Tumor List

Most patients are asymptomatic, but some have activity related pain. One third to half of the patients have bilateral nodules. Pain occurs with weightbearing activities. When the lesions are large enough to press on the plantar nerves, there may be numbness or dysesthesia in the distal portions of the foot. In one pediatric patient, a large lesion caused contracture of the toe flexor tendons and loss toe extension in the lesser toes.

The most common clinical presentation is that of a localized, painful mass.

Monostotic fibrous dysplasia may be completely asymptomatic and is often an incidental finding on x-ray. Pain and swelling at the site of the lesion can also be present. Female patients may have increased symptoms during pregnancy. Unfortunately, this tumor can also present as a pathological fracture that is followed by a nonunion or malunion.

Examination reveals a tender mass with mild surrounding warmth and erythema, but no fever or adenopathy. Laboratory studies typically show a normal white blood-cell count and differential and a mildly elevated sedementation rate. Electrolytes and other laboratory values are unaffected. Plain radiographs show the tumor is adjacent to the bone rather than arising from it. Soft tissue swelling is seen as well as a marked periosteal reaction. There may be new bone formation in the soft tissues and subtle cortical thinning. In rare cases there is local erosion of the cortex. Technetium-99 bone scans show a solitary focus of intense uptake. Magnetic resonance scans show a mass and striking signal abnormalities in the soft tissues as well as the nearby bone marrow that are relatively nonspecific and are consistent with infection, trauma, or tumor.

Most ganglion cysts can be definitively diagnosed based on a careful history and physical examination. By history the lesion has a tendency to both increase and decrease in size over time. On exam, ganglion cyst typically has superficial location, and may be adjacent to a joint. When these lesions occur near a joint, there is often osteoarthritis seen on the xray. The mass is soft when the nearby joint is relaxed, and becomes firm when the nearby joint or muscle is tensed. A pen light or a small laser pointer will transilluminate the cyst.

Most ganglion cysts can be definitively diagnosed based on a careful history and physical examination. By history the lesion has a tendency to both increase and decrease in size over time. On exam, ganglion cyst typically has superficial location, and may be adjacent to a joint. When these lesions occur near a joint, there is often osteoarthritis seen on the xray. The mass is soft when the nearby joint is relaxed, and becomes firm when the nearby joint or muscle is tensed. A pen light or a small laser pointer will transilluminate the cyst.

Pain and swelling, or a slight pathological fracture

Most patients present with slowly progressive pain, with or without a mass. Symptoms arise when the lesion begins to destroy the cortex and irritate the periosteum or when the weakening of the bone caused by the tumor causes pain due to imminent pathologic fracture. Some giant cell tumors present with a pathologic fracture.

The typical patient has a history of gradually increasing pain. In the foot a mass may be apparent due to the limited soft tissues. Pain from pathological fracture or microfracture may cause the patient to seek treatment.

Clinically, the patients report a slow growing painless, firm solitary mass adjacent to the dorsal or plantar tendons, the midfoot joints, or the ankle joint, which has been present for one to two years on average. There may be a history of trauma, and neurological symptoms occur rarely. In one study, lesions in the forefoot occurred in the first, second, and fifth rays exclusively, indicating that there may be some relationship between weight-bearing and this tumor. The tumor may cause or accentuate an angular deformity such as hallux valgus.

In the author's series, the tumor has been found as an incidental lesion in the ankle, a painful mass in the ankle or knee, or as a snapping sensation in the hip. Lesions have been reported in most large joints, including the elbow, shoulder, and the lower extremity. Some tumors in the author's series have been located in a tendon sheath outside the joint entirely, but not anatomically very far from a large joint.

In the author's series, the tumor has been found as an incidental lesion in the ankle, a painful mass in the ankle or knee, or as a snapping sensation in the hip. Lesions have been reported in most large joints, including the elbow, shoulder, and the lower extremity. Some tumors in the author's series have been located in a tendon sheath outside the joint entirely, but not anatomically very far from a large joint.

Clinically, the patients report a slow growing painless, firm solitary mass adjacent to the dorsal or plantar tendons, the midfoot joints, or the ankle joint, which has been present for one to two years on average. There may be a history of trauma, and neurological symptoms occur rarely. In one study, lesions in the forefoot occurred in the first, second, and fifth rays exclusively, indicating that there may be some relationship between weight-bearing and this tumor. The tumor may cause or accentuate an angular deformity such as hallux valgus.

Clinically, glomus tumors are characterized by a triad of sensitivity to cold, localized tenderness and severe intermittent pain. The pain can be excruciating and is described as a burning or bursting.The exact cause of the pain is not completely understood, but nerve fibers containing the pain neurotransmitter substance P have been identified in the tumor.

At initial presentation, the lesion may not be palpable and the characteristic blue-purple discoloration may not be visible. The pt reports a painful area which can be extremely well localized.

Clinically, glomus tumors are characterized by a triad of sensitivity to cold, localized tenderness and severe intermittent pain. The pain can be excruciating and is described as a burning or bursting.The exact cause of the pain is not completely understood, but nerve fibers containing the pain neurotransmitter substance P have been identified in the tumor.

One diagnostic test is sensitivity to pressure with a very small object, such as the head of a pin or a fine blunt k-wire. Cold sensitivity can be tested with ice baths. Application of a tourniquet is said to relieve the pain, which returns rapidly when the tourniquet is released.

The lesion may have a visible blue color.

The majority of osseous granulocytic sarcomas present with skeletal pain referable to the location of the lesion. This tumor has three characteristic clinical presentations: one, in an individual with no known disease where it is a harbinger of acute myelogenous leukemia; two, in an individual with already known myleoproliferative disorder. Subsequent evaluation of peripheral blood and bone marrow biopsy in this case demonstrated this to be granulocytic sarcoma without systemic evidence of acute myelogenous leukemia. The appearance of the tumor in a previously healthy individual presents a significant diagnostic challenge, and 75% of these cases are usually misdiagnosed.

Localized and disseminated GA are the two most common types.

Localized GA comprises about 3 out of 4 cases. One or several small, firm, flesh colored or eyrhematous papules are seen, which may form a ring, and slowly expand in diameter. These lesions typically occur on the lateral and dorsal surfaces of the hands and feet.

Disseminated or generalized GA is characterized by widespread lesions similar in nature to those in localized GA. The lesions may last for several years. Lesions may improve in winter and worsen in summer.

Subcutaneous GA is most common in children 2 to 5 years old. This form most often manifests as a large, asymptomatic soft tissue mass. Although nodules are usually stable for months, they may rapidly enlarge over the course of weeks. Patients with subcutaneous GA present with a firm, nontender, flesh-colored or pinkish nodule without overlying epidermal alteration .Lesions are typically solitary but may occur in clusters. The most commonly reported site of involvement is the lower extremities (65% of cases), often on the pretibial surface. Other typical sites include the fingers and palms and the dorsa of the feet. The buttocks, forehead, and scalp are less commonly affected. Deep dermal or subcutaneous nodules on the extremities are attached to fascia and are often therefore mobile, whereas lesions on the scalp are attached to underlying periosteum and are therefore fixed or only slightly mobile. These lesions do not progress to a systemic illness.

Perforating is a rare type, more common in women, and found on the upper limbs and pelvis, abdomen, trunk, and extremities. The lesions may cause itching and pain.

EG is normally symptomatic. Local pain, swelling and tenderness are common and the ESR may be elevated.