Quiste de inclusión epidérmica intraóseo con osteólisis de la falange distal / Kyste épidermoïde intra-osseux s'associant à une ostéolyse de la phalange distale / Intraosseous Epidermoid Inclusion Cyst with Osteolysis of the Distal Phalanx

Un motivo común de consulta en la práctica de la cirugía de mano es la aparición de algún tipo de tumoración. Afortunadamente la mayoría de dichas lesiones son benignas, sin embargo no deben subestimarse ya que existen lesiones malignas que pueden en apariencia y comportamiento imitar lesiones benignas, lo que puede retardar el diagnóstico o causar errores en el tratamiento inicial con consecuencias desastrosas para la función e incluso para la vida del paciente. El abordaje debe realizarse de acuerdo con los protocolos y lineamientos establecidos para las tumoraciones del sistema musculoesquelético, y los procedimientos quirúrgicos se deben planificarse de manera cuidadosa contando con los recursos técnicos necesarios para la resección adecuada y la reconstrucción funcional en caso necesario(AU)

A common cause of care in hand surgery practice is the appearance of a tumor or tumor like lesion. Fortunately, the majority of them are benign. Nevertheless, malignant lesions with benign-like appearance or behavior should not be underestimate since it may cause delayed diagnosis or inappropriate initial treatment with catastrophic functional consequences or even life threatening. Approach must be done in accordance to musculoskeletal tumor guidelines and surgical procedures carefully planned and executed by a surgeon with the experience to effectively resect and reconstruct if needed(AU)

La survenue de quelque sorte de tumeur au niveau de la main conduit souvent à une consultation de chirurgie. Heureusement, la plupart de ce dites lésions sont bénignes, mais elles ne doivent pas être négligées, car il y a des lésions malignes pouvant faire évoquer des lésions bénignes du fait de leur aspect et comportement, en retardant ainsi le diagnostic et en provoquant des erreurs dans le traitement initial avec des conséquences néfastes pour la fonction, et même pour la vie du patient. L'approche doit suivre les règles et protocoles établis pour les tumeurs du système musculo-squelettique, et les procédés chirurgicaux doivent être planifiés soigneusement au moyen des ressources techniques nécessaires pour une adéquate résection et une reconstruction fonctionnelle en cas nécessaire(AU)

Quantitative ultrasound at the hand phalanges in patients with bisphosphonate-related osteonecrosis of the jaws

Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.

Forensic identification of 50 phalangeal fracture cases / 法医学杂志

OBJECTIVE@#To study the characteristics of forensic identification of phalangeal fracture and to use a combination of medical records, imaging materials, and forensic examination data in identification.@*METHODS@#Fifty cases of phalangeal fracture involved in the forensic identification were collected from 2009 to 2011. The general situation, the distribution of fracture, the fracture morphology, the injury-causing objects and the results of identification were analyzed retrospectively.@*RESULTS@#Majority of the cases of phalangeal fracture were young and middle-aged men. The index finger and distal phalanx fractures were common. There was no difference in the number of phalangeal fracture between left and right hand. Most of the injury-causing objects were knives and sticks, followed by bricks and stones.@*CONCLUSION@#The injury-causing objects and modes are related to the morphology of fracture, the distribution of fracture and the severity of the injury. The comprehensive analysis is helpful in forensic identification of phalangeal fracture.

Case for diagnosis / Caso para diagnóstico

Male patient, 28 years old, presented with an asymptomatic yellowish erythematous papule on his right thigh. Excisional biopsy was performed for histopathological examination of the lesion. Multinucleated cells (Touton giant cells) were observed. S100 immunohistochemistry was negative for CD1a and positive for CD4 and CD68. Based on clinical and histopathological findings associated with immunohistochemistry, we concluded that it was a case of adult-type xanthogranuloma. Because it was a solitary lesion without other clinical signs and symptoms, the medical conduct adopted was patient orientation.

Paciente do sexo masculino, 28 anos, com surgimento de pápula eritemato-amarelada na coxa direita, assintomática. Foi realizado biópsia excisional da lesão para exame histopatológico, tendo sido observado células gigantes multinucleares do tipo Touton e imunohistoquimica com CD1a e S100 negativos e CD4 e CD68 positivos. Pelos achados clinicohistopatológicos associados a imunohistoquimica concluímos ser um caso de xantogranuloma do tipo adulto. Por ter sido uma lesão solitária sem outros sinais e sintomas clínicos, a conduta adotada foi orientação quanto a doença.

Metástasis de carcinoma de esófago en falange. Presentación de un caso y revisión de la literatura / Metastatic carcinoma of the esophagus in phalanx. A case report and review of the literature

Las metástasis acrales en huesos o partes blandas de manos o pies son localizaciones poco comunes de la diseminación a distancia de una enfermedad oncológica. El propósito de este trabajo es presentar el caso de un paciente con cáncer de esófago con metástasis acral en mano izquierda y una revisión de trabajos acerca de esta rara entidad.

Acral metastases in bone or soft parts of the hands or feet are rare entities of distant dissemination of an oncological disease. The purpose of this paper work is to present a patient case with esophageal cancer with metastases acral in his left hand and to revie the literature about the pathology.

Case for diagnosis / Caso para diagnóstico

Lipomas are common benign mesenchymal tumors composed of mature fat cells that may or may not be surrounded by a thin, fibrous capsule. The link with trauma has already been described. Lipomas involving the fingers are extremely rare but must be considered in the differential diagnosis of benign soft tissue masses in this particular location.

