Diagnostics aspects of benign tumors of soft tissues of hand

BACKGROUND: Benign soft tissue masses of the hand are defined by the lack of a generally accepted global classification, consistent terminology, and histological identification criteria, as well as a wide range of forms and frequent recurrences. During preoperative preparation in routine clinical practice, imaging and comprehensive clinical examinations are frequently not performed in patients with soft tissue masses of the hand. In the event of a later recurrence, the selection of treatment approach can be challenging due to limited clinical and imaging findings.

AIM: To assess the prevalence of benign soft tissue masses of the hand among all neoplasms of the hand, based on the histological structure, as well as the characteristics of clinical diagnosis and the efficacy of specialized examination methods.

MATERIALS AND METHODS: A retrospective study was performed in 1.355 patients with benign soft tissue masses of the hand and tumor-like lesions for a 10-year period between 2010 and 2020. The diagnosis was based on clinical, X-ray, and ultrasound findings, with a mandatory histological examination of the excised tumor in all patients. To clarify the diagnosis, additional magnetic resonance imaging was used in 53 patients, computed tomography in 15 patients, angiography in 13 patients, and thermographic and radionuclide studies in 28 patients.

RESULTS: Of the 1,355 cases of tumor-like lesions on the hand, 563 (41.5%) were benign soft tissue masses. The most prevalent were benign synoviomas (263 cases; 46.8%), hemangiomas (94 cases; 16.8%), lipomas (62 cases; 11.2%), fibromas (35 cases; 6.2%), glomangiomas (28 cases; 5%), and fibrolipomas (26 cases; 4.6%). Angiofibromyomas, hemangiopericytomas, and lymphangiomas had the lowest prevalence (3 cases each; 0.5%).

CONCLUSION: The study found that benign soft tissue masses of the hand accounted for 41.5% of all tumor-like lesions on the hand, with benign synoviomas being the most prevalent. The diagnostic significance of mandatory X-ray and ultrasound examinations before surgery was confirmed. Only 884 of 1,355 cases (62.5%) had a preliminary diagnosis made prior to imaging studies that matched the final diagnosis based on histomorphological examination of the excised tumor. The feasibility of widespread use of high-resolution MRI for the differential diagnosis of hand neoplasms was determined. The diagnostic significance of angiography, computed tomography, and thermographic and radionuclide studies in detecting benign hand neoplasms was confirmed. It is incorrect to perform surgery without preliminary clinical and imaging examinations. A histomorphological examination of the excised tumor is mandatory in all cases.