الفهرس 
Aim of the StudyOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
and neoplasms are usually classified in two categories:
benign and malignant; in musculoskeletal tissues,
malignancies may also be subdivided into low grade and high
grade. Cellular growth in benign neoplasms usually proceeds at
a much slower rate than in malignant tumors. Benign lesions
may be expansile and sometimes encapsulated. Distant spread
usually does not occur, and local recurrence is less common in
benign than in malignant lesions.
Malignant neoplasia is characterized by a rapid growth
rate, atypical cellularity, and poor cell differentiation. Local
growth is aggressive and infiltrative; there are only
“pseudocapsules” through which the tumor extends with
satellite lesions. Such tumors are likely to spread as bloodborne
metastases, and local recurrence rates are high after
excision unless a wide margin of normal tissue is included in
the resection. Low-grade malignancies grow more slowly and
infiltrate early but are less likely to metastasize than to recur
locally.
Many benign tumors of the hand or forearm require no
treatment, can be diagnosed clinically, and are asymptomatic.
However, if a lesion increases in size or becomes symptomatic,
or if the physical or radiographic appearance suggests an
aggressive process, appropriate staging studies, including
obtaining tissue for diagnosis, must be done.† Unfortunately,H
lumps and growths that look innocent may not necessarily be
so; every tumor ought to be considered a potential impediment
to function, if not to survival.
Ganglions and giant cell tumors of tendon sheaths are the
first and second most common soft-tissue tumors in the
hand, respectively.
Schwannomas are the most common nerve tumors in the
upper extremity and they most commonly occur on the
flexor surfaces.
Enchondromas are the most common primary bone tumors
in the hand. With Maffucci syndrome, multiple enchondromas and
hemangiomas are seen on radiographs; risk of sarcoma is
high. Epithelioid sarcomas are the most common soft-tissue
sarcomas arising in the hand.Chondrosarcomas are the most common primary
malignant bone tumors arising in the hand.There are well-documented instances of malignant
transformation of enchondromas to chondrosarcomas.
Soft-tissue calcifications may be seen in synovialsarcomas.
The most common acral metastases are seen in the setting
of lung or breast cancer.
Metastasis to hand is very rare, about 0.1%. of metastatic
lesions, they are usually from primary lung cancer.
Tumor workup should include a chest CT, bone scan,
pelvic CT, and laboratory work if a malignancy is suspected.
The biopsy is the single most important step in patients’ staging
workup, having a direct bearing on the outcome. The biopsy
should, in most circumstances, be performed in the same
institution where the definitive tumor surgery will be
accomplished. The tumor is appropriately staged based on the
criteria of Enneking staging system. Depending on the surgical
stage of the tumor, an intralesional, marginal, wide, or radical
excision should be performed.