Diagnosis and tactics of surgical treatment of foot tumors. What is bone osteoma and what danger does it pose?

It occurs in 1.9% of cases of neoplasms and dysplasia. Osteoma refers to benign primary skeletal tumors, the simplest in histological structure. This type of tumor does not replicate normal bone in its structure, but is very close to it.

Osteomas are true tumors that produce in their parenchyma bone tissue. The idea that an osteoma is an ossified fibroma or chondroma is incorrect. Bone exostosis as a manifestation of chondrodysplasia is not osteoma, the basis of which is not ossified tissue, but tumor cells of mature bone tissue.

Expansion of the concept of “osteoma”- a common mistake associated with misconceptions about this tumor and skeletal dysplasias undergoing calcification. Thus, in the book by I. G. Lagunova “Tumors of the Skeleton,” a series of radiographs of patients with ossified exostoses that arose due to exostotic chondrodysplasia and are incorrectly interpreted as osteomas is presented.

True, genetically osteoma is often congenital in nature, can be multiple and is combined with developmental defects. N.N. Petrov (1956) called osteomas “obviously embryonically prepared growths,” considering them tumors from embryonic rudiments. T. P. Vinogradova (1962) noted that most osteomas are malformations of bone tissue, and not true tumors.

At the same time, some osteomas develop in the postnatal period, are not associated with developmental defects and are not calcification of any dysplastic lesion, but the true development of tumor bone cells. There are compact, spongy and mixed (medullary) osteomas. We cannot confirm the indications of the predominant frequency of cancellous osteomas over compact ones (I. G. Lagunova, 1962), since in our observations only one patient had histologically proven cancellous osteoma.

In other cases, the number of compact and mixed forms was the same. Osteomas are most often localized along the edge of the bone; only once we encountered endosteoma. In the patients with osteomas we observed (29 people, of which 18 boys and 11 girls), the tumor was most often located in the nail phalanx of the first toe (in 11 patients), tibia (in 7), skull (in 6 patients, in one with multiple lesions).

One child had a tumor in the ulna, one in the talus, one in the metatarsal bone and in two - in the middle phalanx of the second finger of the hand. The children ranged in age from 4 to 15 years. We could not confirm the predominant localization of osteomas in the bones of the cranial vault, which is indicated in the literature. Osteomas nail phalanx the thumb was located on a narrow pedicle, osteomas of long tubular bones and the skull were located on a wide base.

Osteoma- a benign tumor consisting of mature bone tissue with a compact and spongy structure.

Clinical picture. The transition of normal bone tissue into a tumor does not have clear boundaries (Fig. 122). Osteoma grows slowly, pain or functional disorders depend on the location of the tumor and its compression of surrounding tissues. Most often, osteoma is located on the terminal phalanx of the first toe (Fig. 123), grows upward and somewhat medially, lifting nail plate. Gradually, pain arises from the pressure of shoes on the soft tissues covering the tumor.

The second most common location of osteoma is the bones of the skull. In this case, the tumor has a wide base and grows slowly, so it is diagnosed more often in older children or adult patients. Osteoma can grow into the inner plate of the bones of the cranial vault, put pressure on the membranes and substance of the brain, cause headache and functional disorders. The tumor may be localized in long tubular bones. Osteoma should be distinguished from juvenile exostoses associated with the growth zone, traumatic osteophytes, organized cephalohematoma, and excess callus.

Rice. 122. Osteoma of the humeral spine. X-ray.

Rice. 123. Osteoma of the terminal phalanx of the first toe of the left foot. X-ray.

Treatment. Radical tumor removal in a hospital setting. Incomplete removal of the tumor leads to relapse of the disease.

Nursery Guide polyclinic surgery.-L.: Medicine. -1986

For example, a tumor may be detected by x-rays performed for an injury. Benign tumors clearly defined, do not show a tendency to rapid growth and destruction of bone and soft tissue. Clinical manifestations are mild. Pain is not typical. Benign tumors go through the following stages of development:

Stages

• Stage 1: asymptomatic. They may be patent (do not proliferate) and in such cases no treatment is required.
• Stage 2: active process, often requiring surgery. Relapse is possible.
• Stage 3: aggressive process with destruction. Wide excision required.

Enchondroma

Typically a cartilage-forming tumor. Most often it appears on the hand (50% of all enchondromas are found in the bones of the hand). It is usually discovered accidentally after a pathological fracture. Similar tumors in large bones are unlikely; a single enchondroma of the hand almost never degenerates into chondrosarcoma.

Radiographs reveal well-demarcated osteolytic changes with cortical thinning.

Therefore, treatment of asymptomatic enchondromas is not indicated. If a patient comes in for a pathological fracture, they first wait for the fracture to heal, and then perform curettage and bone grafting.

Ollier's disease

Multiple enchondromas. Not inherited.

Mafucci syndrome

Multiple hemangiomas in addition to enchondroma. With multiple enchondromas, constant monitoring is necessary due to the possibility of their degeneration into chondrosarcoma.

Osteochondroma (exostosis)

Second most common benign bone tumor(after non-ossifying fibroma). The tumor grows from the metaphyseal region towards the diaphysis (from the adjacent joint). The cartilaginous head is similar in its histological picture to the growth zone and stops growing simultaneously with the bone.

Hereditary multiple exostosis

Autosomal dominant condition. Degenerates into chondrosarcoma in 1% of cases. Treatment by excision.

Epidermoid cyst

Occurs almost exclusively in the distal phalanges or bones of the skull. The pathogenesis is the same as that of epidermoid (or dermoid) cysts found in soft tissues: complex (crushing) injury in which the epidermal cells of the nail bed become trapped distal phalanx. Manifested by swelling of the fingertip. The cyst may be visible. Radiographs clearly show a pathological focus that replaces bone tissue, usually on one side of the phalanx. Treatment consists of excision (curettage) of the cyst and, if necessary, bone grafting.

Osteoid osteoma

Osteoid-producing neoplasm. The peak frequency occurs in the second decade of life. In general, the hand and wrist are not typical sites, but when a tumor occurs on the hand, the proximal phalanx is most often affected. There are descriptions of cases of osteoid osteoma in the carpal bones. It manifests itself as pain, which intensifies at night and is relieved by aspirin. Less than 10% of cases are painless. Pain characteristics may vary depending on location. The pain is dull and difficult to localize with osteoid osteoma of the carpal bones; with a tumor of the phalanx, it is sharp and easily localized. When the tumor is localized periarticularly, reactive swelling of the joint is possible, which is more pronounced when the finger is affected (causes dactylitis).

