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Lesions of the Fingers - A 15 year Surgical Pathology Review
Jenna-Lynn B. Senger; Dale Classen, MD, FRCS; Rani Kanthan, MBBS, MS, FRCS
University of Saskatchewan, Saskatoon, SK, Canada

Introduction: Lesions of the fingers are fundamental to the practice of hand surgery. As fingers are critical to activities of daily living, accurate diagnosis of these lesions to guide appropriate surgical management and postoperative care is essential. Pre-operative identification with categorization of these lesions can be surgically challenging. The aim of this study was to identify the wide spectrum of pathologies encountered in a single institution from specimens submitted as finger lesions in the context of the discussion of 2 unusual cases.

Materials & Methods: A fifteen-year (1996-2012) retrospective surgical pathology review was conducted using the Laboratory Information System of the Saskatoon health region, Saskatoon, Canada. All pathologies of the digits of the hand designated as finger/thumb were identified, with analysis of demographics. Pathology results were classified into the categories of neoplasms (malignant and benign), dermatologic, vascular, cystic, infectious, autoimmune, degenerative, inflammatory and ‘miscellaneous’.

Results: A total of 3911 pathology specimens were received in relation to surgical procedures of the five fingers excluding amputations. These lesions were excised by plastic surgeons in 2470 cases (63%). There was no gender distribution discrepancy with males (1925) and females (1986). A slight preponderance towards right-handed (2048) compared with left-handed (1746) lesions was observed in the labeled specimens. The thumb was the most frequently affected (~29%) followed by the long (~23%), index (~21%), ring (~14%) and short finger (~11%) with multiple fingers involved in ~2%. The majority of pathologies were cystic (29%) followed by benign neoplasms (17%), inflammatory (16%), dermatological (7%), infectious (6%), vascular (5%), autoimmune (3%), malignant (3%), and degenerative (1%). The commonest pathological findings reported included: ganglion 802 (21%); giant cell tumors 260 (7%): pyogenic granuloma 227 (6%); epidermal inclusion cysts 207 (5%); verruca vulgaris 181 (5%), fibromatosis /Dupytren’s 136 (3%) and rheumatoid nodules in 111(3%). Unusual clinical presentations included a squamous cell carcinoma of the fingernail that masqueraded as a fungal infection and a schwannoma of the fingertip that was clinically presumed to be an inclusion cyst.

Conclusions: A myriad of pathologies can occur in the fingers. In this context as both cosmesis and dexterity of the fingers are imperative to a good functioning hand, appropriate surgical management is best handled under the expertise of the trained plastic/hand surgeon. Increased awareness of uncommon clinical presentations and uncommon surgical pathologies remain a continuing challenge for accurate preoperative identification of fingers lesions.

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