Lipomas são neoplasias mesenquimais benignas comuns constituídas de células gordurosas maduras que podem ou não estar envoltas por cápsula conjuntiva. A relação com o trauma já foi descrita. Aqueles envolvendo os dedos são extremamente raros, mas devem ser considerados no diagnóstico diferencial das massas benignas de tecidos moles em tal localização.

Nodular Fasciitis with Cortical Erosion of the Hand

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.

Nodular Fasciitis with Cortical Erosion of the Hand

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.

Giant cell tumours in hand bones

To describe the clinical features of Giant cell tumour of hand, in terms of aggressiveness, multicentricity and radiological grading at presentation, surgical procedures and final outcome. A case series. Jinnah Postgraduate Medical Centre [JPMC], Karachi, from January 1990 to January 2009. Seven cases of Giant cell tumour of hand bones were diagnosed in last 19 years and included in this study. Patients with infections in hand and procedure performed at other centre were excluded. Clinical and radiographic features were analyzed, definitive operative procedures performed and follow-up of the patient were studied and updated. Two hundred ten cases of Giant cell tumour of bones were seen in last 19 years at JPMC, Karachi; 7 cases were of GCT of hand bones which constitutes around 3.3% of all GCT. Four patients [57%] were male and 3 [43%] female with mean age of 24.28 +/- 5.7 years. Four [57%] cases were in metacarpal and 3 [43%] in phalanges. Average duration of symptoms was 5.78 +/- 3.26 months; all presented with radiological stage 3 lesions. One case of multicentric lesion presented after treatment of primary GCT of distal radius. Excision of the tumour and reconstruction by autogenous graft was performed in 6 cases and ray amputation in one case. No complication or recurrence noted in any case on an average of 4.5 years [ranging from 1.5-8 years] follow-up. Giant cell tumour in hand bones is rare tumour and shows specific clinical and radiographic features with early involvement of entire bone, more aggressive behaviour and multi centricity. The treatment of choice is resection of the tumour with reconstruction or ray amputation

Phalange metastasis from carcinoma of alveolus.

Metastatic involvement of a phalanx by head and neck cancers is rare. We report a case of a 66-year-old man with squamous cell carcinoma of the alveolus who had no residual disease or local recurrence after treatment but presented with metastasis to the middle phalanx of the middle finger.

Cisto ósseo aneurismático na falange proximal da mão: relato de caso e revisão de literatura / Aneurysmal bone cyst in the proximal phalange: case report and review of the literature

O cisto ósseo aneurismático é uma lesão benigna bastante comum caracterizada por ser expansiva, radioluzente, multiloculada e excêntrica, podendo acometer qualquer osso. O presente artigo relata o caso de uma criança com dor e aumento do volume no quarto dedo da mão direita há três semanas, decorrente de um cisto ósseo aneurismático. Os autores destacam as características de imagens na radiografia, tomografia computadorizada e ressonância magnética, com posteriorcorrelação cirúrgica.

Aneurysmal bone cyst is a common benign lesion characterized by its insuflative, radiolucent, excentric and multiloculated pattern. It also can occur in any kind of bone. The present article report case of a child with pain and swelling in the fourth right finger forthree weeks caused by an aneurysmal bone cyst. The authors highlightthe characteristics of images in radiography, computed tomographyand magnetic resonance imaging, with subsequent surgical correlation.

Epithelioid sarcoma of the foot with subsequent lesion in hand: metastatic lesion or second primary?

Epithelioid sarcomas (ES) are rare tumors of soft tissue that have a propensity to occur in the extremities. Epithelioid sarcomas are known to metastatise to draining lymph nodes and commonly to the lungs. Herein, a case of epithelioid sarcoma which recurred in an unusual site namely the distal phalanx of left middle finger, six months post amputation of the primary lesion in the left foot is being reported. The ipsilateral inguinal lymph node showed metastatic deposits. The tumor at both these sites had similar histology and an identical immunohistochemical (IHC) pattern showing reactivity to cytokeratin (CK), epithelial membrane antigen (EMA), vimentin (Vim) and CD34. This case is presented to record an unusual occurrence of ES in the distal phalanx of middle finger with an ES of foot. The metastasis of ES to the distal acral bones has not been documented till date.

[Epithelioid hemangioendothelioma of the wrist and the hand a case report]

The primitive epitheliod hemangio-endothelioma of bone is a rare vascular tumor recently described. A case of epitheliod hemangio-endothelioma of the distal phalanx and the ulna of the left band in a 15 years old young man is reported. In the same side soft tissue tumors of the hand and the forearm have been simultaneously diagnosed. In the same time radical excision with bone grafting was performed. The histologic and immunohistochemical study confirm the diagnosis. At the 8 years follow-up there was no clinical evidence of recurrence or metastasis. In the literature the outcome is not well defined. However no death was reported in the bone localization. Surgical resection with bone grafting to prevent pathologic fracture is suggested as a treatment, althongh it's not well codified in this rare lesion

Radiographic findings of digital bones and joints in lame cattle of shiraz area

A radiographic study on bone and joint disorders was carried out on 77 cases of lame cattle in some dairy farms of Shiraz area. Various radiographic findings of digital region were recorded as: osteomyelitis, exostosis, alteration of bone density, calcified soft tissue, rotation of phalanges, arthritis, degenerative joint disease, joint bony ankylosis, luxation and angulation. In 70% of the lame cattle, radiographic findings of bone and joint were observed