Survey

• Radiographs reveal a characteristic osteolytic focus surrounded by reactive sclerosis. The manifestation varies depending on the severity of the two components, that is, osteolysis and reactive sclerosis.
• Triphasic bone scanning with technetium 99 provides almost 100% sensitivity.
• CT is highly specific.
• MRI - allows you to differentiate hypervascular osteoid osteoma and other hypovascular conditions.

Treatment

• NSAIDs for pain relief. Remission is possible for a long period of time (2-20 years).
• Surgery: curettage or resection of the affected area of ​​bone. The key point is the exact intraoperative localization of the tumor, since after incomplete excision a relapse will develop. To reduce the consequences of surgical treatment, newer percutaneous techniques have been proposed, which include ablation through a drilled or trocar channel into the bone or radiofrequency ablation and laser treatment. Relapse occurs in 5-25% of cases.

Giant cell bone tumor

Locally aggressive tumor. Aneurysmal bone cyst, chondroblastoma, osteoid osteoma, and osteoblastoma are common in children. Giant cell reparative granuloma is also similar, but is characterized by spindle cells rather than giant cells. More common in women. Metastasizes to the lungs in approximately 2% of cases.

Symptoms and signs

Joint effusion and pain. A pathological fracture is also possible, although the tumor does not normally break through the articular cartilage into the joint cavity.

Survey

• X-ray: lytic changes in the area of ​​the epimetaphysis.
• X-ray of the chest organs to exclude metastases.

Treatment

Curettage, treatment of the tumor walls with a cutter and adjuvant chemoablation (auxiliary) using phenol, hydrogen peroxide or liquid nitrogen. The cavity is then filled with bone cement. Relapse rate is 10-25%. Therefore, wider excision of the tumor and surrounding soft tissue is recommended. With damage to the distal metaepiphysis radius bone grafting with an allograft or reconstruction using a free fibular graft is possible. Radiation therapy contraindicated, as it contributes to tumor recurrence.

Chondromyxoid fibroma

Rare tumor. It occurs predominantly in older men. Manifests mild pain And slow growth tumors. On radiographs it appears as a multilocular bone cyst. The histological picture may be misinterpreted as chondroblastoma or chondrosarcoma. Excision of the tumor with or without bone grafting is recommended.

Aneurysmal bone cyst

It is rare on the hand, but can develop in the phalanges, metacarpal bones and carpal bones. X-rays reveal bone expansion with the formation of septa and destruction of the cortical layer, which may give the impression malignant tumor. Differential diagnosis includes giant cell tumor of bone. Treatment should begin with a biopsy to exclude unnecessary extended resection, since these tumors do not need to be operated on; involution with the formation of a layer of reactive bone along the periphery is possible. Recovery can be accelerated by curettage and bone grafting.

Intraosseous ganglion

It is rare and is sometimes detected incidentally, as a finding on radiographs. May manifest as weakness and dull pain. The diagnosis is also determined by conventional radiography, but to clarify the shape and size, a CT or MRI is required. If detected accidentally and there are no symptoms, treatment is not necessary. Method of choice if there are complaints and clinical manifestations is curettage and bone grafting under X-ray control.

Tumors and tumor-like formations of bones

Rice. 83. Bone cyst of the distal phalanx of the fifth finger.

Clinically, the tumor manifests itself as a single, painful thickening of the phalanx without signs of inflammation and without damage to soft tissues and joints, without functional disorders. Doesn't suffer either general condition sick. The reason for referral is an injury with a pathological fracture of the phalanx, detected by radiography; less often, the thickening of the phalanx itself becomes painful. X-ray examination reveals characteristic features: the presence of a focus of clearing with smooth contours, located closer to the epiphysis, thinning of the cortical layer without a periosteal reaction. Inside the cyst, individual cells can be traced (Fig. 83), separated by more or less distinct partitions. Fibrous osteodystrophy develops in the transverse direction, gradually eccentrically moving apart and thinning the cortical layer. It is necessary to differentiate a bone cyst from giant cell tumor, sarcoma and osteomyelitis. Clinical and x-ray examination, with rare exceptions, allows you to clarify the diagnosis. A pathological fracture in the area of ​​a tumor-like formation is usually without displacement, without significant hemorrhage, little pain and almost no dysfunction. A pathological fracture heals and sometimes helps to cure osteodystrophy, so during this period there should be no rush to surgery. When rapid growth of the cyst or significant thinning of the walls is detected, indicating the possibility of a pathological fracture, surgical treatment is necessary. The operation consists of subperiosteal opening of the cyst, careful curettage of the cavity, sanitation, and filling it with bone chips taken from the iliac or tibial crest. For small cysts in the area of ​​the distal and middle phalanges, we tried simple subperiosteal compression of the cortical layer without filling the cavity or filled it with a hemostatic sponge. Recovery depends on the thoroughness of curettage and filling of the cystic cavity. The wound is sutured tightly; Depending on the location, one or another long-term immobilizing bandage is applied to the finger.

Only a doctor can diagnose and prescribe treatment during a face-to-face consultation.

Scientific and medical news about the treatment and prevention of diseases in adults and children.

Foreign clinics, hospitals and resorts - examination and rehabilitation abroad.

When using site materials, an active link is required.

Osteoma

Osteoma is a benign tumor that develops from bone tissue. It has a favorable course: it grows very slowly, never becomes malignant, does not metastasize and does not grow into surrounding tissues. Osteoma most often develops in patients of childhood and young age (from 5 to 20 years). There are several types of osteomas, differing in their structure and location. Osteomas are usually localized on outer surface bones and are located on the flat bones of the skull, in the walls of the maxillary, ethmoid, sphenoid and frontal sinuses, on the tibia, femur and humerus. The vertebral bodies may also be affected. Osteomas can be solitary, with the exception of Gardner's disease, which is characterized by multiple tumors and congenital osteomas of the skull bones, caused by impaired development of mesenchymal tissue and combined with other defects. Treatment of all types of osteomas is only surgical.

Osteoma

Osteoma is a benign tumor-like formation formed from highly differentiated bone tissue. It is characterized by extremely slow growth and a very favorable course. No cases of osteoma degeneration into a malignant tumor have been identified. Depending on the type, it may be accompanied by pain or be asymptomatic. When adjacent anatomical structures (nerves, vessels, etc.) are compressed, corresponding symptoms arise that require surgical intervention. In other cases surgical removal Osteomas are usually produced for cosmetic reasons.

