Expansile lytic lesion of proximal phalanx of hand managed with novel technique: Case study

Expansile lesions in the hand mostly involve phalanges and metacarpals. Among them, majority comprising enchondroma and less incidence of aneurysmal bone cyst, giant cell tumor. The incidence of GCTs of hand bones is reported to be 2%.

Manjunath et al reported a case of 22 year old male graduate presented to outpatient department with complaints of swelling of the right middle finger for 3 months and associated pain for 2 months which gradually progressed, with no constitutional symptoms. Clinically, there was globular swelling of the proximal phalanx, which was tender on palpation and firm in consistency. The active range of motion (ROMs) of the metacarpophalangeal (MCP) joint was restricted, whereas the ROMs of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints were preserved. The patient’s capillary refill time was normal with normal distal sensation.

Complete blood counts, erythrocyte sedimentation rate, c reactive protein, and serology were found to be normal. A plain radiograph revealed an expansile lytic lesion with pathological fracture which was suggestive of enchondroma. MRI revealed expansile altered marrow signal intensity involving the proximal phalanx, measuring approximately 3.2 cm × 2.3 cm with no adjacent soft tissue involvement. No periosteal reaction/matrix calcification was found, which favoured enchondroma over the GCT as the probable diagnosis. The lesion appeared hypointense at T1 and hyperintense at T2.Based on clinical observations and radiological findings, enchondroma was considered the most likely diagnosis with the differential diagnosis being GCT, aneurysmal bone cyst.