Mateusz Gładysz FESSH prep

FESSH prep Hand tumours Typical patient and site of epidermoid cysts, frequency of the intraosseous form, magnetic resonance imaging features that suggest an atypical lipomatous tumour, nerve compression by adipose tumours, clinical tests for glomus tumour

Epidermoid inclusion cyst, lipoma and other common benign masses of the hand

Last reviewed v1.0

FESSH-078Hand tumours●○○ basic

Regarding the diagnosis of epidermoid cysts, lipomas and other benign masses of the hand:

  1. 1.In a series of 101 epidermoid cysts of the hand, most occurred in male patients, and the palmar aspect of the hand was the commonest site.

  2. 2.Intraosseous lesions account for most epidermoid cysts of the hand.

  3. 3.On magnetic resonance imaging, septa thicker than 2 mm, nodularity and contrast enhancement favour a simple lipoma over an atypical lipomatous tumour.

  4. 4.Adipose tumours of the hand and wrist can present with paraesthesia from compression of an adjacent nerve.

  5. 5.In a series of patients with suspected glomus tumour of the fingertip, the cold-sensitivity test was more accurate than Hildreth's test.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-078
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In a series of 101 epidermoid cysts of the hand, most occurred in male patients, and the palmar aspect of the hand was the commonest site.

    True

    Lincoski and colleagues reviewed 101 epidermoid cysts excised from the hand over 27 years. The majority occurred in male patients, most often in the soft tissues on the palmar side of the hand.

    • Lincoski CJ, Bush DC, Millon SJ. Epidermoid cysts in the hand. J Hand Surg Eur Vol. 2009;34(6):792-6. PMID 19786411

  2. 2. Intraosseous lesions account for most epidermoid cysts of the hand.

    False

    In the same series of 101 cysts only 4% were intraosseous; the rest arose in soft tissue. After marginal excision, 11% of the cysts recurred.

    • Lincoski CJ, Bush DC, Millon SJ. Epidermoid cysts in the hand. J Hand Surg Eur Vol. 2009;34(6):792-6. PMID 19786411

  3. 3. On magnetic resonance imaging, septa thicker than 2 mm, nodularity and contrast enhancement favour a simple lipoma over an atypical lipomatous tumour.

    False

    A systematic review of 13 imaging studies (1390 patients) found that the features most often seen in atypical lipomatous tumour or well-differentiated liposarcoma were large size, age over 60, irregular shape, incomplete fat suppression, contrast enhancement, nodularity and septa thicker than 2 mm. These findings should raise suspicion of an atypical lipomatous tumour rather than reassure.

    • Muhib M, Abidi SLF, Ahmed U, Afzal A, Farooqui A, Khalid Jamil OB, et al.. Use of radiologic imaging to differentiate lipoma from atypical lipomatous tumor/well-differentiated liposarcoma: Systematic review. SAGE Open Med. 2024;12:20503121241293496. PMID 39526094

  4. 4. Adipose tumours of the hand and wrist can present with paraesthesia from compression of an adjacent nerve.

    True

    In Marteau and colleagues' series of 37 adipose tumours of the hand and wrist, the lump was associated with distal paraesthesia in six cases; all were conventional lipomas or benign variants. Leclère and colleagues recorded compression neuropathy in 7 of 14 patients referred with a suspected adipose tumour of the hand.

    • Marteau É, Le Nail LR, Rosset P, de Pinieux G, Laulan J, Roulet S, et al.. Epidemiological, clinical and histological features of adipose tumors in the hand and wrist: Findings from a continuous series of 37 cases. Orthop Traumatol Surg Res. 2020;106(2):329-334. PMID 32037290
    • Leclère FM, Casoli V, Pelissier P, Vogt PM, Desnouveaux E, Spies C, et al.. Suspected adipose tumours of the hand and the potential risk for malignant transformation to sarcoma: a series of 14 patients. Arch Orthop Trauma Surg. 2015;135(5):731-6. PMID 25736165

  5. 5. In a series of patients with suspected glomus tumour of the fingertip, the cold-sensitivity test was more accurate than Hildreth's test.

    True

    Bhaskaranand and Navadgi reported 18 patients with thumb or fingertip pain, 14 of whom had histologically proven glomus tumours. The authors report 100% sensitivity for the cold-sensitivity test and 77.4% for Hildreth's test, both with 100% specificity; overall accuracy was 100% for cold sensitivity and 78% for Love's and Hildreth's tests. The series is small.

    • Bhaskaranand K, Navadgi BC. Glomus tumour of the hand. J Hand Surg Br. 2002;27(3):229-31. PMID 12074607