Osteomas usually develop in childhood and adolescence. Male patients are more often affected (with the exception of osteomas of the facial bones, which more often develop in women). Gardner's syndrome, accompanied by the development of multiple osteomas, is hereditary. In other cases, it is assumed that the provoking factors may be hypothermia or repeated injuries.

Classification

Taking into account their origin, there are two types of osteomas in traumatology:

• Hyperplastic osteomas develop from bone tissue. This group includes osteomas and osteoid osteomas.
• Heteroplastic osteomas develop from connective tissue. This group includes osteophytes.

Osteoma is no different in structure from normal bone tissue. Formed on the bones of the skull and facial bones, including in the walls of the paranasal sinuses (frontal, maxillary, ethmoid, sphenoid). Osteoma in the area of ​​the skull bones is 2 times more common in men, in the area of ​​the facial bones – 3 times more often in women. In the vast majority of cases, single osteomas are detected.

With Gardner's disease, the formation of multiple osteomas in the area of ​​long tubular bones is possible. In addition, there are congenital multiple osteomas of the skull bones, which are usually combined with other developmental defects.

Osteomas themselves are painless and asymptomatic, but when they compress adjacent anatomical structures they can cause a wide variety of clinical symptoms - from visual impairment to epileptic seizures.

Osteoid osteoma is also a highly differentiated bone tumor, but its structure differs from normal bone tissue and consists of abundantly vascularized (rich in blood vessels) areas of osteogenic tissue, chaotically located bone beams and zones of osteolysis (destruction of bone tissue). Typically, osteoid osteoma does not exceed 1 cm in diameter. It occurs quite often and accounts for about 12% of the total number of benign bone tumors.

Can be located on any bones except the sternum and skull bones. Typical localization of osteoid osteoma is the diaphyses (middle parts) and metaphyses (transitional parts between the diaphysis and the articular end) of long tubular bones lower limbs. About half of all osteoid osteomas are detected on the tibia and in the area of ​​the proximal metaphysis of the femur. Develops in at a young age, is more often observed in men. It is accompanied by increasing pain that appears even before radiographic changes occur.

Osteophytes can be internal or external. Internal osteophytes (enostoses) grow into the medullary canal, are usually single (with the exception of osteopoikilosis, an inherited disease in which multiple enostoses are observed), are asymptomatic and become a random finding on an x-ray. External osteophytes (exostoses) grow on the surface of the bone and can develop as a result of various pathological processes or occur without apparent reason. The latter type of exostoses is often found on the facial bones, skull and pelvic bones. Exostoses can be asymptomatic, manifest as a cosmetic defect, or compress neighboring organs. In some cases, concomitant bone deformation and fracture of the exostosis leg are noted.

Heteroplastic osteomas can appear not only on bones, but also in other organs and tissues: at the sites of tendon attachment, in the diaphragm, pleura, brain tissue, membranes of the heart, etc.

Osteoma

The clinic of osteoma depends on its location. When osteoma is localized on the outer side of the skull bones, it is a painless, immobile, very dense formation with a smooth surface. Osteoma located on the inside of the skull bones can cause memory disorders, headaches, increased intracranial pressure and even cause the development of epileptic seizures. And osteoma, localized in the area of ​​the “sella turcica,” can cause the development of hormonal disorders.

Osteomas located in the paranasal sinuses can cause various eye symptoms: ptosis (drooping eyelid), anisocoria (different pupil sizes), diplopia (double vision), exophthalmos (bulging of the eyeball), decreased vision, etc. In some cases, obstruction is also possible respiratory tract on the losing side. Osteomas of long bones are usually asymptomatic and are detected when Gardner's disease is suspected or become an incidental finding during X-ray examinations.

The differential diagnosis of osteomas in the area of ​​the facial bones and skull bones is carried out with solid odontoma, ossified fibrous dysplasia and reactive growths of bone tissue, which can occur after severe injuries and infectious lesions. Osteomas of long tubular bones must be differentiated from osteochondroma and organized periosteal callus.

The diagnosis of osteoma is made on the basis of additional studies. At the initial stage, radiography is performed. However, such a study is not always effective due to the small size of osteomas and the peculiarities of their location (for example, on inner surface skull bones). Therefore, the main diagnostic method often becomes more informative computed tomography.

Depending on the location, osteomas are treated either by neurosurgeons or maxillofacial surgeons, or traumatologists. If there is a cosmetic defect or symptoms of compression of adjacent anatomical structures appear, surgery is indicated. In case of asymptomatic osteoma, dynamic observation is possible.

Osteoid osteoma

Most often, osteoid osteoma develops in the area of ​​the diaphysis of long tubular bones. The first place in prevalence is tibia, followed by the femur, fibula, humerus, radius and flat bones. Approximately 10% of the total number of cases are osteoid osteomas of the vertebrae.

The first symptom of osteoid osteoma is limited pain in the affected area, which initially resembles muscle pain in nature. Subsequently, the pain becomes spontaneous and becomes progressive. The pain syndrome with such osteomas decreases or disappears after taking analgesics, as well as after the patient “diverges”, but reappears at rest. If the osteoma is localized on the bones of the lower extremities, the patient can spare the leg. In some cases, lameness develops.

At the beginning of the disease no external changes not detected. Then a flat and thin painful infiltrate forms over the affected area. When osteoma occurs in the area of ​​the epiphysis (articular part of the bone), fluid accumulation may be detected in the joint.

When located near the growth plate, osteoid osteoma stimulates bone growth, so children may develop skeletal asymmetry. When osteoma is localized in the vertebral area, scoliosis can form. Both adults and children with this location may also experience symptoms of peripheral nerve compression.

The diagnosis of osteoid osteoma is made based on the characteristic X-ray picture. Typically, due to their location, these tumors are easier to see on x-rays than a regular osteoma. However, in some cases, difficulties are also possible due to the small size of the osteoid osteoma or its localization (for example, in the vertebral area). In such situations, computed tomography is used to clarify the diagnosis.

During x-ray examination under the cortical plate, a small rounded area of ​​clearing is revealed, surrounded by a zone of osteosclerosis, the width of which increases as the disease progresses. At the initial stage, a clearly visible boundary between the rim and the central zone of osteoma is determined. Subsequently, this boundary is erased, as the tumor undergoes calcification.

Histological examination of osteoid osteoma reveals osteogenic tissue with a large number of vessels. The central part of the osteoma consists of areas of bone formation and destruction with intricately intertwined beams and cords. In mature tumors, foci of sclerosis are detected, and in “old” tumors, areas of real fibrous bone are detected.

