Diagnosis and management of primary malignant tumors in the upper extremity

Abstract

Bone and soft tissue sarcomas of the upper extremity are relatively uncommon. In many cases, they are discovered incidentally during evaluation of traumatic injuries or common ailments such as rotator cuff tendonitis or tennis elbow. Thus, it is important for all orthopedic surgeons to understand the differential diagnosis, workup, and treatment for upper extremity lesions. An appreciation of the clinical and radiographic features of primary malignant lesions aids in identifying patients that need referral to an orthopedic oncologist and a multidisciplinary team.

Tricks and pitfalls in the surgical treatment of malignant bone tumours of the forearm in children and adolescents

“…With the help of adjuvant treatments, the smaller tissue cuffs may be sufficient in these cases. 2 Tumour-free margins can be achieved by limb-salvage surgery in most patients. The location of the tumour, size, proximity to neurovascular structures, distant metastasis, age and general condition of the patient should be taken into account for the decision of limb-salvage surgery or amputation.…”

“…When wide margins cannot be achieved, a post-surgical severe functional deficit predicted or an unresectable lesion is present, local control can be managed by definitive radiotherapy. 2 Radiotherapy can also be applied to maintain local control of the lesion in addition to surgical resection either pre- or postoperatively.…”

“…In the literature, approximately 5% to 10% of malignant upper extremity tumours were treated with amputation. 2 Prior unplanned excision resulting in tumour contamination and high-grade tumour with neurovascular involvement are indications for amputation. It should be noted that performing limb salvage surgery on tumours in this location may not always be possible due to the involvement of critical structures.…”

“… 15 , 26 Approximately 15% to 38% of bone sarcoma patients may develop local recurrence and/or late-onset lung metastases. 2 , 26 The standard approach for local recurrences is mostly radical amputation, whereas late-onset lung metastases are managed by resection and/or chemotherapy.…”

“…Signs of malignancy, such as osteolysis, cortical erosion, new bone formation and periosteal reaction, may be present on radiographs. 2 Patients usually complain of persistent, unexplained, non-mechanical resting pain and soft-tissue swelling. Malignant bone tumours are often localized to the metaphysis.…”