Article
An unusual lump in the hand: desmoplastic fibroblastoma
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Authors
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Rudo Madada-Nyakauru
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Ian Grant
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Soft tissue tumours of the hand are common and usually benign. Enlargement of tumours within the confined spaces of the hand can cause pain and stiffness. We report the case of a desmoplastic fibroblastoma (collagenous fibroma): a rare histological finding in the hand. Only a small number of sporadic cases and series have previously been documented.
Methods: A 41 year old right hand dominant male presented with worsening wrist pain and decreased range of movement. Eight years earlier he had sustained a scaphoid fracture which was successfully managed with six weeks of immobilization. He had plain film X-rays of his wrist requested in primary care, which were unremarkable. He subsequently developed a visible dorsal wrist soft tissue swelling and was referred to the hand clinic of a University Teaching hospital
Results and Conclusions: Magnetic Resonance Imaging (MRI), showed an abnormal mass arising dorsal to the capitate and extending through the gap between the second and fourth extensor compartment to lie immediately beneath the skin, measuring 15 mm thick by 27 mm wide and over 40 mm longitudinally. His management was discussed in a sarcoma-multi-disciplinary clinic: he was offered an excision biopsy.
Surgery was performed under general anaesthetic with tourniquet control. A marginal excision was performed: histology of the excised specimen showed well demarcated lobules comprising dense fibrous stroma and scattered spindle cells. Immunohistochemistry showed minimal expression of Actin, Desmin and other diagnostic surgical pathology protein markers such as S100, CD34 or Epithelial membrane antigen (EMA). These histopathological and immunohistochemistry findings supported the diagnosis of a desmoplastic fibroblastoma.
After 4 weeks he returned to work as a security guard, his pain was reduced, his wrist mobility and hand strength returned to within 90% of his contralateral limb within 8 weeks.
Prior to surgery the most likely diagnosis seemed to be a Giant Cell Tumour: definitive diagnosis required histological assessment.
Reporting the behaviour and appearance of rare soft tissue tumours should help future hand surgeons to consider a more comprehensive list of possible causes for a lump, and allow more confident decision making
