A Soft Tissue Chondroma Presenting As A Rapidly Enlarging Mass Within The Hand With Associated Median Nerve Compression

摘要

We present the case of a rapidly enlarging mass in the hand which was removed at surgery with comparative ease and confirmed to be a soft tissue chondroma. Case History A 90 year old lady presented with a one year history of a large soft tissue swelling in her right dominant palm. She was aware of some loss of power grip and in the month prior to admission developed clumsiness of her right hand and impaired sensibility in the thumb, index and long fingers with associated nocturnal waking.A smooth oval shaped swelling measuring around 5x4 centimetres was found arising from the centre of her right palm. It was firm and unattached to the palm skin. There was reduced power in all the intrinsic muscles of the hand and diminished static two-point discrimination in her radial digits. MRI with intra-venous gadolinium contrast revealed a large mass measuring 4.7x3.9x3.6 cm (transverse, proximal distal and AP respectively) extending between the flexor tendons just distal to the carpal tunnel. The radiological diagnosis was that of a sarcoma.A decision was made to proceed with complete excision. The lesion was deep to palmar fascia and distal to the carpal ligament. The median nerve was of normal calibre and displaced radially. The superficial palmar arch was stretched over the palmar aspect of the lesion. The lesion was sent for histology (Figure 1).