What To Do About Benign Tumors of the HandBenign tumors may not spread and cause death but they can create significant problems just the same. Tumors of the hand (the focus of this article) can wrap themselves around nerves, cut off blood supply, and cause fractures. Undiagnosed and untreated, they can invade surrounding soft tissues and eat away at the bone causing significant loss of motion, deformity, and disability.
Although benign tumors of the hand are fairly common, there are no large studies comparing one treatment to another. Therefore, today's modern treatment is largely based on the hand surgeon's experience and what little information can be gleaned from case studies published in medical journals.
That's why these two hand surgeons combined their knowledge and expertise in presenting an up-to-date review on benign tumors of the bone and soft tissues of the hand. They base their recommendations on studies that are available and on their own experiences. The authors point out the fact that many tumors in the hand are treated based on similar tumors in other parts of the body, not necessarily from experience or evidence with hand tumors.
Benign tumors under consideration can affect the bone (e.g., osteoid osteoma, cysts, giant cell tumors), cartilage (e.g., osteochondroma, enchondroma, periosteal chondroma, fibromas), fat/connective tissue (e.g., lipomas, giant cell tumor of tendon sheath), nerves (e.g., Schwannoma, neurofibroma), and blood vessels (e.g., glomus tumor).
The authors discuss each one of these benign tumors, their clinical presentation, diagnosis, and treatment. The diagnosis is made when patients observe an odd lump under the skin or hard bump on the bone. Concern about what this might be brings them into see the doctor. Pain, swelling, and local tenderness are the most common symptoms (when symptoms are present).
X-rays or other diagnostic imaging tests (CT scan, MRI) and biopsy help make the diagnosis. Many times, it's quite obvious that the problem is a benign tumor of the hand so biopsy isn't necessary.
Conservative (nonoperative) care may be possible for some tumors. Aspirin for pain management seems to work well for osteoid osteomas (benign bone tumors). Radiofrequency ablation (a heat treatment) has been tried for other tumors of this type elsewhere in the body.
A few studies have been published with mixed results of radiofrequency ablation with hand tumors. The structures of the hand are so small, it's easy to damage the small bones of the hand, as well as the tiny nerves, and blood vessels.
But many tumors must be carefully removed, a procedure called surgical excision. If a large amount of bone is removed, bone replacement called grafting may be needed to fill in the hole. When the cartilage is involved, the surgeon does everything possible to preserve the joint surface.
If bone fracture has already occurred (and that's why the patient was diagnosed), treatment involves removing the tumor as well as healing the fracture. Lipomas (fatty tumors) and Schwannomas (tumor along a nerve) may be treated with simple observation (a "wait-and-see" approach). If and when the tumors cause symptoms, then it may be necessary to perform surgery to remove it.
In all cases, benign tumors can come back (recur) or even convert to a malignant tumor. Aneurysmal bone cysts are the most likely to recur. Young people whose bones are still growing seem to have the most trouble with these lesions coming back and growing fast. In extreme cases, it is necessary to remove the hand to stop the tumor.
Giant cell tumors of the bone are particularly tricky because this is one benign bone tumor that can metastasize (spread). The lungs are the most likely place tumor cells will travel to first. Anyone diagnosed with giant cell tumor of the bone should have a chest X-ray done right away to see if metastasis has already occurred.
Whatever type of lesion is present and regardless of successful treatment, patients must be followed carefully and observed for any signs of recurrence or conversion. Surgeons who understand the different types of benign hand tumors will be able to provide the most appropriate treatment aimed at reducing symptoms and preserving anatomy and function.
William T. Payne, MD, and Greg Merrell, MD. Benign Bony and Soft Tissue Tumors of the Hand. In The Journal of Hand Surgery. November 2010. Vol. 35A. No. 11. Pp. 1901-1910.
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