Diagnostic Imaging of Benign and Malignant Osseous Tumors of the Fingers

Abstract

Primary lesions of the tubular bones of the digits are not uncommon, and the vast majority of these lesions are benign. Benign intramedullary lesions such as enchondromas are frequently discovered incidentally, unless they are associated with a pathologic fracture. Expansile lesions or lesions that are pedunculated and protrude from the cortex may manifest with pain and functional deficits from local inflammatory reactions. Systemic disorders such as sarcoidosis and local soft-tissue lesions with involvement of adjacent bone may mimic primary phalangeal bone tumors. Primary or secondary malignant lesions of the phalanges, most commonly chondrosarcomas, are extremely rare, and their characterization may require the use of multiple modalities, including radiography, computed tomography, and magnetic resonance imaging. Although ultrasonography is extremely useful in the evaluation of soft-tissue lesions of the hand, its role in the evaluation of osseous lesions is limited. The authors describe the imaging features of the most common benign osseous and chondral lesions of the fingers, including enchondromas, cystic lesions, and osteochondromas. In addition, they discuss malignant entities that may occur in the fingers (eg, chondrosarcomas and metastatic lesions) and commonly encountered mimics of primary osseous lesions (eg, glomus tumors, intraosseous epidermal inclusion cysts, infectious entities, and manifestations of systemic diseases). They also discuss the advantages and disadvantages of the most commonly used imaging modalities in differentiating benign from malignant lesions.

Benign bone tumors of hand and wrist: evaluation of diagnosis and treatment

“…Benign bone tumors and tumor-like lesions of the hand and wrist are rare. They are often found incidentally [2] and reportedly account for 2-5% of all skeletal tumors. Enchondroma was reported for up to 90% of them.…”

“…Malignant and metastatic osseous tumors of the hand are rare, and the most common tumors are in the benign group. [ 1 ] Benign bone tumors and tumor-like lesions of the hand and wrist are often found incidentally[ 2 ] and reportedly account for 2-5% of all skeletal tumors. Enchondroma was reported in up to 90% of all benign tumors of the hand.…”

Osteoma Osteoide de falange. Reporte de cinco casos y revisión bibliográfica

“…Típicamente se puede visualizar edema en la médula ósea y en los tejidos blandos que rodean la lesión (Figura 10). 23,24 Cuando el nido está parcialmente mineralizado, se puede ver una imagen en escarapela. La administración de gadolinio aumenta notablemente la visibilidad del nido debido a su alta vascularización.…”

“…El diagnóstico diferencial es clínico y por imágenes, y se debe establecer entre las siguientes entidades: -tumor glómico, 16,18,21 -osteomielitis, 7,9,11,14,16,18 -tenosinovitis, 7,11 -quiste epidermoide de inclusión, 9,14,16,18 -periostitis reactiva, 9 -fístula arteriovenosa, 14,16 -neoplasia. 7,14,23,29 En concordancia con otras publicaciones, [3][4][5]9,11,18,20,22,23,30 los pacientes aquí presentados habían realizado múltiples consultas previas, muchas veces, fueron diagnosticados erróneamente y recibieron tratamientos innecesarios que, a menudo, retrasan el diagnóstico.…”

“…Un paciente (caso 4) requirió un segundo procedimiento por resección incompleta. El tamaño medio de las lesiones en su diámetro máximo medidos por TC fue de La edad media de presentación fue de 18.8 años (rango [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. El tiempo promedio transcurrido entre la primera consulta y el diagnóstico fue de 10.6 meses (rango 5-16).…”