Differential diagnosis of osteoid osteoma is carried out with limited sclerosing osteomyelitis, osteochondrosis dissecans, osteoperiostitis, chronic Brodie's abscess, and less often - Ewing's tumor and osteogenic sarcoma.

Treatment of osteoid osteoma is usually carried out by traumatologists and orthopedists. Treatment is only surgical. During the operation, resection of the affected area is performed, if possible, together with the surrounding area of ​​osteosclerosis. Relapses are very rare.

Osteophytes

Such growths can occur for various reasons and differ from classical osteomas in a number of characteristics (in particular, origin). However, due to their similar structure - highly differentiated bone tissue - some authors classify osteophytes as osteomas.

Of practical interest are exostoses - osteophytes on outer surface bones. They can be shaped like a hemisphere, a mushroom, a spike, or even a cauliflower. Noted hereditary predisposition. Formations most often occur during puberty. The most common exostoses are the upper third of the leg bones, the lower third of the femur, the upper third of the humerus and the lower third of the forearm bones. Less commonly, exostoses are localized on the flat bones of the torso, vertebrae, and bones of the hand and metatarsus. They can be single or multiple (with exostotic chondrodysplasia).

The diagnosis is made based on X-ray and/or computed tomography data. When studying x-rays, it is necessary to take into account that the real size of the exostosis does not correspond to the x-ray data, since the upper, cartilaginous layer is not displayed on the images. Moreover, the thickness of such a layer (especially in children) can reach several centimeters.

Surgical treatment is carried out in the department of traumatology and orthopedics and consists of removing exostosis. The prognosis is good, relapses with single exostoses are rare.

Traumatology for everyone

Practical advice for injuries and diseases of the musculoskeletal system. Useful materials for doctors - traumatologists, orthopedists, surgeons.

Calendar

Revolver Maps

Receive new articles

Tumors of the hand

All types of tumors can develop on the hand and fingers, as an inseparable part of the human body, with the exception of those specific to nervous system neoplasms. From a pathological point of view, the appearance, development and outcome of tumors of the fingers and hand are no different from tumors of other parts of the body. Their specificity is explained more by the special soil (highly differentiated tissues, moving parts) on which they develop, and the small spatial capabilities that they have.

Aeller describes only 36 cases of tumors of the hand and fingers based on case material, Gurtl - 26 cases, and Redi - only 5 patient cases.

Distinguish the following types tumors of the fingers and hand, presented according to the simplest classification:

a) soft tissues; b) bones.

a) soft tissues; b) bones.

3. Metastatic tumors:

a) soft tissues; b) bones.

Benign tumors of the soft tissues of the fingers and hand.

These include various benign neoplasms arising from the epithelium, sweat glands, sebaceous glands and connective tissue of muscles, tendons and tendon sheaths, joint capsules, nerves and blood vessels. Some of them are not tumors in the full sense of the word, however, due to their tumor-like appearance, they will be discussed in this lecture.

Xanthomas are encapsulated tumors, cluster-shaped and ranging in size from 1 to 3 cm. Xanthomas are usually localized on the palmar side of the hand near the base of the fingers. They most often originate from the sheaths of the flexor tendons. Histological analysis reveals cells containing a lipoid substance, among which giant cells and foam cells located in the connective tissue stroma are found.

This tumor usually does not cause any particular dysfunction.

Pigment spots and pigment tumors

These are usually congenital skin changes. They are flat or raised above the skin level, covered in most cases with hairs. It is believed that each spot is potentially malignant and can degenerate into melanosarcoma. Treatment is expectant and, if the formation is localized in an area subject to friction, it is necessary to operate. When surgically removing it, you must be very careful, i.e., excise deep to healthy tissue or do not operate at all (if the localization of the tumor does not cause concern or an aesthetic defect).

These are quite rare tumors of the hand and fingers. They are localized deeper and covered with normal mobile skin. These formations originate from the fascia of the hand and fingers. The average size of these tumors is 1-5 cm. Fibromas are quite hard formations and can, by pressing on a nerve, cause neuralgic pain. Most often they are located on the palmar surface of the hand, as they come from the palmar aponeurosis.

Treatment - surgical removal.

Warts are mainly located on the back of the hand and fingers. They are benign papillomatous growths round shape, hard, protruding above the skin, ranging in size from 2 to 4 mm in diameter. In the central part of the wart there are several papillomatous processes. They are painless to the touch, but if you pick them, they begin to bleed and then the papillomatous formations are better visible.

Treatment consists of cauterization electric shock and removal.

This is the most common tumor-like formation of the hand, most often localized on the back of the hand. In the origin of the ganglion, the leading moment is trauma or physical activity. The neoplasm occurs as a result of the degeneration of connective tissue (Lidderhjse, Stanl). Arises

more often in women. It is an elongated formation located in the projection of a particular tendon. The consistency can be from soft, elastic to hard. The surrounding tissues do not prevent its displacement. The movement of the tendon in the canal causes mild pain (not to be confused with tenosynovitis!).

The contents of the ganglion appear to be a gelatinous mass, ranging from colorless to yellow-brown, depending on the “age” of the ganglion.

Treatment. Surgical treatment is the most effective. All other methods (puncture, drainage, crushing, etc.) usually lead to relapse.

Technique of operation. Local infiltration anesthesia. A straight or curved incision along the tendon away from it. Ganglion excision is a procedure that requires attention and accuracy. To avoid relapse, the changed tissue should be completely removed. Leaving even a small area can lead to relapse. After excision of the ganglion, the synovial vagina is not sutured; skin sutures. Immobilization of the hand and fingers is necessary only for the period until disappearance postoperative edema(4-5 days). In the future, careful development of movements is recommended, since otherwise cicatricial insufficiency of the affected tendon may occur. The removed part of the tendon sheath does not interfere with function if the movements are correctly developed.

A tumor-like formation is round in shape, 1-2 cm in diameter, rarely more. Hygromas are most often localized on the back of the wrist joint, but can also occur in other joints.

The origin of hygroma is from the joint capsule. IN initial stages the formation of a hygroma may have a connection with the joint cavity. A sign of a “young” hygroma is its disappearance when pressing with a finger or changing the position of the hand. In this case, the contents of the hygroma go through the anastomosis into the joint cavity. In old cases, the hygroma is often detached from the joint and is then often diagnosed as a ganglion. Sometimes the communication between the hygroma and the joint is maintained through a narrow stalk with a small hole. Patients are most concerned cosmetic defect. Like tendon ganglion, hygromas occur more often in women.

