Analysing the Clinicopathological Spectrum of Hand Lesions at a Tertiary Care Centre: A Retrospective Observational Study
Authors: Sankaran Trisha , Balasubramanian Subalakshmi , Balasubramanian Nellaiyappan , Cruze Lawrence D , Subramanian PS Muthu 
Published: December 2024

Introduction: Primary bone lesions of the hand usually comprise only a minor percentage of the total bone lesions encountered, and diagnostic challenges occur due to a lack of demographic knowledge concerning the frequency and distribution of these hand lesions. The present study will help readers to understand the different hand lesions encountered in order to improve the differential diagnosis, aiding in better patient management and treatment.

Aim: To analyse the spectrum of non neoplastic and neoplastic hand lesions presenting at a tertiary care centre.

Materials and Methods: This was a retrospective observational study conducted in the Department of Orthopaedics-Hand Surgery at Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. The study involved the records of patients who presented with hand lesions for which histopathological diagnosis was performed by the Department of Pathology over a five-year period from January 2019 to December 2023. The study was conducted between January 2024 and March 2024. Medical records of 147 patients were collected, documenting details including age, sex, location of the lesion, clinical and pathological diagnosis, and ancillary studies wherever necessary. The results were tabulated using descriptive statistics.

Results: A total of 147 hand lesions were studied, with lesions being more common in males 83 (56.4%) than in females 64 (43.5%). In males, inflammatory lesions (n=40, mean age 49.2) were the most common, while in females, benign lesions (n=40, mean age 37.2) were more frequently observed. The total age range of all lesions at presentation was 11 to 82 years, with a mean age of 42.52 years. In individuals less than 40 years old, benign lesions were the most common, whereas inflammatory lesions were more prevalent in those above 40 years. All four malignant lesions in present study occurred in patients over the age of 60 years. The distribution of tumours was more common in the right hand, particularly the right digits, comprising 33% of the tumours. Among the 147 cases, the common lesions encountered were benign lesions, which constituted 76 lesions (51.7%), with ganglion cysts 22 (14.97%) being the most common, followed by Giant Cell Tumour (GCT) of the tendon sheath 12 (8.16%). The second most common group of lesions were inflammatory lesions, which included 54 (36.7%) lesions, with inflammatory processes being the most frequently encountered 39 (26.53%). The third category included infective lesions, comprising 13 (9.52%) lesions, among which necrotising fasciitis (n=4) and phaeohyphomycosis (n=3) were the most common. Malignant lesions accounted for 4 (2.72%) lesions, which included well-differentiated Squamous Cell Carcinoma (SCC) (n=2), spindle cell sarcoma (n=1), and Diffuse Large B Cell Lymphoma (DLBCL) (n=1).

Conclusion: The distribution of hand lesions is varied, and a proper diagnosis is essential since recurrence is common. Hence, interdisciplinary collaboration among hand surgeons, rheumatologists, oncologists, and pathologists is crucial for the comprehensive management of tumorous conditions of the hand.