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Research Article | DOI: https://doi.org/10.31579/2694-0248/057
1 Department of Orthopedic, Royal Rehabilitation Center, King Hussein Medical Center, Amman, Jordan.
2 Department of Pathology, Princess Iman Research Center, King Hussein Medical Center, Amman, Jordan.
*Corresponding Author: Ahmad Almigdad, Department of Orthopedic; Royal medical Services; Amman – Jordan.
Citation: Ahmad Almigdad, Mohammad Al-Alwan, Yasmin AlSaidat, Ali Al-Qudah, and Yasmeen ALSoboh, (2023), Bony and Soft Tissue Hand Tumors, J. Clinical Orthopedics and Trauma Care, 5(2); DOI:10.31579/2694-0248/057
Copyright: © 2023 Ahmad Almigdad, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 23 February 2023 | Accepted: 08 March 2023 | Published: 22 March 2023
Keywords: hand tumor; biopsy; histopathology; bone; soft tissue; Jordan
Background: The hand is a common site of tumors and tumor-like pathology. This study aimed to evaluate hand tumors and their distribution regarding age, gender, and histopathological characteristics to promote better understanding and aid in diagnosis.
Material and Methods: A total of 261 incisional or excisional biopsies for hand tumors were reviewed retrospectively from January 2017 to December 2022 at Princess Iman Research Center. The tumor was assessed according to the tumor origin, and histopathological diagnosis was analyzed regarding age and gender to find the correlation. Biopsies with more than one possible diagnosis and excised hand tumors that were not sent to a pathologist were not included.
Results: Soft tissue tumors represented 93.5% and bone tumors 6.5% of all hand tumors. Malignant tumors were reported in 6.1%. Tendon sheath (19.2%) and synovial (17.6%) origin tumors were the most common types, followed by skin (13%) and vascular (12.6%) tumors. Giant cell tumor was the most common hand tumor type (18.8%), followed by Ganglion cyst (16.5%). Enchondroma was the most common bone tumor (3.1%), and squamous cell carcinoma was the most common malignant tumor in hand. There was no difference in the distribution of tumors between different gender and ages.
Conclusions: Although ganglion is the most common hand tumor in all reports, in our study, it was the second most common after the Giant cell tumor of tendon sheath because many surgeons depended on the clinical picture alone. Multicenter studies and other study designs, such as clinical and radiological evaluation, are required for a better understanding of the distribution of hand tumors.
Running Title: Hand Tumors
The hand represents 2% of total body surface area and 1.2% of total body weight [1]. However, it is a common site of tumors and tumor-like pathology, and soft tissue tumor of the hand represents 15% of body soft tissue tumors [2]. Hand tumors are recognized early due to superficial location and easy palpation. Therefore, hand tumors are more frequently surgically treated [3].
Hand tumors may originate from different embryological precursors and, therefore, can differentiate into different structures, including bone, cartilage, muscle, tendon, synovium, skin, vessels, and nerves [5]. According to the World Health Organization (WHO) classification, soft tissue and bone tumors, tumors are classified based on their resemblance to their normal counterpart. Tumor-like lesions or pseudotumors originated from different structures and are not true neoplasms [6].
Although diagnosis can be reached based on clinical and radiological features, a biopsy is a definitive test to confirm the diagnosis. On many occasions, it is difficult to differentiate benign and reactive lesions from malignant and aggressive tumors only on clinical presentation. Therefore, orthopedic clinicians should be familiar with hand tumors and refer suspicious tumors to specialized units for proper treatment because simple tumor excision may compromise the outcome.
Studies are limited in Jordan regarding hand tumors. Therefore, this study aimed to evaluate hand tumors and their distribution regarding age, gender, and histopathological characteristics to promote better understanding and aid in diagnosis.