Treatment. Hygroma is subject to surgical treatment. Surgery consists of excision of the hygroma along with the walls and ligation of the pedicle, if any. Certain difficulties may arise if the leg of the hygroma goes under the extensor ligament of the wrist. In this case, the ligament can be partially resected (but no more than ? width), and then access to the pedicle opens. Dissection of the ligament to remove the hygroma is unacceptable! To reliably save the patient from relapse, as additional measure It is permissible to treat the bed of the removed hygroma with a bipolar electrocoagulator. The scar tissue that forms in this place will not allow the hygroma to form again.

Fig.1. Stages of hygroma removal surgery.

Subsequently, the load on wrist joint increase, gradually reaching full volume over 2-3 weeks.

Relapses at proper treatment are rare, although the formation of a hygroma of a different location within the same joint is in principle possible.

These are tumors made from fatty tissue. The formations are soft, subcutaneous. They are not always strictly limited and are located on the palmar surface of the hand. Often their sizes are significant. Lipomas can penetrate between the metacarpal bones and reach the dorsum of the hand. The hand becomes wider, fleshier, softer, plump, and the fingers also expand. At first, the function of the hand is almost preserved, but later it becomes more and more impaired. Fingers lose the ability to make subtle movements.

In differential diagnostic terms, one must remember about tuberculous tenosynovitis. It is characteristic that lipomas do not cause crepitations and palpable granularity, caused by the presence of rice-like bodies that appear with tuberculous tenosynovitis. Lipomas never pass through the carpal tunnel, which is very often observed with tuberculous tenosynovitis.

Treatment consists of removing the tumor.

These are vascular birth defects developments located in soft tissues. They often show through the skin. The most common locations for these lesions are the thenar, base of the thumb, and dorsum of the hand. The formations have a dough-like consistency, soft to the touch. Rarely are they harder and infiltrated. A characteristic symptom is pain. Pertusi and other authors believe that the pain is caused by compression of the nerve endings or a large branch of the nerve by the tumor mass. When the tumor mass penetrates any of the joints, its mobility is impaired. Most often, some joints of the thumb or the first carpometacarpal joint are affected. In the latter case, the opposition of the thumb is disrupted.

Treatment is difficult. Extirpation is not always radical and sometimes the entire segment has to be amputated.

It is also a tumor of the circulatory system. Normal glomus bodies are arteriovenous anastomoses. They play a role in heat regulation. Hypertrophy of these normal formations is called glomus tumor. The latter has a diameter of several millimeters. Localized in 70% of cases on upper limbs. 30% of tumors are located in the hand and forearm. Less often they are found on the palmar side of the 1st and 2nd phalanges. When a glomus tumor is located under the nail plate, due to the lack of space for development between the underside of the nail plate and the upper surface of the phalanx, the tumor may cause separation of the terminal phalanx. A characteristic symptom is severe pain, especially when pressed. Often, when pressing on a glomus tumor, the patient becomes ill (Kosh). Masson studied glomus tumors in detail. Therefore, this formation is also called Masson's tumor. Masson found that in addition to the arteriovenous anastomosis, nerve elements also participate in the glomus tumor, as a result of which he calls this tumor angioneuroma. The tumor has many autonomic and nerve endings, causing its exceptional pain. Malignant degeneration of the tumor is also possible.

Epidermoid or implantation cysts

Typically, such cysts are the result of epithelium implantation into the deep layers of the skin during an injection or wound. Although rare, epidermoid cysts have also been observed to be located in the bones, usually in the distal phalanx. Implantation cysts have also been described after finger amputation.

Treatment. Treatment consists of surgical removal of the cyst and filling the cavity.

Benign tumors of the bones of the hand and fingers

Benign tumors of the bones of the hand and fingers include bone cysts, enchondromas, osteomas, and myeloplax tumors.

Bone cysts in the area of ​​the hand and fingers are very rare. Only isolated cases are described. They are localized in the metaphyseal zones of the phalanges.

Clinical signs include mild pain, limited mobility of adjacent joints, and with a pathological fracture – pain and loss of function.

Treatment consists of curettage and filling the cavity with bone grafts.

Chondromas and enchondromas

These tumors are very similar to each other. Many authors divide them only by location - inside or outside the bone. The formations are cartilaginous tumors, emanating, according to String, exclusively from the separated cartilaginous cells of the epiphyseal cartilage of the phalanges and from the ossifying nuclei of the small bones of the hand.

There are multiple and single forms. Some authors believe that multiple chondromas are prone to malignant degeneration. This phenomenon has indeed been observed, but rarely. Therefore, chondromas of the hand are generally considered a benign tumor of a typical histological structure. Pathological bone fractures are often observed.

The X-ray picture is characteristic of both enchondroma and chondroma. The bone most often thickens symmetrically and is less often deformed.

Treatment consists of removing the tumor. Access to the tumor should be planned in such a way as to preserve the capsular-ligamentous apparatus of the joints and the tendons of the flexors and extensors of the fingers. This is a difficult but solvable task. Let's look at a few examples.

Fig. 2 The most common localization of enchondromas and the stages of their excochleation.

The tumor is located at the level of the middle phalanx, at its base. In this case, for access it is advisable to use not the rear, but the lateral access, passing along the midline of the finger. After dissecting the skin, the lateral portion of the extensor muscles, the triangular ligament, will be revealed interphalangeal joint. By moving the tendons of the lateral portion of the extensor volarly, and the central portion to the side, we obtain an area of ​​about 1 cm?. This is quite enough for excochleation of the tumor in such a hard-to-reach place.

The tumor originates from the base of the proximal phalanx. Access can be dorsolateral or lateral, along the midline of the finger. By moving the same tendons, we get a platform of 1.5 - 2.0 cm?. Removal of the tumor and filling of the cavity is carried out according to general rules.

The location of the tumor is near the metacarpophalangeal joint, on the metacarpal bone. The approach is planned so as not to come into contact with the extensor tendon of the corresponding finger. To do this, a linear incision is made in the intermetacarpal space, with ligation of all the veins of the dorsum of the hand at the level of the incision. Measures should also be taken to preserve the intertendon connections in this area, as they prevent tendon dislocation.

