QT Pathologies (EN)
Any abnormal lump or bump, or "mass", is considered a tumor. The term "tumor" does not necessarily mean it is malignant or that it is a cancer. In fact, the vast majority of hand and wrist tumors are benign or non-cancerous. Any lump or bump in your hand or wrist is a tumor regardless of what causes it.
Tumors can occur on the skin, such as a mole or a wart, or can occur underneath the skin in the soft tissue or even the bone. Because there are so many tissue types in the hand (e.g. skin, fat, ligaments, tendons, nerves, blood vessels, bone, etc) there are many types of tumors that can occur. However, only a few of them are seen commonly.
The most common tumor in the hand and wrist is a ganglion cyst. It is frequently found at the wrist but can occur at the base of the fingers or around the finger joints (see Ganglion cyst section).
The 2nd most common hand tumor is a giant cell tumor of tendon sheath. Unlike the fluid-filled ganglion cyst, these tumors are solid. They occur anywhere near a tendon sheath (outer lining layer that supports the tendon) and are benign (non-cancerous) and are slow-growing. They may be caused by trauma to the tendon sheath that stimulates abnormal growth.
Another common tumor is an epidermal inclusion cyst. It is also benign and forms just underneath the skin, originating from the undersurface of the skin where there may have been a cut or puncture. Skin cells normally produce a protective waxy substance called keratin. When skin cells get trapped under the surface, such as with a skin puncture, they continue to grow and make keratin, forming the cyst. The cyst is like a sac with a fibrous outer lining and is filled with a soft, cheese-like material, the keratin.
There are other less common types of tumors seen in the hand. They include lipomas (fatty tumors), neuromas (nerve tumors), nerve sheath tumors, fibromas, and glomus tumors, among others. They are practically all benign.
Bone spurs can form, from arthritis or trauma, which feel like hard tumors. Foreign bodies, such as a splinter, can also cause reactions that form lumps or bumps in the hand.
The most common bone tumor is exostosis. It is a benign bone growth that appears during growth and is produced by a cartilage cap. Its most common location is the metaphyses of long bones.
Cancer in the hand is extremely rare. The most common cancers that originate in the hand are skin cancers, such as squamous cell carcinoma, basal cell carcinoma, or melanoma. Other cancers are very rare but include sarcomas of the soft tissue or bone. It is also possible for cancer to spread to the hand or wrist from somewhere else in the body, such as the lung or breast. This is called metastatic cancer. As with any cancer, a biopsy is usually required to make a definitive diagnosis.
- Bone tumor (arrow) of the Enchondroma type
- Bone tumor of the Chondrosarcoma type
- Tumors of the Botryomycoma type
- Thenar tumor of the Lipoma type
- Forearm tumor of the Lipoma type
- Synovial villonodular tumor
- Median nerve Schwannoma
- Cutaneous fibroma
- Squamous cell carcinoma
- Swelling of the finger tip and skin lesion on foreign body (here, shot air gun)
- Abnormal growth of the hand (here, a dirty funnel)
- Tumoral mass of foreign body reaction type (here, a splinter)
- Tumoral mass of foreign body reaction type (here, a piece of glass in place since 9 years)
Hand benign tumors may have different causes.
As previously said, the giant cell tumors of the tendon sheath may follow trauma. This is also the case for many types of tumors of the hand.
Epidermal inclusion cysts, another common type of tumor of the hand, develop following a finger injury, and skin cells that would normally be out of the body, are retained under the skin, and still secrete keratin thereby forming the cyst.
Tumors can also occur in response to a foreign body, such as when a splinter causes the development of a mass under the skin.
Most hand tumors are visible to the eye on the surface of the skin. If the tumor has formed beneath the skin on the bone or near a nerve, it may not be visible, but will oftentimes be painful.
While the majority of hand tumors are benign, it is always a possibility that the tumor could be cancerous, which is why you should not hesitate to see a doctor if you suspect that you have a tumor in your hand or wrist.
A careful history and physical exam help to determine the type of hand or wrist tumor.
X-rays might be taken to evaluate the bones, joints, and possibly the soft tissue.
Further studies such as CT, MRI, or bone scan may be done to help narrow down the diagnosis.
Recommendations for treatment are based on the experience of the hand surgeon and preferences of the patient.
Typically, definitive treatment with the lowest recurrence rate involves surgical excision of the tumor. Removing the tumor also allows a pathologist to analyze it and to determine what type it is with reasonable certainty. Needle biopsy or incisional biopsy (cutting out a small sample of the tumor) may be considered if the surgeon wants to confirm the diagnosis before recommending definitive treatment. Often, surgery is done under a local or regional anesthesia (numbing the extremity or area) and on an outpatient basis. Risks and benefits should be discussed with the surgeon. Most hand and wrist tumors can be cured with surgery.
Some patients may choose to do nothing and simply live with the tumor once they learn that it is probably benign. However, if the tumor changes (eg. skin discoloration, pain, increased size) or if it causes problems with nearby structures (for example, numbness or pain from pressure on a nearby nerve) re-evaluation by a hand surgeon is recommended. Patients should consider the risks, benefits, and consequences of treatment, whether with surgery or without surgery.
During your consultation, Dr. D'Agostino will discuss the current treatment options and can help you choose the best treatment based on your particular case.