BenignVascular and Malignant Vascular Tumors

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Benign Vascular and Malignant Vascular Tumors


Earl W. Brien and Stuart H. Kuschner



History and Clinical Presentation


Case A. A 35-year-old right hand dominant woman complains of a painful mass about the tip of the index finger of 6 months’ duration. She states that the pain is aggravated by cold and often radiates proximally after tactile stimulation. She denies any history of trauma, puncture wounds, or fever.


Case B. A 55-year-old right hand dominant woman with a history of swelling about the left upper extremity after radical mastectomy and lymph node dissection 10 years prior complains of a painless, enlarging mass in the left hand of 4 months’ duration. She denies any history of trauma, puncture wounds, or fever.


Physical Examination


Case A. The patient has 1.5-cm, firm, nonmobile mass about the tuft of the index finger. The lesion revealed a blue-red hue subungual. She has lancinating pain proximally upon pinprick about the digit. She has no proximal adenopathy and the remainder of her examination is within normal limits.


Case B. The patient has 2.5-cm dorsoradial wrist mass superimposed on a nonpitting, brawny edema. It is firm, superficial, nontender, and nonmobile, without any warmth or erythema. The lesion did not transilluminate and there was a purple hue about the skin. She has full range of motion of the wrist and hand and is neurovascularly intact to all digits. She has no proximal adenopathy and the remainder of her examination is within normal limits.


Diagnostic Studies


Case A. Anteroposterior, lateral, and oblique radiographs of the hand show a soft tissue mass about the tuft with a well circumscribed scalloping about the distal phalanx (Fig. 87–1).



Image

Figure 87–1. Well-circumscribed lesion, distal phalanx.



Image

Figure 87–2. Magnetic resonance imaging through the base of the hand of a dorsoradial mass.


Case B. Anteroposterior, lateral, and oblique radiographs of the hand show a soft tissue mass dorsally without calcification. Magnetic resonance imaging (MRI) (Fig. 87–2) reveals a 2.5-cm mass, intermediate signal on T1- and bright signal on T2-weighted imaging. Laboratory studies were unremarkable.


Differential Diagnoses


Case A


Glomus tumor


Melanoma


Inclusion cyst/foreign body granuloma


Infection


Metastatic squamous carcinoma of the lung


Case B


Ganglion cyst


Giant cell tumor of the tendon sheath


Soft tissue sarcoma


Other benign tumors


Atypical infection/synovitis


Inclusion cyst/foreign body granuloma


Pathologic Examination


Case A. Histopathologic examination revealed small round blue cells forming vascular structures in a myxoid stroma (Fig. 87–3). On high power (Fig. 87–4

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Mar 5, 2016 | Posted by in Hand surgery | Comments Off on BenignVascular and Malignant Vascular Tumors

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