Review of Histology Results of Hand Masses: A South African Audit

Christian Vyamungu1, Pascaline Fru2, Tatolo Sefeane3, Cynthia Sathekga3, Elias Ndobe1.
1-Department of Plastic and Reconstructive Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
2-Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,7 York Road, Parktown, Johannesburg, South Africa
3-Department of Orthopedic Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg South Africa.

Correspondence to: Dr. Christian Vyamungu; Email: chvyamungu@gmail.com
 

Received: 12th November 2020; Revised: 10th January 2021; Accepted: 3rd February 2021; Available online: 9th March 2021 

Abstract

Background: Patients with hand masses present for consultation either for pain, loss of function, or cosmetic embarrassment caused by the mass. The majority of hand masses are benign soft tissue tumors. The aim was to review the histology results of hand masses operated on at the Chris Hani Baragwanath Academic Hospital Hand Unit in Johannesburg, South Africa, to explore the relationship of the types of masses according to age, sex, side, and compare the findings with what is in the current literature. Methods: Patients operated on in the hand unit, for hand masses between April 2016 and April 2019 with histology results were included in the study for statistical analysis. Results: There were 64 males and 105 females with a mean age of 41.03 ± 18.81 years. The most frequent masses were ganglion cysts. Females appeared to be more affected than males by the different hand masses, but there were no statistically significant differences. Of the 21 giant cell tumors, 15 occurred on the right hand (p-value = 0.021). Conclusion: The profile of hand masses at a high-volume hand unit in Johannesburg, were comparable to the reported literature. There were no significant differences between sex and diagnosis, however, there was a relationship between diagnosis and side for giant cell tumors of tendon sheaths (GCTs), requiring further exploration.

 

Keywords: Hand masses, hand tumor, hand growth, ganglion cyst, giant cell tumor

Ann Afr Surg. 2021 ; 18(3): 163-169 

DOI: http://dx.doi.org/10.4314/aas.v18i3.7
Conflicts of Interest: None
Funding: None

© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction
Hand masses account for some of the conditions presenting to a healthcare practitioner working in a hand unit (1). Most patients who present do so either because of pain and limited hand function caused by the mass or due to aesthetic concerns.
The majority of hand masses are benign, and ganglion cysts (GCs) are the most common, followed by the giant cell tumors of tendon sheaths (GCTs), and lipomas (1–3). The hand masses may compress the surrounding tissues such as nerves or blood vessels and this can result in carpal tunnel syndrome or Guyon’s canal syndrome due to the compression of the median or ulnar nerve, respectively (4, 5). Even though malignant hand masses are rare, they can be devastating and generally result in amputation of a digit or the whole hand involved (1, 2).
Hand tumors and tumor-like conditions can arise from the soft tissues or from the bones (1, 6). The soft tissues involved can be skin and adnexa, fat, nerves, blood vessels, and tendon sheaths (6). Cavit et al. (1) reviewed 402 cases of hand tumors and found that 89.8% of cases were soft tissue tumors while 10.2% were bone tumors. There was a female preponderance with an average age of 41.9 years. However, most studies have reported on the frequency of the different masses with only a few reporting on the statistical difference with regard to sex or side of the hand. With regard to hand masses of bone origin, enchondromas are the most frequent masses whilst malignant bone lesions are very rare (2). Besides clinical assessment, special investigations include X-rays, ultrasound, computed tomography, and magnetic resonance imaging scans (6). Treatment of hand masses ranges from observation to surgical excision, the latter being the definitive treatment form (2). There was a need to look at the local profile of hand masses at a high-volume hand unit in Johannesburg, South Africa, and to compare the findings with that of existing literature. This review of records will serve as an additional tool for the teaching of hand tumor management, as well as serving as a reference to advocate for resource allocation to the hand unit as a teaching institution.
The study aimed to review the histology results of hand masses that were operated on at the Chris Hani Baragwanath Academic Hospital Hand Unit theatre over a 37-month period from April 2016–April 2019, and to review the types of hand masses according to age, sex, and side of the hand, and to compare the findings with what is available in the current literature.

 

Methods
Permission to conduct this study was granted by both the Chris Hani Baragwanath Hospital Ethics Committee and the Wits Human Research Ethics Committee with clearance certificate number M191049.This is a retrospective quantitative audit that analyzed the histology results of patients operated on for masses of the hand at the Hand Unit. All patients operated on from April 2016 to April 2019 and the histology results were included in this study. To obtain data as complete as possible, the Hand Unit theatre register and the registrar theatre database were used to acquire the histology results, age, sex of the patients, and information on the side of the hand that the mass occurred on. All cases were operated on under local anesthesia except for an 8-month-old patient. The specimens were placed in 10% formalin solution for histopathological processing and diagnosis. Paraffin-embedding of the tissue occurred and 3-μm tissue sections were prepared for hematoxylin and eosin (H&E) staining and immunohistochemistry. Diagnoses were based on the World Health Organization (WHO) classification of tumors of soft tissues and bone (7). Histopathological reporting of the malignant cases was aligned with international cancer protocol templates. The hand was defined as the part of the upper limb from the wrist down to the tip of the digits, the dorsum as the extensor surface, and the volar area as the flexor surface.
All data was entered into an Excel software (Microsoft Corporation, Redmond, WA, USA) spreadsheet and exported to Statistica software (Statsoft Inc, Dell, Tulsa, OK, USA) for statistical analysis. The mean ± standard deviation (SD) and percentages for the quantitative and categorical data were reported, respectively. The chi-square (χ2) test was used to test the relationship between the variables. A p-value less than 0.05 was considered significant. Dependent variables were the histologic types of masses, and the independent variables included age, sex, and side.

 

Results
A total of 169 histology results of hand masses from 169 patients were included in this study. Of all the patients, 105 (62.13%) were females and 64 (37.87%) were males. The mean age of patients was 41.03 ± 18.81 years, the median age was 40 years, and the age range was