). A significant predominance of the osteochondroma is demonstrated for the phalanges (85.7%, Figure 5C). The current dataset only shows osteochondroma to be diagnosed by the end of the sixth decade, primarily in the first 20 years, thereafter no cases were reported (Figure 5D). Benign parosteal osteochondromatous proliferations (BPOP), also known as Nora’s lesion, were primarily found in the phalanges (84.9%, Figure 5G). Radiographic appearance demonstrates a cortical attachment and increased focal calcification in the lesion of the proximal phalanx (Figure 5E). The histological image partially resembles an appearance of osteochondromas (Figure 5F). It consists of cancellous bone with irregular cartilaginous or fibrocartilaginous tissue.


Incidence, histopathologic analysis and distribution of tumours of the hand.

Simon MJ, Pogoda P, Hövelborn F, Krause M, Zustin J, Amling M, Barvencik F - BMC Musculoskelet Disord (2014)

Anatomical site distribution of the six tumour categories. Cartilage tumours dominate in the phalanges and metacarpals. Carpals are mostly affected by tumours of osteogenic origin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4048624&req=5

Figure 2: Anatomical site distribution of the six tumour categories. Cartilage tumours dominate in the phalanges and metacarpals. Carpals are mostly affected by tumours of osteogenic origin.
Mentions: Table 1 clearly illustrates that cartilage tumours were the most commonly found tumour in the hand (69.1%) followed by bone cysts with 71 cases (11.3%) in this study. Osteogenic tumours were only detected in 8.7% (n = 55). Vascular tumours appeared 14 times (2.2%), followed by fibrogenic tumours in 6 cases (0.9%). Forty-nine cases of different tumour entities were grouped together under “other” tumours (7.8%). Significance was calculated with the global chi-square test for enchondromas and giant cell tumours.The majority of hand tumours were found in the phalanges (69.7%); of these 10.2% were not benign. Metacarpal bones were affected in 24.7%. Malignancy in metacarpals was found in 12.2%. The carpal bones were affected by primary tumours in 5.5% of cases and of these 8.6% were malignant (Figure 1E). Another distribution perspective of the three skeletal parts of the hand is illustrated in Figure 2. Cartilage tumours in the phalanges and the metacarpal bones were the most often registered tumour type, 74.5% and 64.7% respectively. Osteogenic tumours (34.3%) were the highest in the carpal bones, but these were closely followed by bone cysts (28.5%) and cartilage tumours (20.0%). There were no fibrogenic tumours detected in the metacarpals or carpals.The following Figures 3, 4 and 5 illustrate the most often-occurring tumour types in the hand which surpassed the 5% margin of all bone tumours of the hand in the current dataset. Each of the following six tumour types is presented with a radiographic and a histological image. Additionally, the tumour distributions in the three anatomical sites of the hand as well as the occurrence of this particular tumour across life decades are demonstrated. In Figure 3A-D, enchondroma is presented which is the most frequently occurring tumour of the hand. The radiograph shows a medullary lesion with sharp margins in the proximal phalangeal bone (Figure 3A). Histologically, one identifies at low magnification a typical hypocellular area with a blue-gray taint in the cartilaginous matrix. There is hardly any manifestation of enchondromas in the carpal region (Figure 3C). The peak occurrence is identified for the fourth and fifth decade (Figure 3D). The second most often-occurring tumour type of the hand is the chondrosarcoma (Figure 3E-H). It appears only in the phalangeal and metacarpal region of the hand (Figure 3G). The tumour has a greater occurrence in later stages of life (Figure 3H). A typical ballooned cystic expansion is demonstrated in the metacarpal bone, which is very representative in appearance for an aneurysmal bone cyst (ABC) (Figure 4A). ABCs predominately manifest in the first 40 years of life (Figure 4D). The osteoid osteoma is more often present in the first 4 decades of life and in approximately 60% in the phalangeal bones (Figure 4G-H). A significant predominance of the osteochondroma is demonstrated for the phalanges (85.7%, Figure 5C). The current dataset only shows osteochondroma to be diagnosed by the end of the sixth decade, primarily in the first 20 years, thereafter no cases were reported (Figure 5D). Benign parosteal osteochondromatous proliferations (BPOP), also known as Nora’s lesion, were primarily found in the phalanges (84.9%, Figure 5G). Radiographic appearance demonstrates a cortical attachment and increased focal calcification in the lesion of the proximal phalanx (Figure 5E). The histological image partially resembles an appearance of osteochondromas (Figure 5F). It consists of cancellous bone with irregular cartilaginous or fibrocartilaginous tissue.

Bottom Line: The dominant tissue type found in phalanges and metacarpals was of cartilage origin.Osteogenic tumours were predominant in carpal bones.All primary skeletal tumours can be found in the hand and are most often of cartilage origin followed by bone cysts and osteogenic tumours.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistr, 52, 20246 Hamburg, Germany. amling@uke.de.

ABSTRACT

Background: The aim of this large collective and meticulous study of primary bone tumours and tumourous lesions of the hand was to enhance the knowledge about findings of traumatological radiographs and improve differential diagnosis.

Methods: This retrospective study reviewed data collected from 1976 until 2006 in our Bone Tumour Registry. The following data was documented: age, sex, radiological investigations, tumour location, histopathological features including type and dignity of the tumour, and diagnosis.

Results: The retrospective analysis yielded 631 patients with a mean age of 35.9 ± 19.2 years. The majority of primary hand tumours were found in the phalanges (69.7%) followed by 24.7% in metacarpals and 5.6% in the carpals. Only 10.6% of all cases were malignant. The major lesion type was cartilage derived at 69.1%, followed by bone cysts 11.3% and osteogenic tumours 8.7%. The dominant tissue type found in phalanges and metacarpals was of cartilage origin. Osteogenic tumours were predominant in carpal bones. Enchondroma was the most commonly detected tumour in the hand (47.1%).

Conclusions: All primary skeletal tumours can be found in the hand and are most often of cartilage origin followed by bone cysts and osteogenic tumours. This study furthermore raises awareness about uncommon or rare tumours and helps clinicians to establish proper differential diagnosis, as the majority of detected tumours of the hand are asymptomatic and accidental findings on radiographs.

Show MeSH
Related in: MedlinePlus