gms | German Medical Science

Objectives/Interrogation: The purpose of this study is to highlight the possible existence of rare tumors in hand. Clinical diagnosis can be difficult in these cases and only paraclinical examinations, such as IRM and histopathology, can orient and establish the diagnosis. Therefore, these rare tumors must be considered, even when they are present in hand.

Methods: This study included 14 patients, diagnosed and treated over a period of 9 years. In 7 cases, the tumor was a lipoma. Their localization was the thenar eminence in 6 cases and mid-palm region in 1 case. All tumors were over 5 cm (giant), the sizes of the mid-palm one being 9.5/5/3.5 cm, with a weight of 137 grams. The IRM exam oriented us to the diagnosis of cystic formation, but it did not give other details. Also, in the other 7 cases, the IRM exam was very helpful, with oriented-detailed descriptions for liposarcoma in 1 case, epidermal inclusion cyst in 1 case and rice-bodies tenosynovitis in 5 cases. In the liposarcoma case, the image on MRI was of a heterogenous, poorly encapsulated tumor, with thick fibrous septa and nodules on T1-weighted sequences and hypertenseptae on fat-suppressed T2-weighted. The IRM exam with contrast agent for the epidermal inclusion cyst revealed the presence of a cystic-polyloculated tumor (hypersignal T2, hyposignal T1) with a moderate contrast medium uptake in the wall and septa, located on the palmar face of the right hand, with significant deformations of the region and sizes of approximately 21/22/53mm. For the rice-bodies tenosynovitis, MRI exam showed milimetric and nodular images in flexor group tendon sheath in T2-weighted sequences, thickening of the synovial membrane with increased vascularization, fluid within the tendon sheath, reactive inflammation around the tendon and swelling of the tendon. In all cases, the treatment consisted in surgery with complete excision of the lesions and the histopathological examination established the diagnosis.

Results: In all cases, the ablation of tumors was performed with good results, without relapse at distance. Socio-professional reintegration was complete and fast, functional and aesthetic results were very good. The patients rated the results with "good" and "very good" in one interview.

Conclusions: Although the clinical examination is sometimes uncertain, the symptoms being similar for different tumors, the imagistic exams, like MRI, can orient us for the best. Of course, the histopathological examination offered the diagnostic certainty.