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Hand Soft Tissue Tumor

Hand Soft Tissue Tumor. Quiz 2 22/9/86. 13 y old girl complained from CTS like symptoms and a soft tissue mass in the anterior surface of the wrist. P/I: From 2 years ago insidious onset of CTS symptoms From one year ago the mass appeared with very slow enlarging. P/E:

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Hand Soft Tissue Tumor

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  1. Hand Soft Tissue Tumor Quiz 2 22/9/86

  2. 13 y old girl complained from CTS like symptoms and a soft tissue mass in the anterior surface of the wrist.

  3. P/I: • From 2 years ago insidious onset of CTS symptoms • From one year ago the mass appeared with very slow enlarging

  4. P/E: • Soft tumor 2*4 cm. in size • Mobile without definitive borders • Tinel sign is negative

  5. Paraclinical findings • EMG-NCV showed mild to moderate CTS • Plain X-ray is normal • MRI, soft tissue tumor adjacent to flexor tendons in carpal tunnel

  6. MRI

  7. The patient underwent operation • Extensile transverse carpal ligament release

  8. Intra-operative photography

  9. Proximal limit

  10. Distal end

  11. Internal architecture of the tumor

  12. Internal architecture of the tumor

  13. What is the best diagnosis? • What is the result of histo-pathology? • What is the definitive treatment? • What is the prognosis? Questions ?

  14. Answers ;

  15. This is a case  of  DEJERINE SOTTAS DISEASE :  a localized enlargement of a peripheral nerve caused by hypertrophic interstitial neuropathy. • The most common site is median nerve.It cannot be excised whith out resecting the nerve with should not be done. • Dividing the transvese carpal ligament may help to releive pain & occasionaly has decreased the size of the nerve distally . •  The swelling will subside spontanously after surgery

  16. javabe case DEJEINE-SOUTASS ast .  • type 3 C-M-T • be tore localize asab haye mohity ra dargir mikonad . • be tore typic asabe median dar gir ast . • be dalile dysmyelination , myelin haye asab daeman takhrib va bazsazi mishavad . • va be in dalil asab besyar bozorg va hypertrophy mishavad . • biopsy be tashkhis komak konanade ast • tamame toole asab dargir ast • darman serfan baz kardane toonele carp ast

  17. EMG and NCV could revealed the peripheral neuropathies with the abnormal findings in other nerves. • DEJEINE-SOUTASS is usually benign disease without progression • Carpal ligament release is suitable choice. Discusion

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