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Differential Diagnoses of Pediatric Upper Limb Masses
Cheryl Pei Chyi Yong1, Mark Edward Puhaindran1, Soumen Das De1
1Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore.
Insights
This study analyzed pediatric upper limb masses, finding most are benign. A clinical algorithm was developed to aid in evaluating and managing these common childhood conditions.
Area of Science:
- Pediatric Orthopedics
- Skeletal Oncology
- Epidemiology
Background:
- Upper limb masses are common in outpatient settings, yet pediatric-specific epidemiological data is limited.
- Understanding the characteristics of these masses in children is crucial for accurate diagnosis and management.
Purpose of the Study:
- To determine the differential diagnoses of upper limb masses in pediatric patients (aged ≤18 years).
- To describe the clinical characteristics of pediatric upper limb masses.
- To establish an evidence-based clinical algorithm for managing these conditions.
Main Methods:
- Retrospective review of patients aged ≤18 years with upper limb masses over a 5-year period.
- Data collection included demographics, clinical features, imaging, intraoperative findings, and histology.
- Correlation between clinical and histopathological diagnoses was assessed for surgical cases.
Main Results:
- 141 upper limb masses were analyzed; the mean age was 12 years.
- The majority (91%) of masses were benign, with 10% being malignant or locally aggressive.
- Common presentations included swelling, pain, and paresthesia; 31% of patients underwent surgery.
Conclusions:
- Pediatric upper limb masses are predominantly benign, but a significant minority present as malignant or locally aggressive disease.
- A clinical algorithm was developed to assist healthcare providers in the evaluation and management of pediatric upper extremity masses.
Purpose:
Upper limb masses are one of the most common presentations in the outpatient setting. However, there is a paucity of information in the literature regarding the epidemiology of upper-extremity masses in the pediatric population. The aim of this study was to determine the differential diagnoses and clinical characteristics in children aged ≤18 years presenting with upper limb masses.
Methods:
A retrospective review of patients aged ≤18 years managed at our institution over a 5-year period was performed. We obtained information on patient demographics, clinical features, radiological investigations, intraoperative features, and histology. We also evaluated the correlation between the clinical and histopathological diagnoses in patients who underwent surgery.
Results:
There were 141 upper limb masses in our series. The mean age at presentation was 12 years (SD, 5 years). The most common presenting complaints were asymptomatic swelling, pain, and paresthesia. The majority (128; 91%) of tumors were benign; there were 5 locally aggressive tumors and 6 malignant tumors. The dominant hand was involved in 60 patients. Of 140 patients, 43 (31%) patients had surgery. The procedures included incisional biopsy, excisional biopsy, wide resection, and reconstruction. One patient required a below elbow amputation for an osteosarcoma.
Conclusions:
Ten percent of cases represented malignant or locally aggressive disease. We have used our observations to develop a clinical algorithm that can assist clinicians in evaluating and managing children and adolescents presenting with upper-extremity masses.
Type Of Study/Level Of Evidence:
Prognostic IV.
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