gms | German Medical Science

Objectives: This work aims to characterize the presence of multiples tumours in the hand, with specifical affectation in the thumb through case report.This study seeks to contribute to the specialized knowledge of these severe lesions in the hand

Methods: Descriptive analysis of a clinical case: male 49 years old, who refers a bulky zone on his thumb by two years,with pain in the last six months, and limitations on the extension function of the affected finger, without paresthesias.

Physical examination: Patient has a subcutaneous bulk, indurated on dorsal zone of his left thumb with affectation of interphalangeal joint and proximal phalanx. There is some swelling on the metacarpophalangea joint. No affected skin.

Radiological examination: The lesion causes a soft tissue mass with cortical pressure erosion and calcifications on the proximal phalanx and there is a lytic lesion on the metacarpal metaphyseal arising in the medulla with a geographic pattern of bone destruction, bony expansion with cortical thinning.

MRI reveal a typical lobulated pattern suggestive of a cartilage tumours with soft tissue extension in the distal lesion.

Treatment: Wide resection en-bloc for the distal lesion. Proximal lesion required simple curettage and bone grafting. After 3 weeks post op, a physical therapy program was carried out to recover full mobility of the involved joints.

Results and Conclusions: Patient was carried out after 8 months, with good osteointegration of the graft and full function of the thumb. No pain and without infection. Biopsies: periosteal chondroma (distal lesion) and enchondroma (proximal lesion).

Although very uncommon, periosteal chondroma is a benign cartilaginous tumor arising at the periosteal surface of bone. It represents only the 20 % of the total condromas. This lesion can arise in both long and small tubular bones. If it is situated close to a joint it is called juxta-articular chondroma. The mass is palpable and can be painful. To Histology in periosteal chondroma increased cellularity as compared to enchondroma is seen. The major differential diagnoses are periosteal osteosarcoma, periosteal chondrosarcoma and giant cell tumour of the tendon sheath. The recurrence rate is rather low (1-5 %) for both types of tumours found. Discarding Olier's disease, the coexistence of both tumours described is uncommon presenting a diagnostic challenge for correct therapeutic management. This paper highlights the importance of increasing knowledge in this specific area of hand surgery and oncology.