The hand represents 2% of total body surface area and 1.2% of total body weight [1]. However, it is a common site of tumors and tumor-like pathology, and soft tissue tumor of the hand represents 15% of body soft tissue tumors [2]. Hand tumors are recognized early due to superficial location and easy palpation. Therefore, hand tumors are more frequently surgically treated [3].
Hand tumors may originate from different embryological precursors and, therefore, can differentiate into different structures, including bone, cartilage, muscle, tendon, synovium, skin, vessels, and nerves [5]. According to the World Health Organization (WHO) classification, soft tissue and bone tumors, tumors are classified based on their resemblance to their normal counterpart. Tumor-like lesions or pseudotumors originated from different structures and are not true neoplasms [6].
Although diagnosis can be reached based on clinical and radiological features, a biopsy is a definitive test to confirm the diagnosis. On many occasions, it is difficult to differentiate benign and reactive lesions from malignant and aggressive tumors only on clinical presentation. Therefore, orthopedic clinicians should be familiar with hand tumors and refer suspicious tumors to specialized units for proper treatment because simple tumor excision may compromise the outcome.
Studies are limited in Jordan regarding hand tumors. Therefore, this study aimed to evaluate hand tumors and their distribution regarding age, gender, and histopathological characteristics to promote better understanding and aid in diagnosis.
In this retrospective, single-center study, we will include all patients who underwent incisional or excisional biopsies for hand tumors at Princess Iman Research Center (PIRC)/ King Hussein Medical City (KHMC) from January 2017 to December 2022. Sociodemographic data will be extracted from patients' records.
Princess Iman Research Center receives specimens from KHMC and all-district military hospitals in Jordan, which cover many Jordanian population insurances. Therefore, studies from the such center are representative. Each biopsy was evaluated by two histopathologists, first by a specialist for the diagnosis, then confirmed by a consultant.
The tumors were classified into soft tissue and bony origin. Tumors were further subdivided according to the tumor origin, such as skin, fat, muscle, nerve, vessels, synovium, bone and cartilage, and unknown origin. Histopathological diagnosis was analyzed regarding age and gender to find the correlation.
A total of 261 hand tumor specimens were evaluated. The study included all diagnostic or excisional biopsies confirming tumors and pseudotumors of the hand and a single diagnostic biopsy. Reports with more than one possible diagnosis were excluded, and excised hand tumors that were not sent to a pathologist were excluded.
The mean and standard deviation were used to describe the continuously measured variables, and the frequency and percentages were used to describe the categorically measured variables. The chi-squared test of independence was used to assess the correlations between categorically measured variables. The One-way ANOVA test was used to assess the statistical mean differences in metric variables across the levels of more than two categorical measured variables. The SPSS IBM V21 statistical data analysis program was used for the data analysis. The alpha significance level was considered at 0.050 level.
The mean and standard deviation were used to describe the continuously measured variables, and the frequency and percentages were used to describe the categorically measured variables. The chi-squared test of independence was used to assess the correlations between categorically measured variables. The One-way ANOVA test was used to assess the statistical mean differences in metric variables across the levels of more than two categorical measured variables. The SPSS IBM V21 statistical data analysis program was used for the data analysis. The alpha significance level was considered at 0.050 level.
Two hundred sixty-one hand tumor biopsy results were reviewed retrospectively. Table 1 summarizes findings for the patients' sociodemographic characteristics and histopathological origin. Females represented 52.5% of the study sample. More than half of the patients were aged 20 to 50, and their mean age was 37.86 (±18.763). Soft tissue tumors represent the majority of hand tumors, with a percentage of 93.5. tendon sheath tumors were the most common tumor origin, and two-thirds of tumors formed by tendon and tendon sheath, synovial origin, skin, and vessels. However, osseous and cartilaginous origin tumors represented 6.5% of all tumor types. Malignant tumors were reported in 16 histopathological results, representing 6.1%; Soft tissue malignancies of the hand accounted for 5.3% secondary to the inclusion of skin cancers, while bone tumors of the hand accounted for 0.8% of all hand tumors.
