Abstract
Lesions occurring in them are infrequently reported. In this retrospective study, we analyze all types of lesions affecting bones of the hands or feet, including infections and inflammatory conditions, benign and malignant tumors, and tumor like lesions, correlating clinical, pathologic and biopsy findings. Out of 50 lesions included in the study, infections/ inflammatory lesions constituted 46.0%, benign tumors 32.0%, malignant tumors 12.0%, and tumor like lesions 10.0%. Osteomyelitis was the most common lesion in this series, accounting for 44% of the cases. In other study also it is the commonest lesion. Walking barefoot and Diabetes mellitus constitutes a significant predisposing risk factor for osteomyelitis of the foot. Tuberculosis constitutes the major cause of osteomyelitis in India hence higher incidence of tuberculous osteomyelitis in the small bones of the hands or feet as compared to that in the West. Benign tumors were more common than malignant tumors in our series, GCT constituting 43.8% of benign tumors. Chondrosarcoma was the most common malignant tumor. Metastatic bone lesions and hematologic neoplasms were not seen in our study. Bones of the hands and feet are the most common extragnathic sites for GCR. Three such cases with typical histologic features were diagnosed in bones of the hand. It was difficult to differentiate them clinically and radiologically from GCT. This is important in view of the lower recurrence rate in the former compared to the latter. The only other 3 cases of GCR reported during the study period were located in the mandible. In view of overlapping ultrastructural and light microscopic features, as well as similar biologic behavior, aneurysmal bone cyst and giant-cell reparative lesions are thought to represent related responses to intraosseous hemorrhage. Florid reactive periostitis is a reactive process that predominantly involves the bones of the hands or feet, mostly in young women, and a history of minor trauma is seen in less than half of the cases. Similar clinical findings were noted in our patient as well. The importance of this entity lies in the possibility of it being misdiagnosed as a malignant lesion, especially osteosarcoma. Such a lesion was not seen in any other bone in our institution during the study period. Conclusion: Lesions of the bones of the hands or feet are uncommon. Infections/inflammatory lesions are more common in India. Benign tumors were more common than malignant tumors in our series. Giant cell tumor is the commonest neoplastic lesion. . Awareness and correlation of clinical, radiologic, and pathologic features help in making correct diagnoses Keywords: Hand Swelling, Foot swelling, Neoplasia in Hand, Neoplasia in foot
Highlights
The bones of the hands and feet constitute more than half of the bones in the human skeleton (106/206), but lesions occurring in them are infrequently reported. [1,2] If we review the literature of neoplastic swellings there are very few studies regarding this. [3,4] many of the lesions that occur in the rest of the skeletal bones can occur in the bones of the hands or feet, the distribution and frequency differ
Of the 50 lesions included in the study, infections/ inflammatory lesions constituted 23 (46.0%), benign tumors 16 (32.0%), malignant tumors 6 (12.0%), and tumorlike lesions 5 (10.0%)
Benign tumors were more common than malignant tumors in our series, similar to other reported series where cartilage-forming tumors were the most common. [1,3,4,13] Benign cartilage-forming tumors (n = 8) including enchondroma, chondroblastoma, periosteal chondroma, and osteochondroma constituted the largest group; Giant cell tumor (GCT) (n = 7) was the single most common benign tumor, constituting 43.8% of benign tumors involving bones of the hands or feet
Summary
The bones of the hands and feet constitute more than half of the bones in the human skeleton (106/206), but lesions occurring in them are infrequently reported. [1,2] If we review the literature of neoplastic swellings there are very few studies regarding this. [3,4] many of the lesions that occur in the rest of the skeletal bones can occur in the bones of the hands or feet, the distribution and frequency differ. The bones of the hands and feet constitute more than half of the bones in the human skeleton (106/206), but lesions occurring in them are infrequently reported. [3,4] many of the lesions that occur in the rest of the skeletal bones can occur in the bones of the hands or feet, the distribution and frequency differ. Metastatic lesions and myeloma are extremely uncommon, whereas florid reactive periostitis and bizarre periosteal osteochondromatous proliferation are peculiar to the bones of the hands and feet. We analyze all types of lesions affecting bones of the hands or feet, including infections and inflammatory conditions, benign and malignant tumors, and tumorlike lesions, correlating clinical, pathologic and biopsy findings features so as to calculate the prevalence of neoplasia in these swellings
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