A comparative analysis of hand sarcoma by anatomical site: A case series

Hand sarcomas are very rare, and few studies have focused on their anatomical distribution, such as involvement of the fingers vs. the palm/dorsum (PD). The present study reviewed 24 cases of hand sarcomas identified from medical records of National Cancer Centre Hospital (Tokyo, Japan) between January 2010 and December 2022, examining sex, age, maximum tumour size, metastasis, histology, origin (bone vs. soft tissue), pain, biopsy performance, unplanned excision at previous institutes, treatment (surgery including reconstructive procedures, chemotherapy, and radiotherapy) and prognosis. The patients were divided into two groups, finger and PD, to facilitate comparison. Among the 24 cases, 9 occurred in the fingers and 15 occurred in the PD. Soft tissue was involved in 21 cases, while 3 cases arose from the bone, all in the fingers. Pain was present in 11 cases, with 6 cases (33%) in the fingers and 5 cases (66%) in the PD group. Synovial sarcoma, the most common histological subtype among the series, occurred exclusively in the PD group (n=7). In the finger group, 9 patients were managed with amputation, and only one received adjuvant therapy. In contrast, 10 of the 15 PD sarcomas underwent wide resection with reconstruction, and 6 received chemo- or radiotherapy. Overall, hand sarcomas had a favourable prognosis, with 86% overall survival and 77% disease-free survival rates; however, pleomorphic spindle cell sarcoma exhibited an exceptionally poor prognosis. In conclusion, synovial sarcoma was more prevalent in the PD region and finger sarcomas exhibited a slight tendency to cause pain. Treatment strategies varied significantly between the finger and PD groups.