| Number | % | |
| Gender | ||
| Male | 124 | 47.5 |
| Female | 137 | 52.5 |
| Age Group | ||
| < 20> | 49 | 18.8 |
| 20 – 50 years | 148 | 56.7 |
| > 50 years | 64 | 24.5 |
| Extremity | ||
| Right | 147 | 56.3 |
| Left | 114 | 43.7 |
| Tumor origin | ||
| Soft tissue | 244 | 93.5 |
| Bone | 17 | 6.5 |
| Grade | ||
| Benign | 245 | 93.9 |
| Malignant | 16 | 6.1 |
| Histopathological origin | ||
| Tendon and tendon sheath | 50 | 19.2 |
| Synovial origin | 46 | 17.6 |
| Skin | 34 | 13.0 |
| Vessels | 33 | 12.6 |
| Nerve origin | 22 | 8.4 |
| Fibrous Producing | 20 | 7.7 |
| Inflammatory | 19 | 7.3 |
| Fat Producing | 15 | 5.7 |
| Chondroid producing | 9 | 3.4 |
| Osteoid producing | 8 | 3.1 |
| Muscle Origin | 3 | 1.1 |
| Mesenchymal cells | 1 | 0.4 |
| Unknown Origin | 1 | 0.4 |
Table 1: Hand tumors descriptive analysis, N= 261.
Table 2 compares the mean age of patients with different tumor origins. Patients with soft tissue tumors are older than patients with bony tumors.
However, skin tumor patients had the highest mean age (50.09 ±23.253) followed by fat-origin tumors, while chondroid-origin tumors are younger. However, there was no statistical significance for other tumor origins.
| Mean age (SD) | P-value | |
| Total patients | 37.86 (±18.763) | 0.04 |
| Bone tumors | 25.29 (±12.403) | |
| Soft tissue Tumor | 38.74 (±18.834) | |
| Tendon and tendon sheath | 38.08 (±16.552) | 0.075 |
| Synovial origin | 37.07(±17.903) | 0.106 |
| Skin | 50.09 (±23.253) | 0.001 |
| Vessels | 36.67 (±18.508) | 0.131 |
| Nerve origin | 32.18 (±13.588) | 0.416 |
| Fibrous Producing | 34.80(±18.323) | 0.246 |
| Inflammatory | 37.58 (±18.919) | 0.127 |
| Fat Producing | 43.40 (±19.748) | 0.026 |
| Chondroid producing | 26.33(±14.705) | 0.026 |
| Osteoid producing | 24.13(±10.077) | 0802 |
| Muscle Origin | 23.33 (±11.150) | 0.804 |
| Mesenchymal cells | 51.00 | 0.198 |
Table 2: Mean age of different tumor origins.
The giant cell tumor of the tendon sheath was the most common and accounted for 18.8%, followed by a ganglion cyst (16.5%). Granuloma, lipoma, and traumatic neuroma accounted for 6.1%, 5.4%, and 4.6%, respectively, see table 3. There was no difference in the distribution of the tumors between gender, Figure 1. Similarly, there was no difference in the distribution of different tumors between different age groups except for skin and vessel-origin tumors, Figure 2. Skin tumors tend to occur in older patients, while vessel-origin tumors occur more frequently in patients between 20 and 50, table 4.
