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Tumors of the Hand By: Prof. Dr. Hussein Abdel Fattah

Tumors of the Hand By: Prof. Dr. Hussein Abdel Fattah. The hand is the site of a great variety of benign lesions and a few malignant lesions but benign ones predominates . Malignant skin tumors squamous cell carcinoma, basal cell carc. & malignant melanoma are not included in this survey

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Tumors of the Hand By: Prof. Dr. Hussein Abdel Fattah

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  1. Tumors of the HandBy: Prof. Dr. Hussein Abdel Fattah

  2. The hand is the site of a great variety of benign lesions and a few malignant lesions but benign ones predominates . • Malignant skin tumors squamous cell carcinoma, basal cell carc. & malignant melanoma are not included in this survey • Tumor like conditions are mentioned

  3. Patients seek advice early because of simplicity of recognition and the disability that attends a small lesion in the hand.

  4. Benign lesions in the hand are first noticed as a palpable mass, an enlarged digit, or a mechanical dysfunction . • Pain may be the presenting symptom in glomus tumor,osteoid osteoma osteoblastoma

  5. Many metabolic and degenerative processes are seen in the hand as radiolucent areas, subchondral degenerative cysts in arthropathies and in gout. • Parathyroid adenoma

  6. Diagnosis • Standard X-ray of the hand of excellent quality and definition are essential • C.T. & M.R.I. & Bone scan • Clinical photo prior to surgery

  7. Angiography in the hand is a useful technique for determining the anatomical extent of the lesion and its relationship to intricate system. Particularly in vascular tumors.

  8. Many lesions in the hand are part of systemic processes. Radioactive isotope scan serves as a total skeletal survey. Any area of increased activity must be judged in light of the over all clinical picture.

  9. Planning Treatment for Hand Tumours • For benign lesions of the digits incisions should be placed in such a way that they do not subsequently interfere with function.

  10. Types of Surgical Approach • Marginal excision. • Curettage & graft. • Wide resection and intercalary reconstruction. • Wide ray resection.

  11. In many instances ray resection may be a cosmetically and functionally superior method of reconstruction than composite tissue grafting.

  12. Caution is needed against overenthusiastic reconstruction with potential loss of the remaining function of the hand.

  13. Enchondroma: Solitary and Multiple The small bones of the hand and have a marked predilection to proximal and middle phalanx and to metacarpal

  14. Cartilagenous tumors • ECCHONDROMA ENCHONROMA Common painless unless pathological fracture

  15. Enchondroma fifth metacarpal • Curettage & graft after path. fracture.

  16. Multiple chondromata Curettage & collapse of the wall

  17. Preoperative Postoperative

  18. Ollier,s disease

  19. Multiple chondromata Maffuci syndrome With cavernous haemangimata showing calcified thrombi

  20. Big benign enchondroma distal Ulna

  21. Bone tumors • Osteochndrma • Osteoid osteoma • Giant cell tumor • Osteosarcoma • Secondary deposit

  22. OSTOID OSTEOMA PAINFUL SMALL LESION HOT IN BONE SCAN

  23. BENIGN OSTEOBLASTOMA PAINFULL DENSE TUMOR WITH TENDECY TO RECURRENCE

  24. REURRENCE AFTER CURETTAGE B. OSTEOBLASTOMA RADICAL EXCISION & ILIAC BONE GRAFT

  25. OSTEOCHONDROMA

  26. MULTIPLE HEREDITARY EXOSTOSIS

  27. ANEURYSMAL BONE CYST

  28. G.C.T. OF SECOND METACARPAL DIFF. DIAGNOSIS PARATHYROID BROWN TUMOR HEALS AFTER EXCISON OF ADENOMA

  29. G.C.T. INDEX CURETTAGE & GRAFT POSSIBILTY OF RECURRENCE HIGH

  30. RAY RESECTION IS MORE RADICAL

  31. G.C.T. DISTAL RADIUS EXCISION & FIBUALR GRAFT

  32. In contrast, many sarcomas in the hand and particularly on the dorsum tend to mimic an inflammatory process with diffuse swelling, local heat and erythema rather than appear as a discrete swelling.

  33. Fibrous Tissue Tumors • Fibroma, localised well differeniated • Palmar fscia contracture, hereditary slowly growing nodules over years

  34. Fibrous tissue localised fibroma

  35. DUPUYTREN,S CONTRACTURE Subcutaneous fibrosis in palmar Facia with with progressive contracure& flexion deformity

  36. Rt hand operated 3 months ago Lt. hand operated 10 years ago at age of 53 Age 63 now

  37. Fibrous Tissue Tumors Diffuse Fibromatosis • Diffuse Fibromatosis is a soft tissue tumour of neurolemmal sheath ,muscular fibrous sheath that has a nasty habit of many local recurrences if not completely excised. These tumors can be very painful and disfiguring. They show tendency to malignant destructive recurrence.

  38. M.R.I. coronal section

  39. M.R.I. AXIAL CUTS

  40. Ray resection of the medial two RAYS to save good function of the hand

  41. AFTER THREE YEARS

  42. FIBROMATOSIS OF SECOND RAY FOR RESECTION

  43. Recurrent malignant Triton tumorDiffuse fibromatosis

  44. M.R.I.showing extensive infiltration in the sole of the foot

  45. Symes amputation was mandatory after four previous excisions

  46. Synovial Tumors Pigmented villonodular synovitis A REACTIVE LESION OF TENDON SHEATH USUALLY ON THE PALMAR ASPECT OF DIGIT SLOWLY GROWING 20% SHOWS BONE EROSION, 2O% LOCAL RECURENCE

  47. Pigmented villonodular synovitisin the index MARGINAL EXCISION

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