Having gained access to the changed area of ​​the bone, you should use a sharp narrow chisel to form a “window”, possibly larger size, through which excochleation or parietal resection of the changed part of the bone is performed. Dental carbide burs can provide significant assistance in this regard. Fixed in a small-sized drill or directly in the handpiece of a drill, they allow for high-quality treatment of the cavity. Subsequently, the cavity can be filled with muscle, bone autograft or bone chips. There is evidence of the usefulness of filling such cavities with enzymes (lidase, chymotrypsin, etc.). By dissolving tumor remnants, they promote good bone tissue restitution even without bone grafting. If bone grafting is still performed, it deserves special attention selection of the donor bone collection area. Taking into account the small volume of bone tissue required to fill the bone cavity, it is not advisable to use a wing ilium. You can use a site that is quite suitable for such purposes. It is located in the region of the metaepiphysis of the radius under the extensor carpi radialis. From a linear approach (about 3 cm), the tendon is removed from the canal and taken onto a holder. A part of the synovial membrane with the periosteum is cut out in a U-shape (they cannot be separated!). Under this “valve”, an autograft of the required size is taken using a grooved chisel. If necessary spongy bone can be additionally extracted with a bone spoon in the required volume. After this, the “valve” is placed in place and fixed with 2-3 sutures with absorbable material. The tendon is also placed there. The synovial membrane is also sutured with 2-3 sutures using absorbable thread. The advantage of this method is that it does not require anesthesia of another segment where the autogenous bone is supposed to be taken, bone material best suits the needs of this type of bone grafting. It was not by chance that we chose the extensor carpi radialis. This is a powerful muscle with a thick tendon and, with proper guidance to the patient, postoperative period It is easy to maintain radial wrist extension movements. The scars on the tendon that form after such an operation are small and easily stretchable. In some cases, when a tumor destroys the articular end of a particular bone, it is necessary to perform arthrodesis using a thick cortical autograft. In this case, it is also convenient to use a section of the diaphysis of the radial bone, which is cut out with a circular or oscillating saw. Arthrodesis is performed by placing the finger in a comfortable functional position.

Relapses are possible even with a well-performed operation, but they are not observed often.

Osteomas are tumors with a hard consistency. Most often, eburnate osteoma is localized in the area of ​​the hand, and very rarely, the spongy form of osteoma is localized. Lesions most often involve the metacarpal bones. Osteomas do not recur.

Myeloplax tumors are relatively rarely localized in the area of ​​the hand and fingers. They are expressed in cystic swelling of the bone, swelling of soft tissues and cause the patient a mild feeling of warmth and pain. The function of the hand is impaired to a greater or lesser extent. When the tumor grows significantly, the bone easily breaks and the tumor masses penetrate into the soft tissue.

Malignant tumors of the hand and fingers

Malignant tumors of the soft tissues of the hand and fingers

Primary skin cancer is rare. These are tumors localized

only on the back of the hand. They begin as hyperkeratosis and gradually ulcerate. Tumor masses spread both over the surface of the skin and deep into it. Necrotic tissue is sloughed off and wide and deep ulcers with raised edges are formed. The ulcers become infected and emit an unpleasant odor.

A typical localization of epidermal malignant tumors of the hand is the subungual bed of the thumb - carcinoma subunguale.

Treatment consists of extensive excision to healthy tissue or amputation with removal lymph nodes in the elbow crease and under the armpit.

These tumors are also very rare. They initially appear as a swelling, which quickly increases in size. At first, they are very similar to fibromas and have almost the same initial localization as them - they are located in the fascial connective tissue. However, over a few months their size increases greatly. The function of the hand is impaired. The brush becomes deformed. At this stage, patients experience severe pain.

Less common are the so-called paraosseous sarcomas, which arise from the periosteum of the hand bones. These tumors straddle the line between soft and osteogenic tumors.

Surgical treatment is removal of the tumor.

This type of sarcoma comes from the connective tissue elements of blood vessels. Kaposi (1872) describes it as follows: “Dark red nodules with a smooth surface and a spongy structure appear on the skin. The arms and legs are the favorite locations for this tumor. The changes may spontaneously disappear and pigmented scars remain in their place. The disease is most common among men aged around 40 years, mainly in Eastern Europe.”

The histological picture of the tumor varies depending on the stage of observation. The description given here is done in the most general outline. In the first stage, many capillaries are found. In the endothelial cells of these capillaries, many mitotic figures are established. The walls of the vessels are thickened, and its lumen is expanded. Lymphatic vessels dilated and form cysts. Between the capillaries there are connective tissue bundles with elongated cells with spindle-shaped nuclei. Some authors consider them tumor cells, while others simply connective tissue cells (Koi Ruffani et al.).

One of characteristic features The tumor is caused by the appearance of dark spots of pigmented hemosidern. They are the result of the breakdown of red blood cells in connective tissue. Metastases are often observed. The prognosis is often poor.

Treatment is carried out with arsenic preparations.

Synovioma (sarcoma, sarcoendothelioma) is a tumor that originates from tendon sheaths and joint capsules. Clinically it is expressed as a tumor of soft consistency with unclear contours. Prone to relapse. Rarely metastasizes. It occurs more often in young people and children.

At differential diagnosis it should be distinguished from specific tendovaginitis and tuberculous synovitis. Synovioma manifests itself in in rare cases and how benign neoplasm.

Treatment consists of extirpation, and in advanced cases and relapses, amputation.

Malignant tumors of the bones of the hand and fingers

This is almost the only bone tumor that is primarily observed in the bones of the hand. Fortunately, sarcoma is very rare in this area. Characterized by clinical signs other malignant bone tumors – rapid development, pain, etc. The same can be said about chondrosarcoma.

Benign chondroma and myeloplax tumor can also degenerate into malignant, as mentioned above.

Metastatic tumors of the hand and fingers are extremely rare and therefore have little practical significance. Guerin collected 30 cases of metastases in the hand area from the literature. Of course, this figure is not true. In their works on tumors of the bones of the hand, Martinelli and Marconi describe 2 more cases, and Lochovski and Pavlansky from Czechoslovakia report another case of metastases to the lunate bone in pulmonary cancer.

These are small tumors, sometimes without external signs. X-rays for vague pain reveal a focus of destruction, and histological examination shows that we're talking about about metastasis. In this way, it is possible to find out the nature of the primary tumor and, if it has not been identified, to establish its presence.

Concluding the conversation about tumors of the hand and fingers, I would like to emphasize that the treatment of these diseases is very challenging task in most cases. This is due to the close anatomical and physiological relationships between the important structures of the hand and fingers, and the absence of any supply of soft tissue. Of course, treating malignant tumors of the hand and fingers is an extremely difficult task, however, these tumors themselves are quite rare, and they are most often treated by specialists - oncologists. All you have to do is “just” recognize the disease in time and refer the patient to an oncologist.

