Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore.
Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore.
J Hand Surg Am. 2022 Jul;47(7):685.e1-685.e10. doi: 10.1016/j.jhsa.2021.06.010. Epub 2021 Jul 29.
Upper limb masses are one of the most common presentations in the outpatient setting. However, there is a paucity of information in the literature regarding the epidemiology of upper-extremity masses in the pediatric population. The aim of this study was to determine the differential diagnoses and clinical characteristics in children aged ≤18 years presenting with upper limb masses.
A retrospective review of patients aged ≤18 years managed at our institution over a 5-year period was performed. We obtained information on patient demographics, clinical features, radiological investigations, intraoperative features, and histology. We also evaluated the correlation between the clinical and histopathological diagnoses in patients who underwent surgery.
There were 141 upper limb masses in our series. The mean age at presentation was 12 years (SD, 5 years). The most common presenting complaints were asymptomatic swelling, pain, and paresthesia. The majority (128; 91%) of tumors were benign; there were 5 locally aggressive tumors and 6 malignant tumors. The dominant hand was involved in 60 patients. Of 140 patients, 43 (31%) patients had surgery. The procedures included incisional biopsy, excisional biopsy, wide resection, and reconstruction. One patient required a below elbow amputation for an osteosarcoma.
Ten percent of cases represented malignant or locally aggressive disease. We have used our observations to develop a clinical algorithm that can assist clinicians in evaluating and managing children and adolescents presenting with upper-extremity masses.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
上肢肿块是门诊最常见的表现之一。然而，关于儿科人群上肢肿块的流行病学，文献中信息很少。本研究的目的是确定≤18 岁儿童上肢肿块的鉴别诊断和临床特征。
对我院 5 年来≤18 岁患者进行回顾性分析。我们获得了患者人口统计学、临床特征、影像学检查、术中特征和组织学等信息。我们还评估了手术患者的临床和组织病理学诊断之间的相关性。
本系列有 141 例上肢肿块。发病时的平均年龄为 12 岁（标准差，5 岁）。最常见的首发症状是无症状肿胀、疼痛和感觉异常。大多数（128 例；91%）肿瘤为良性；有 5 例局部侵袭性肿瘤和 6 例恶性肿瘤。优势手受累 60 例。140 例患者中，43 例（31%）患者接受了手术。手术包括切开活检、切除活检、广泛切除和重建。1 例骨肉瘤患者需要行肘下截肢。
10%的病例为恶性或局部侵袭性疾病。我们根据观察结果制定了一个临床算法，可以帮助临床医生评估和治疗上肢肿块的儿童和青少年。
研究类型/证据水平：预后 IV。
