Professor Dr Nakul Kumar Datta, Ex-Chairman, Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2023 Jan;32(1):135-143.
Tumors in the hand are relatively uncommon but 95% are benign. Tumors occurring in the hand, forearm and arm often have unique growth patterns and potential for metastasis that may be different from those seen elsewhere in the body. Secondary metastatic tumors in the hand are very rare (0.1%). Diagnosis is mainly clinical, but X-ray, USG and MRI help as a diagnostic aid. The aim of the study was to early diagnosis, see the pattern and proper management of the hand tumor and ensure good hand function. This prospective study was done from January 2004 to July 2019. We found 220 hand tumors in the hand unit, Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Bangladesh. Among 220 patients, male were 114(51.81%) and female were 106 (48.19%). Out of 220 patients we found 190(86.36%) benign tumor and tumor like lesions and 30(13.64%) was malignant hand tumors. Out of 190 benign lesions, benign tumor was 158(83.15%) and 32(16.85%) was tumor like lesions. Among 158 benign tumor, bone tumors were 40(25.31%) and soft tissue tumours were 138(74.69%). Out of soft tissue tumor, peripheral nerve tumor was 20(12.66%). Enchondroma and Giant cell tumors are the most common among the benign bone tumors, on the other hand giant cell tumors of tendon sheath, Glomus tumor, haemangioma, neurofibroma, schwanoma are the common soft tissue tumors. Compound palmar ganglion, fibromatosis and tuberculosis of phalanx are the most common tumor like lesions. Synovial sarcoma 10(33.33%), osteosarcoma 03(10%), chondrosarcoma 03(10%), ewings sarcoma 02(6.66%), fibrosarcoma 04 (13.33%), Malignant fibrous histocytoma 01(3.33%), soft tissue sarcoma 01(3.33%), Merkel cell tumor 01(3.33%), pleomorphic Rabdomyosarcoma 01(3.33%), malignant melanoma 01(3.33%), clear cell sarcoma of tendon and aponeurosis 01(3.33%), undifferentiated carcinoma 01(3.33%) and extra skeletal chondro sarcoma 01(3.33%) were the malignant tumors. Most of the benign lesions recovered fully after excision except neurofibroma and malignant tumors were treated with excision (including amputation) and chemo-radiotherapy successfully, but 4 patients were refereed to higher center due to recurrence and deteriation of hand function and one patient died due to metastasis. Malignant hand tumor management is very difficult even after amputation with multidisciplinary approach. Hand tumor is uncommon and malignant tumors are rare but any abnormal lump or bump in the hand or wrist is considered as tumor. Early detection and intervention are essential for better prognosis and survival for malignant tumors of hands and upper limbs.
手部肿瘤相对少见，但 95%为良性。手部、前臂和手臂的肿瘤往往具有独特的生长模式和转移潜能，这可能与身体其他部位的肿瘤不同。手部继发性转移性肿瘤非常罕见（0.1%）。诊断主要依靠临床，但 X 光、超声和 MRI 有助于辅助诊断。本研究的目的是早期诊断、了解手部肿瘤的模式和适当的管理，确保手部功能良好。本前瞻性研究于 2004 年 1 月至 2019 年 7 月在孟加拉国达卡的 Bangabandhu Sheikh Mujib 医科大学骨科手部科进行。在手部科，我们共发现 220 例手部肿瘤。220 例患者中，男性 114 例（51.81%），女性 106 例（48.19%）。在 220 例患者中，我们发现 190 例（86.36%）为良性肿瘤和肿瘤样病变，30 例（13.64%）为恶性手部肿瘤。在 190 例良性病变中，良性肿瘤 158 例（83.15%），肿瘤样病变 32 例（16.85%）。在 158 例良性肿瘤中，骨肿瘤 40 例（25.31%），软组织肿瘤 138 例（74.69%）。在软组织肿瘤中，周围神经肿瘤 20 例（12.66%）。软骨瘤和巨细胞瘤是最常见的良性骨肿瘤，另一方面，腱鞘巨细胞瘤、血管球瘤、血管瘤、神经纤维瘤、雪旺细胞瘤是常见的软组织肿瘤。复合性掌部神经节瘤、纤维瘤病和指骨结核是最常见的肿瘤样病变。滑膜肉瘤 10 例（33.33%）、骨肉瘤 3 例（10%）、软骨肉瘤 3 例（10%）、尤文肉瘤 2 例（6.66%）、纤维肉瘤 4 例（13.33%）、恶性纤维组织细胞瘤 1 例（3.33%）、软组织肉瘤 1 例（3.33%）、Merkel 细胞癌 1 例（3.33%）、多形性横纹肌肉瘤 1 例（3.33%）、恶性黑色素瘤 1 例（3.33%）、透明细胞肉瘤和腱膜 1 例（3.33%）、未分化癌 1 例（3.33%）和骨外软骨肉瘤 1 例（3.33%）为恶性肿瘤。大多数良性病变在切除后完全恢复，除神经纤维瘤和恶性肿瘤外，均成功采用切除（包括截肢）和化疗-放疗进行治疗，但 4 例患者因复发和手部功能恶化而转至上级中心，1 例患者因转移而死亡。即使采用多学科方法进行截肢，恶性手部肿瘤的治疗也非常困难。手部肿瘤并不常见，恶性肿瘤也很少见，但手部和腕部任何异常肿块或隆起都应视为肿瘤。早期发现和干预对于手部和上肢恶性肿瘤的预后和生存至关重要。
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