The situation is much more complicated with benign neoplasms of this localization. Any practicing surgeon encounters such diseases quite often in his work, and only knowledge of the pathology, coupled with the anatomy of the segment, will allow you to feel confident during treatment and avoid recurrence of hygromas, tendon ganglia, achieve radicality and preservation of function in the treatment of enchondromas, and so on.

Osteoma is a benign neoplasm. What it is and what the consequences of its appearance may be will be discussed in this article.

During the formation of physiological tissues, many different disturbances can occur, resulting in the appearance of tumors. They are classified into benign and malignant. Appearance benign education does not affect the functionality of the body. Malignant ones can cause disruption of the functionality of organs and systems in which they are localized, which is fraught with unexpected and undesirable consequences.

Osteoma is a disease caused by the formation of a benign tumor from bone tissue, characterized by slow development and resembling a hemisphere in appearance. Previously, this disease included all formations of bone tissue that appeared as a result of trauma, inflammation, neurotic manifestations, and blastomatosis.

Such a tumor can appear in different places. The neoplasm can be localized on the bone tissue of the skull, facial skeleton, thumbs legs, hips, shoulders. In most cases they are single, but sometimes multiple occurrences are observed. The neoplasm can be hard, spongy, or brain-like.

There are 2 types of tumor:

• Hyperplastic - a tumor developing from bone tissue.
• Heteroplastic - connective tissue neoplasm.

Osteoma is a disease characterized by a benign course. The neoplasm does not metastasize and does not grow into nearby organs and tissues.

Sometimes the disease is latent and is discovered by chance during an X-ray during a routine preventive examination. Its development mainly occurs in childhood, puberty (from five to 20 years). In most cases, such tumors develop in men.

Why is osteoma dangerous? Education can be quite painful, but that's not the only problem. Sometimes the tumor reaches enormous sizes, which leads to compression of nearby tissues, vessels, and nerves. Then immediate surgical intervention is required.

Causes

Scientists do not always agree on the reasons for the appearance of osteomas. The main ones are considered to be:

• hereditary predisposition;
• injuries;
• past infections;
• syphilis;
• gout;
• rheumatism;
• insufficient amount of calcium in the body.

As for genetic predisposition, according to statistics, about 50% of patients suffer from tumors for this reason.

Classification

All clinical manifestations of this neoplasm depend on its location.

1. Osteoma, formed on the outside of the skull, is a painless and immobile dense tumor with a smooth surface.
2. The same tumor only inside the skull leads to memory impairment, headaches, increased intracranial pressure and even epileptic seizures.
3. The appearance of osteoma in the area of ​​the paranasal sinuses is fraught with ptosis, anisicoria, diplopia, exophthalmos, and blurred vision.
4. There is a formation in the ilium, which most often appears due to tissue developmental disorders and other defects.
5. A neoplasm in the head region can be localized in the frontal, parietal or occipital region. Such tumors in the temporal bone and occipital parts heads do not cause concern if they are located on the outside of the skull. Their internal development often leads to serious hormonal disorders due to their close proximity to the pituitary gland.
6. The formation on the legs is characterized by pain and is often accompanied by lameness of the patient.

Symptoms

The symptoms of osteoma directly depend on the location of the tumor. Accordingly, they manifest themselves in different ways. The appearance of a tumor on the inside of the skull causes the following symptoms:

• headaches resulting from increased intracranial pressure;
• epilepsy attacks;
• memory impairment;
• nervous system disorders;
• general poor health.

Localization of osteoma in the area of ​​the paranasal sinuses is accompanied by:

• eye diseases, blurred vision;
• pain in the spine, with significant growth of osteoma, a feeling of compression and deformation appears;
• hearing loss;
• impaired sense of smell.

Sometimes, due to osteoma, serious hormonal disruptions occur in the body.

In most cases, a benign neoplasm is accompanied by mild symptoms. Pain is felt if the tumor obstructs the movement of bones or puts pressure on a nerve.

Large osteomas, localized on the long tubular bones of the legs, are accompanied by lameness and pain when moving.

Diagnostics

If the pathology progresses calmly, the neoplasm can be detected by x-ray. More often than not, a tumor is discovered completely by accident.

Since the symptoms of the disease are usually mild, it is important for the doctor to pay attention to the patient’s complaints. At the slightest suspicion of osteoma, radiography is prescribed. With its help, a tumor is recognized, its location is identified, its size is determined, and the condition of the tissues around it is assessed.

A detected neoplasm requires a more detailed examination. To do this, using a puncture or surgical intervention material is taken from the tumor for laboratory tests, during which the stage of its development and the degree of spread are determined.

Using radiography and biopsy, osteoma can be distinguished from.

In addition, computed tomography is prescribed, which is also necessary for differentiation from sarcoma.

A blood test is very important in diagnosing osteoma. A shift in its formula with an increase in the number of ESR, leukocytes, and protein may indicate the presence of a malignant tumor.

Using a urine test for hydroxyproline, a benign neoplasm is detected. This research method requires special preparation of the patient, so it is used infrequently.

MRI is used to determine the type of tumor.

Treatment

Osteoma is a rather finicky tumor that does not respond to chemotherapy or radiation treatment. You can get rid of it only by surgical excision of the tumor along with healthy bone tissue.

In some cases, when the neoplasm does not tend to grow, occurs without significant symptoms and does not interfere with the functioning of nearby organs and systems, treatment of osteoma is not required. It is important to monitor her with x-rays every 30 days. If tumor growth is not observed, X-rays can be taken every six months.

An oncologist surgeon removes osteoma using endoscopic method. The operation is performed under anesthesia. If there are several large tumors they are removed in parts.

A craniotomy is required to remove a large tumor inside the head.

Since there are types of neoplasms (for example), which do not cause much harm to the patient, there is also osteogenic sarcoma, which is characterized by a rapid course and an unfavorable prognosis.

Osteoma should not be confused with osteophytes, growths that appear due to degeneration processes in the spine. At the slightest suspicion of this problem It is better to consult a doctor and conduct an instrumental examination.

Prognosis and prevention

Timely medical care for osteoma, ensures complete recovery. After the operation, it is important for the patient to adhere to the clear recommendations of the doctors. Excision of the tumor in the early stages helps to maximize the preservation of healthy tissue located near it.

There are no preventive methods to prevent the development of neoplasms. It is important to periodically visit the X-ray room in order to detect a tumor in a timely manner and take appropriate measures. Detected growths on bones of unknown origin should be a reason to consult a doctor.

