Outcomes of Surgery for Benign Tumours in The Upper Extremity

Abstract

Benign tumours of the upper extremity are common in hand surgeons’ practice. The most commonly diagnosed are giant-cell tumours of the tendon sheath and lipomas. The objective of this study was an investigation into the distribution of tumours in the upper limb, their symptomatology and outcomes of surgery, particularly regarding the rate of recurrence. Material and Methods A total of 346 patients, 234 women (68%) and 112 men (32%), who had undergone surgery for tumours located in the upper extremity which were not ganglion cysts were enrolled into the study. The follow-up assessment was performed at a mean of 21 months (range 12–36) post-operatively. Results The most common tumour in this study was giant cell tumour of the tendon sheath − 96 cases (27.7%), followed by lipoma − 44 cases (12.7%). Most lesions − 231 (67%) were localized in the digits. A total of 79 (23%) recurrences were noted, the most common after surgery for rheumatoid nodules - 43.3% and the giant-cell tumours of the tendon sheath − 31.3%. The independent factors increasing risk of recurrence following the tumour’s resection were: histological type of the lesion - the giant-cell tumour of the tendon sheath (p=0.0086) and the rheumatoid nodule (p=0.0027), as well as a combination of incomplete (non-radical) and not “en block” resection of tumours. A brief review of the literature referring to the presented material is offered.

Is a routine histopathological examination justified for all tumours resected from the upper extremity?

“…Lesions of the upper extremity are common, with an estimated 15 % of all soft tissue tumours found in the human body localised in the hand. Among all benign upper extremity tumours, ganglions are the most common (50-60 %), followed by giant cell tumour of tendon sheath (15-20 %), lipomas (10-15 %) and rheumatoid nodules (10 %) [1][2][3]. The risk of an upper extremity lesion being malignant is very low, less than 1 % for both soft tissue tumours and bony tumours [4].…”

Surgery of Schwannoma in the upper limb – sensitivity and specificity of preoperative magnetic resonance imaging and relation between tumour size and symptoms

“…Depending on the tumour expansion affecting the nerve fibres, patients with Schwannoma may experience paraesthesia and pain as well as impaired sensory and motor function [ 1 , 3 , 10 , 14 – 18 ]. The treatment is surgical removal of the tumour mass without injuring healthy surrounding nerve tissue, but excision may still harm the nerve fibres and lead to augmentation or development of new symptoms [ 17 , 19 – 21 ]. For this reason, microsurgical technique under high magnification has been recommended to minimise this risk [ 1 , 5 , 8 , 15 , 22 – 24 ].…”