Benign Hand Soft Tissue Masses

Abstract

Objective: To evaluate soft tissue masses of the hand and the wrist with ultrasonography and to correlate radiological diagnosis with pathological findings. Material and Methods: Fifty-eight suspected benign soft tissue tumors of the hand were evaluated with ultrasound preoperatively, retrospectively over an 8-year period. The radiological diagnosis was then compared with histopathology. Results: There were 29 females (50.8%). The mean age was 50 ± 13.7 years (range, 17-76 years). Forty-two masses were in the right hand (72.4%). The locations included the triphalangeal fingers (53.4%), thumb (20.68%), hand (20.7%), and wrist (10.34%). The most frequent pathological diagnosis was giant cell tumors of tendon sheath (GCTTS; n = 18). Less frequent tumors were the epidermal inclusion cyst (n = 9), vascular tumors (n = 8), ganglion cyst (n = 7), fibromas (n = 5), lipoma (n = 3), granulomatous foreign body reaction (n = 2), nonspecific inflammation (n = 2), and only one case of mixoma, one of neurofibroma, one of fibrokeratoma, and one of gouty tophus. A preoperative sonography diagnosis was given in the 79% of cases, and this was discrepant with the definitive histological diagnosis in 36%. We compared the discrepant and the concordant diagnosis with the most experimented sonographers or the less experimented, and we did not found significant statistical differences ( P, .1). The tumor that was most likely to have a discrepant diagnosis was the epidermal inclusion cyst (38%), as well as with the clinical evaluation (22.2%) and the surgeons’ macroscopic evaluation (50%). Less frequent discrepant diagnosis were the fibromas (14.2%), followed by non specific synovitis (n = 2), GCTTS (n = 2), fibrokeratoma (n = 1), lipoma (n = 1), neurofibroma (n = 1), angioleiomioma (n = 1), and tophus (n = 1). We evaluate the sensitivity and specificity of sonography in the diagnosis of GCTTS with the 84.6% and the 69.7%, respectively ( P, .001). The vascular tumors (3 cases of angioleiomioma, 3 cases of glomic tumor, 1 case of angioma, and 1 case of pseudotumor due to trombosis) had better sensibility (83.3%) and specificity (97.5%) with sonography ( P < .0001), as well as ganglion cyst (sensibility, 83.3% and specificity, 90%; P, .005). Discussion: Sonography can help in the preoperative diagnosis of hand soft tissues masses but, according to our results, its specificity is low to establish the specific diagnosis. In most conditions, imaging findings are nonspecific, and diagnosis rests on pathologic evaluation.