Narrow Results

This case report demonstrates and emphasises the unusual radiographic appearance of silver nitrate treatment in a 30-year-old patient, who subsequently underwent excision biopsy of a presumed potentially malignant lesion.

Digital papillary adenocarcinoma (DPA) is a rare but locally aggressive eccrine tumour that has metastatic potential and most frequently found in the upper extremity. It usually presents as an unremarkable swelling of the skin, commonly misdiagnosed as a benign lesion. We present a 67-year-old male who presented with a slowly growing mass of the right middle finger that was biopsied and diagnosed with DPA. The patient was treated with wide local excision (WLE) and sentinel lymph node biopsy by us during the same operative encounter. This report highlights the need for increased clinical vigilance to diagnose DPAs, and that WLE and sentinel lymph node biopsies can be safe and effective treatments offered.

Level of Evidence: Level V (Therapeutic)

Angioleiomyoma is a rare benign soft tissue tumour arising from smooth muscle, representing <1% of upper limb soft tissue tumours. We report a 54-year-old male presenting with a progressively enlarging atraumatic lesion along the palmar side of the base of the ring and little finger. A biopsy was done to determine the diagnosis. Intraoperatively, the lump was found to be intimately related to the radial digital artery, it could not be excised en-bloc without transecting the radial digital artery of the little finger. Following excision, the ends of the digital artery were anastomosed. At 10-months follow-up, the hand was fully functional without any evidence of cold-intolerance or neurological deficit along the distribution of the digital nerve. We review the literature on angioleiomyoma and report careful resection of the tumour with digital artery transection and repair as a treatment option for angioleiomyoma of the digital artery.

Level of Evidence: Level V (Therapeutic)

Synovial osteochondromatosis is a relatively rare condition of the hand. We present a rare case of a locked finger in a paediatric patient with synovial osteochondromatosis, in which a tumourous lesion was continuous with the flexor tendon and trapped proximal to the A1 pulley. After resection of the tumour and synovium, no recurrence was observed over a 6-month follow-up period. Synovial osteochondromatosis in the hand or fingers can lead to swelling and limited range of motion; however, symptom progression is usually slow. Moreover, it is uncommon for an extra-articular tumour to cause a sudden onset of locking symptoms without prior warning signs. Comprehensive excision of the synovium is essential, and ongoing observation for recurrence is necessary during follow-up.

Level of Evidence: Level V (Therapeutic)