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The Use of Denosumab in Osteoblastoma of the Metacarpal
Osteoblastoma is a benign aggressive primary bone tumor that occasionally presents in the hand. Because surgical treatment remains the mainstay of treatment, there are no established nonsurgical pharmacological options for patients in whom resection is not feasible. Novel therapies, such as denosumab, are currently being investigated in primary bone tumors. We report a case of osteoblastoma of the first metacarpal that was successfully treated with denosumab. The patient showed a rapid and dramatic response to treatment that led to the transformation of a locally destructive tumor into an ossified painless mass, restoring function while avoiding surgery.Ewing Sarcoma in an Infant Metacarpal
We describe a case of Ewing sarcoma in the metacarpal of a 5-month-old male. After pain, erythema, and swelling of the hand failed to resolve with antibiotics, radiographs and magnetic resonance imaging raised suspicion for a neoplastic condition. Open biopsy confirmed the diagnosis of Ewing sarcoma and treatment with chemotherapy and surgical resection was initiated. Ewing sarcoma of the hand in a patient this young is an exceedingly rare diagnosis, which highlights the importance of a broad differential diagnosis when the treatments for more common conditions fail.Metacarpal Aneurysmal Bone Cyst En Bloc Resection Reconstructed With Osteoarticular Allograft
Aneurysmal bone cysts are large lytic lesions that appear most often around metaphyseal bone. The lesions are locally aggressive with high recurrence rates. Therefore, wide resection is commonly necessary, leading to challenging reconstruction of the defect, especially when the articular surface is involved. We present a case of an aneurysmal bone cyst of the fourth metacarpal, treated with an en bloc resection and reconstruction with a metacarpal osteoarticular allograft. At 8 years after surgery, the patient has shown no signs of recurrence, but radiographic articular reabsorption was noted.Blastomycotic Osteomyelitis: An Unusual Cause of Hand Swelling
Isolated blastomycosis hand infections are extremely rare, and are often clinically unsuspected, leading to delays in clinical diagnosis. Conclusive diagnosis often necessitates fungal cultures and histopathological demonstration of budding yeasts in tissues. In this report, we describe the rare occurrence of isolated blastomycotic hand infection, without any other organ involvement, in a 42-year-old male patient. Analyzing tissue specimens with frozen section has been shown in the past to demonstrate granulomatous inflammation and yeast forms of the organism; however, as demonstrated in this patient, the presence of pseudoepitheliomatous cells may deceptively appear as malignant, causing substantial concern and anxiety.
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