Outcomes of Surgery for Benign Tumours in The Upper Extremity

Abstract

Benign tumours of the upper extremity are common in hand surgeons’ practice. The most commonly diagnosed are giant-cell tumours of the tendon sheath and lipomas.

The objective of this study was an investigation into the distribution of tumours in the upper limb, their symptomatology and outcomes of surgery, particularly regarding the rate of recurrence.

Material and Methods A total of 346 patients, 234 women (68%) and 112 men (32%), who had undergone surgery for tumours located in the upper extremity which were not ganglion cysts were enrolled into the study. The follow-up assessment was performed at a mean of 21 months (range 12–36) post-operatively.

Results The most common tumour in this study was giant cell tumour of the tendon sheath − 96 cases (27.7%), followed by lipoma − 44 cases (12.7%). Most lesions − 231 (67%) were localized in the digits. A total of 79 (23%) recurrences were noted, the most common after surgery for rheumatoid nodules - 43.3% and the giant-cell tumours of the tendon sheath − 31.3%. The independent factors increasing risk of recurrence following the tumour’s resection were: histological type of the lesion - the giant-cell tumour of the tendon sheath (p=0.0086) and the rheumatoid nodule (p=0.0027), as well as a combination of incomplete (non-radical) and not “en block” resection of tumours. A brief review of the literature referring to the presented material is offered.

Zusammenfassung

Hintergrund Gutartige Tumoren der oberen Extremität sind ein häufiges Krankheitsbild in der handchirurgischen Sprechstunde. Sieht man von Ganglien ab, werden Riesenzelltumoren der Sehnenscheiden und Lipome am häufigsten gefunden.

Ziel Diese retrospektive Studie untersucht welche gutartigen Tumore außer Ganglien an der oberen Extremität wie häufig beobachtet werden, ihr Erscheinungs- und Beschwerdebild sowie die Ergebnisse nach operativer Entfernung, insbesondere die Rezidivrate.

Patienten und Methoden 346 Patienten (234 Frauen=68% und 112 Männer) wurden durchschnittlich 21 (12–36) Monate nach Operation eines gutartigen Tumors der oberen Extremität, bei dem es sich nicht um ein Ganglion handelte, nachuntersucht.

Ergebnisse Riesenzelltumoren der Sehnenscheiden kamen mit 27,7% (96 Fälle) am häufigsten vor, gefolgt von Lipomen mit 44 Fällen (12,7%). Die meisten Tumoren (231=67%) waren an den Fingern lokalisiert. 79 Rezidive (23%) wurden beobachtet, mit 43,3% am häufigsten nach Entfernung von Rheumaknoten und in 31,3% von Riesenzelltumoren der Sehnenscheiden. Das Risiko für das Auftreten eines Rezidivs war vorrangig abhängig von der Art des Tumors und einer Kombination aus unvollständiger Resektion und fragmentierter, statt „en block“-Resektion.

Key words

benign hand tumours - risk of recurrence

Schlüsselwörter

gutartige Handtumoren - Rezidivrisiko

Publication History

Received: 01 November 2022

Accepted: 16 December 2022

Article published online:
09 March 2023

• References

• 1 Henderson MM, Neumeister MW, Bueno RA. et al. Hand tumors: I. skin and soft-tissue tumors of the hand. Plast Reconstr Surg 2014; 133: 154e
• 2 Zyluk A, Mazur A. Statistical and histological analysis of the tumors within the upper extremity. Obere Extr 2015;
• 3 Simon MJ, Pogoda P, Hövelborn F. et al. Incidence, histopathologic analysis and distribution of tumours of the hand. BMC Musculoskelet Disord 2014; 15: 182
• 4 Cavit A, Özcanli H, Sancmis M. et al. Tumorous conditions of the hand: a retrospective review of 402 cases. Turk Patoloji Derg 2018; 34: 66-72
• 5 Darwish FM, Haddad WH. Giant cell tumour of tendon sheath: experience with 52 cases. Singap Med J. 2008; 49: 879-882
• 6 Ozben H, Coskun T. Giant cell tumor of tendon sheath in the hand: analysis of risk factors for recurrence in 50 cases. BMC Musc Dis 2019; 20: 457
• 7 Koutserimpas C, Kastanis G, Ioannidis A. et al. Giant cell tumors of the tendon sheath of the hand: an 11-year retrospective study. J Buon 2018; 23: 1546-1551
• 8 Al-Qattan MM. Giant cell tumours of tendon sheath: classification and recurrence rate. J Hand Surg Br 2001; 26: 72-75
• 9 Fotiadis E, Papadopoulos A, Svarnas T. et al. Giant cell tumour of tendon sheath of the digits. A systematic review. Hand. 2011; 6: 244-249
• 10 Gouin F, Noailles T. Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis). Orthop Traumatol Surg Re.s 2017; 103: 91-97
• 11 Di Grazia S, Succi G, Fraggetta F. et al. Giant cell tumor of tendon sheath: study of 64 cases and review of literature. G Chir 2013; 34: 149-152
• 12 Williams J, Hodari A, Janevski P. et al. Recurrence of giant cell tumors of the hand: a prospective study. J Hand Surg Am. 2010; 35: 451-456
• 13 Lichon S, Khachemoune A. Clinical presentation, diagnostic approach, and treatment of hand lipomas: a review. Acta Dermatovener Alp Pann Adriat 2018; 27: 137-139