Benign Tumours of the Hand

By:
Nevinia Ann A/P Robert

Introduction
Benign tumors of the hand may be
categorized using the different anatomic
subunits of the hand.
Each subunit has potential for disease
processes and abnormal growth.
Notably, the musculoskeletal, vascular,
osseous, perionychial, cutaneous, and soft
tissue elements can develop benign lesions
that may manifest as localized masses of
the hand

 Excluding cutaneous malignancy, 95% of

tumors of the hand are benign.
The nonneoplastic ganglion is probably the
most common mass found on the hand and
wrist.
Following ganglions, inclusion cysts, warts,
giant cell tumors, granulomas, and
hemangiomas follow in frequency.

Classification of Musculoskeletal Tumours

Benign tumors are classified as having 3 stages:
First are latent stage I tumors, which do not
need excision. These lesions resolve
spontaneously or remain unchanged.
Active stage II benign neoplasms grow within a
limited zone and are contained by natural
barriers. Excision and treatment usually
involves a marginal or intralesional procedure
such as curettage.
Locally aggressive stage III benign tumors
extend beyond natural borders and often
require resection for cure.

Vascular Lesions
Hemangiomas
Subcutaneous hemangiomas are the fourth most
common tumor of the hand. They consist primarily of a
benign proliferation of blood vessels within the soft tissue
The palm is the most common location
Progressive enlargement of the lesion and throbbing pain
are the most common symptoms.
General characteristics of a hemangioma include, readily
compressible, poorly defined, bluish discoloration,
subcutaneous mass that distend when venous return is
obstructed and contract when the extremity is elevated.
Hemangiomas occur 3 times more frequently in females
than in males

Pre-operative view showing the

vascular tumor on the medial
aspect of the distal arm.

The Hemangioma is nearly

completely removed at this stage
of the operation. It is imperative to
ligate all feeding vessels to
decrease the recurrence rate.

Osseous Lesions
Enchondromas
Arise from cartilage, are the most common primary bone
tumors.
Enchondromas account for more than 90% of bone
tumors seen in the hand.
The proximal phalanx is the most common site of
occurrence, with lesions also occurring in the metacarpal
region.
Radiographically, an enchondroma is usually seen as a
well-defined radiolucent lesion in the diaphysis or
metadiaphysis.
These lesions may also have a well-defined sclerotic rim.
The cortex may have small concavities or may be
scalloped in appearance.

Plain radiograph (left) and magnetic resonance

image (right) showing a large enchondroma of the
fifth metacarpal of the hand.

Giant Cell Tumours

Giant Cell Tumour of the hand are most frequently
found in patients aged 20-40 years.
Pain is frequently the primary symptom.
The prevalence rate of pathologic fracture is
approximately 6%.
For the wrist and hand, the distal radius is affected
most commonly.
Giant cell tumors have also been reported in the
middle phalanx.
Radiological images reveal a destructive lesion often
situated eccentrically. CT scan images are more useful
for demonstrating cortical destruction and the reactive
bone shell.
Surgical options include arthroplasty or arthrodesis for
reconstruction of larger defects.

Soft tissue tumor visible on the volar radial

surface of the middle finger proximal phalanx.

Skin flap elevated exposing the localized

variant of a giant cell tumor. Dissection
procedes to remove the tumor completely.

Specimen

Soft Tissue Lesions

Ganglions

Ganglions are the most common soft tissue tumors of the hand.
These common lesions are usually found on the dorsum of the
wrist, followed by the volar wrist, flexor tendon sheath, and
dorsal distal interphalangeal joint (the mucous cyst).
They are defined as cystic swellings that are closely connected
to joint or tendon sheaths and contain mucinous material.
A ganglion is a pseudo-encapsulated cystic structure that is filled
with thick, viscous, mucinous material and may arise from any
synovial lined structure i.e. tendon sheath or joint and may
present anywhere this type of tissue is present.

Lateral view of a large

dorsal wrist ganglion
originating from the EDC
(Extensor Digitorum
Comminus) tendon
synovium with a transverse
incision marked out over the
mass for excision.
Ganglion being excised.
Ganglions are typically
filled with thick gelatinous
material and frequently
are septated and is why
they are difficult to
completely aspirate

Completely excised
intact.

Nonsurgical Treatment
Observation
Immobilization
Aspiration
Surgical Treatment
Surgery involves removing the cyst as well as part of the involved
joint capsule or tendon sheath, which is considered the root of the
ganglion. Even after excision, there is a small chance the ganglion
will return.
A ganglion cyst at the wrist is removed during a surgical
procedure called excision.
Excision is typically an outpatient procedure and patients are able
to go home after a period of observation in the recovery area.
There may be some tenderness, discomfort, and swelling after
surgery.
Normal activities usually may be resumed 2 to 6 weeks after
surgery.

Thank you