| Tumor origin | Diagnosis | Total (%) | Male (%) | Female (%) | P-value |
| Soft Tissue tumors | |||||
| Fat | Lipoma | 14 (5.4) | 6 (42.9) | 8 (57.1) | 0.268 |
| Fat necrosis | 1 (0.4) | 1 (100) | 0 | ||
| Fibrous | Fibroma | 11 (4.2) | 8 (72.7) | 3 (27.3) | 0.430 |
| Fibrosis | 5 (1.9) | 2 (40) | 3 (60) | ||
| Dermatofibroma | 2 (0.8) | 1 (50) | 1 (50) | ||
| Fibromatosis | 1 (0.4) | 0 | 1 (100) | ||
| Chondromyxoid fibroma | 1 (0.4) | 0 | 1 (100) | ||
| Muscle | Myositis ossificans | 3 (1.1) | 1 (33.3) | 2 (66.6) | 0.137 |
| Nerve | Neuroma | 2 (0.8) | 0 | 2 (100) | 0.093 |
| Schwannoma | 6 (2.3) | 2 (33.3) | 4 (66.6) | ||
| Traumatic neuroma | 12 (4.6) | 9 (75) | 3 (25) | ||
| Plexiform neurofibroma | 2 (0.8) | 0 | 2 (100) | ||
| Synovium | Ganglion cyst | 43 (16.5) | 18 (41.9) | 25 (58.1) | 0.356 |
| Synovial cyst | 3 (1.1) | 0 | 2 (100) | ||
| Tendon and tendon sheath | GCT of the tendon sheath | 49 (18.8) | 17 (34.7) | 32 (65.3) | 0.178 |
| Calcifying aponeurotic fibroma | 1 (0.4) | 1 (100) | 0 | ||
| Vessels | Arteriovenous Malformation | 4 (1.5) | 1 (25) | 3 (75) | 0.211 |
| Hemangioma | 11 (4.2) | 6 (54.5) | 5 (45.5) | ||
| Cavernous hemangioma | 3 (1.1) | 1 (33.3) | 2 (66.6) | ||
| Glomus tumor | 3 (1.1) | 3 (100) | 0 | ||
| Cherry angioma | 1 (0.4) | 1 (100) | 0 | ||
| Angiomyoma | 1 (0.4) | 1 (100) | 0 | ||
| Epithelioid hemangioendothelioma | 1 (0.4) | 0 | 1 (100) | ||
| Hemangiopericytoma | 2 (0.8) | 2 (100) | 0 | ||
| Masson Hemangioma | 2 (0.8) | 1 (50) | 1 (50) | ||
| Vascular hamartomas | 1 (0.4) | 0 | 1 (100) | ||
| Inflammatory | Granuloma | 16 (6.1) | 8 (50) | 8 (50) | 0.274 |
| Abscess | 2 (0.8) | 0 | 2 (100) | ||
| Rheumatoid nodule | 1 (0.4) | 0 | 1 (100) | ||
| Mesenchymal cells | Ewing Sarcoma | 1 (0.4) | 0 | 1 (100) | 0.159 |
| Unknown origin | Epithelioid Sarcoma | 1 (0.4) | 0 | 1 (100) | 0.467 |
| Skin | Epidermal inclusion cyst | 12 (4.6) | 10 (83.3) | 2 (16.7) | 0.168 |
| Squamous cell carcinoma | 10 (3.8) | 5 (50) | 5 (50) | ||
| Nevus | 4 (1.5) | 3 (75) | 1 (25) | ||
| Malignant melanoma | 1 (0.4) | 0 | 1 (100) | ||
| Others | 7 (2.7) | 2 (28.6) | 5 (71.4) | ||
| Bone tumors | |||||
| Cartilage | Enchondroma | 8 (3.1) | 6 (75) | 2 (25) | 0.571 |
| Nora lesion | 1 (0.4) | 1 (100) | 0 | ||
| Bone | Osteochondroma | 3 (1.1) | 2 (66.6) | 1 (33.3) | 0.255 |
| Osteomyelitis | 2 (0.8) | 2 (100) | 0 | ||
| Fibroblastic osteosarcoma | 1 (0.4) | 0 | 1 (100) | ||
| Osteoid osteoma | 1 (0.4) | 0 | 1 (100) | ||
| Simple bone cyst | 1 (0.4) | 0 | 1 (100) | ||
| * Numbers within the brackets represent the percentage of all tumors in the "Total" column and the percentage within the same category in the other columns. | |||||
Table 3: Bivariate analysis of different tumors with gender.
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