Soft Tissue Sarcoma of the Hand and Wrist: Epidemiology and Management Challenges

Abstract

Soft tissue sarcomas (STSs) of the hand and wrist are rare and confer a unique set of management challenges. We present a 15-year review and discussion of the epidemiology, tumor characteristics, treatment, and reconstructive strategies for such cases presenting to our regional sarcoma service. Three case examples are described. Of 218 STSs of the upper limb, 17 involved the hand or wrist. Alveolar rhabdomyosarcoma, synovial, and myxofibrosarcoma were the most common ones. Two patients required amputation for recurrence. Eight patients required flap reconstruction, of which five were free flaps with no failures or wound healing complications. Two-year overall survival rate was 92%. Local recurrence occurred in 12%. Limb-sparing surgery is possible in most patients, although there is often a degree of functional loss due to the surgical resection, and complex multistage reconstruction may be required. These lesions are still often incidental or unexpected findings when patients are treated for a presumed benign swelling. Clinicians treating localized swellings of the hand and wrist should maintain vigilance toward the possibility of a sarcoma diagnosis, to avoid delays in definitive treatment.

A Juxta-Articular Myxoma of the Thumb

“…Less than 1% of all upper-limb tumors occur in the hand, 6 so tumors at this body site are not well-studied. 7 In the patient in the current report, the rare diagnosis of a JAM in the hand was established.…”

“…The presence or absence of pain does not seem to be applicable for differentiating benign from malignant hand lesions. 7 First described by Virchow in 1863, 14 the pathogenesis of myxomata is still incompletely understood, but the literature describes an association with previous trauma and osteoarthritis.…”

“…12,13 Unfortunately, the diagnosis is often confirmed only by histologic examination after excision, so reoperation may be needed. 7 Careful preoperative planning including MRI and even core biopsy should be considered in these cases. Nodular fasciitis is a benign reactive myofibroblastic lesion that may occur after trauma.…”

A woman in her fifties with a lump in the palm of her hand

“…Det er tidligere estimert at mindre enn 1 % av maligne tumorer i overekstremitetene oppstår i hånden (7). Senere studier har vist noe høyere forekomst (8). En fulltids håndkirurg kan i løpet av et arbeidsliv forvente å se tilstanden én til to ganger (1).…”

Synovial sarcoma of the hand-wrist: a case report and review of the literature

“…Most cases, however, are diagnosed only when their size is larger than 5 cm [8]. Similar to other soft tissue sarcomas, synovial sarcomas in the hand-wrist area are infrequent [9]. This paper documents an unusual case of hand-wrist synovial sarcoma in a 69-year-old Caucasian woman, and characterizes this condition's demographic, pathologic, and clinical features with a literature review.…”