儿童手和手腕的肿瘤和肿瘤样病变:临床表现和恶性肿瘤的危险因素。

IF 1.5 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2025-10-01 Epub Date: 2025-06-04 DOI:10.1097/BPO.0000000000003017
Akbar N Syed, David Kell, Alexandre Arkader, Sulagna Sarkar, Pille-Riin Värk, Apurva S Shah
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引用次数: 0

摘要

背景:小儿手部和手腕的恶性肿瘤是罕见的。我们假设疼痛、大尺寸和手掌/手腕位置是儿童恶性肿瘤的危险因素。方法:回顾性分析of年龄小于18.9岁的手部和腕部肿瘤或肿瘤样病变患者,时间超过15年。排除有皮肤病变、常见皮下肿块(脂肪瘤、神经节囊肿和皮脂腺囊肿)、多发性遗传性外生性囊肿和脂肪肝疾病的患者。数据收集包括人口统计学、临床表现、影像学特征和手术处理。采用受者操作特征和描述性统计分析确定恶性肿瘤的危险因素。结果:312例患者共发现327例肿瘤及肿瘤样病变,平均年龄10.1±4.6岁。良性病变315例(96.3%),恶性病变12例(3.7%)。最常见的良性骨肿瘤为骨软骨瘤(75/160,46.9%)和内生软骨瘤(50/160,31.3%),最常见的良性软组织肿块为血管畸形(39/155,25.2%)和肌腱鞘巨细胞瘤(30/155,19.3%)。最常见的位置是手指。所有恶性肿瘤(骨3例,软组织9例)均位于掌部或腕部。上皮样肉瘤(4/9)和滑膜肉瘤(2/9)是最常见的软组织恶性肿瘤,骨肉瘤(3/3)是唯一发现的骨恶性肿瘤。总体而言,最常见的主诉是肿胀(63%)和疼痛(19.9%)。双变量分析发现尺寸>11.4 mm和手掌/手腕位置是恶性肿瘤的危险因素。根据ROC分析,年龄和疼痛评分是恶性肿瘤的不良预测因子。在骨肿瘤中,侵袭性转移区、骨膜反应和皮质破坏是恶性肿瘤的重要影像学危险因素。结论:儿童手和手腕最常见的肿瘤和肿瘤样疾病包括骨软骨瘤、内软骨瘤、血管畸形和tendon鞘巨细胞瘤。较大的肿瘤(>11.4 mm)和在手掌/腕部发现的病变更可能是恶性肿瘤,应谨慎处理。证据等级:iii级-治疗性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tumors and Tumor-like Lesions of the Pediatric Hand and Wrist: Clinical Presentation and Risk Factors for Malignancy.

Background: Malignant tumors of the pediatric hand and wrist are rare. We hypothesize that pain, large size, and palm/wrist location are risk factors for malignancy in children.

Methods: A retrospective review was conducted of patients younger than 18.9 years of age presenting to our institution with hand and wrist tumors or tumor-like lesions over a 15-year period. Patients with skin lesions, commonly encountered subcutaneous masses (lipomas, ganglion cysts, and sebaceous cysts), multiple hereditary exostoses, and Ollier disease were excluded. Data collection included demographics, clinical presentation, imaging features, and surgical management. Risk factors for malignancy were determined using receiver operating characteristic and descriptive statistical analysis.

Results: Three hundred twenty-seven tumors and tumor-like lesions were identified in 312 patients, with a mean age of 10.1 ± 4.6 years. Three hundred fifteen (96.3%) lesions were benign, and 12 (3.7%) lesions were malignant. The most common benign bone tumors were osteochondromas (75/160, 46.9%) and enchondromas (50/160, 31.3%), while the most common benign soft-tissue masses were vascular malformations (39/155, 25.2%) and giant cell tumors of the tendon sheath (30/155, 19.3%). The most common location was the digit. All malignant tumors (3 bone, 9 soft tissue) were in either the palm or wrist. Epithelioid sarcoma (4/9) and synovial sarcoma (2/9) were the most common soft-tissue malignancies, and osteosarcoma (3/3) was the only identified malignant bone tumor. Overall, the most common presenting complaints were swelling (63%) and pain (19.9%). Bivariate analysis found size >11.4 mm and palm/wrist location as risk factors for malignancy. Based on ROC analysis, age and pain ratings were poor predictors of malignancy. Among bone tumors, an aggressive zone of transition, periosteal reaction, and cortical destruction were significant radiographic risk factors for malignancy.

Conclusions: The most common tumors and tumor-like conditions of the pediatric hand and wrist include osteochondromas, enchondromas, vascular malformations, and giant cell tumors of the tendon sheath. Larger tumors (>11.4 mm) and lesions found in the palm/wrist are more likely to represent malignancies and should be approached with caution.

Level of evidence: Level III-therapeutic.

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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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