• Osteoid osteoma
• Osteobdastomy
• Chondroma (enchondroma, periosteal chondroma = ecchondroma)
• Osteochondroma (exostosis)
• Chondromyxoid fibroma
• Fibrous tumor of bone (fibrous cortical defect, ossifying fibroma, fibrous dysplasia)
• Single-chamber (solitary) bone cyst
• Aneurysmal bone cyst
• Epidermal cyst
• Giant cell tumor of bone

Benign tumors are most often discovered incidentally. For example, a tumor may be detected by x-rays performed for an injury. Benign tumors are clearly defined and do not show a tendency to rapid growth and destruction of bone and soft tissue. Clinical manifestations are mild. Pain is not typical. Benign tumors go through the following stages of development:

Stages

• Stage 1: asymptomatic. They may be patent (do not proliferate) and in such cases no treatment is required.
• Stage 2: active process, often requiring surgery. Relapse is possible.
• Stage 3: aggressive process with destruction. Wide excision required.

Enchondroma

Typically a cartilage-forming tumor. Most often it appears on the hand (50% of all enchondromas are found in the bones of the hand). It is usually discovered accidentally after a pathological fracture. Similar tumors in large bones are unlikely; a single enchondroma of the hand almost never degenerates into chondrosarcoma.

Radiographs reveal well-demarcated osteolytic changes with cortical thinning.

Therefore, treatment of asymptomatic enchondromas is not indicated. If a patient comes in for a pathological fracture, they first wait for the fracture to heal, and then perform curettage and bone grafting.

Ollier's disease

Multiple enchondromas. Not inherited.

Mafucci syndrome

Multiple hemangiomas in addition to enchondroma. With multiple enchondromas, constant monitoring is necessary due to the possibility of their degeneration into chondrosarcoma.

Osteochondroma (exostosis)

The second most common benign bone tumor (after non-ossifying fibroma). The tumor grows from the metaphyseal region towards the diaphysis (from the adjacent joint). The cartilaginous head is similar in its histological picture to the growth zone and stops growing simultaneously with the bone.

Hereditary multiple exostosis

Autosomal dominant condition. Degenerates into chondrosarcoma in 1% of cases. Treatment by excision.

Epidermoid cyst

Occurs almost exclusively in the distal phalanges or bones of the skull. The pathogenesis is the same as that of epidermoid (or dermoid) cysts found in soft tissue: a complex (crushing) injury in which the epidermal cells of the nail bed become trapped in the distal phalanx. Manifested by swelling of the fingertip. The cyst may be visible. Radiographs clearly show a pathological focus that replaces bone tissue, usually on one side of the phalanx. Treatment consists of excision (curettage) of the cyst and, if necessary, bone grafting.

Osteoid osteoma

Osteoid-producing neoplasm. The peak frequency occurs in the second decade of life. In general, the hand and wrist are not typical sites, but when a tumor occurs on the hand, the proximal phalanx is most often affected. There are descriptions of cases of osteoid osteoma in the carpal bones. It manifests itself as pain, which intensifies at night and is relieved by aspirin. Less than 10% of cases are painless. Pain characteristics may vary depending on location. The pain is dull and difficult to localize with osteoid osteoma of the carpal bones; with a tumor of the phalanx, it is sharp and easily localized. When the tumor is localized periarticularly, reactive swelling of the joint is possible, which is more pronounced when the finger is affected (causes dactylitis).

Survey

• Radiographs reveal a characteristic osteolytic focus surrounded by reactive sclerosis. The manifestation varies depending on the severity of the two components, that is, osteolysis and reactive sclerosis.
• Triphasic bone scanning with technetium 99 provides almost 100% sensitivity.
• CT is highly specific.
• MRI - allows you to differentiate hypervascular osteoid osteoma and other hypovascular conditions.

Treatment

• NSAIDs for pain relief. Remission is possible for a long period of time (2-20 years).
• Surgery: curettage or resection of the affected area of ​​bone. The key point is the precise intraoperative localization of the tumor, since recurrence will develop after incomplete excision. To reduce the consequences of surgical treatment, newer percutaneous techniques have been proposed, which include ablation through a drilled or trocar channel into the bone or radiofrequency ablation and laser treatment. Relapse occurs in 5-25% of cases.

Giant cell bone tumor

Locally aggressive tumor. Aneurysmal bone cyst, chondroblastoma, osteoid osteoma, and osteoblastoma are common in children. Giant cell reparative granuloma is also similar, but is characterized by spindle cells rather than giant cells. More common in women. Metastasizes to the lungs in approximately 2% of cases.

Symptoms and signs

Joint effusion and pain. A pathological fracture is also possible, although the tumor does not normally break through the articular cartilage into the joint cavity.

Survey

• X-ray: lytic changes in the area of ​​the epimetaphysis.
• X-ray of the chest organs to exclude metastases.

Treatment

Curettage, treatment of the tumor walls with a cutter and adjuvant chemoablation (auxiliary) using phenol, hydrogen peroxide or liquid nitrogen. The cavity is then filled with bone cement. Relapse rate is 10-25%. Therefore, wider excision of the tumor and surrounding soft tissue is recommended. If the distal metaepiphysis of the radius is affected, bone grafting with an allograft or reconstruction using a free fibular graft is possible. Radiation therapy is contraindicated as it promotes tumor recurrence.

Chondromyxoid fibroma

Rare tumor. It occurs predominantly in men aged 20-40 years. It manifests itself as mild pain and slow tumor growth. On radiographs it appears as a multilocular bone cyst. The histological picture may be misinterpreted as chondroblastoma or chondrosarcoma. Excision of the tumor with or without bone grafting is recommended.

Aneurysmal bone cyst

It is rare on the hand, but can develop in the phalanges, metacarpal bones and carpal bones. X-rays reveal bone expansion with the formation of septa and destruction of the cortical layer, which can give the appearance of a malignant tumor. Differential diagnosis includes giant cell tumor of bone. Treatment should begin with a biopsy to exclude unnecessary extended resection, since these tumors do not need to be operated on; involution with the formation of a layer of reactive bone along the periphery is possible. Recovery can be accelerated by curettage and bone grafting.

Intraosseous ganglion

It is rare and is sometimes detected incidentally, as a finding on radiographs. May manifest as weakness and dull pain. The diagnosis is also determined by conventional radiography, but to clarify the shape and size, a CT or MRI is required. If detected accidentally and there are no symptoms, treatment is not necessary. The method of choice in the presence of complaints and clinical manifestations is curettage and bone grafting under X-ray control.