Dados do Trabalho

Título

Low-grade chondrosarcoma in the metacarpal region in a young patient and complications after surgical excision: a case report

Apresentação do caso

A 22-year-old female patient underwent surgery for the conservative excision of a tumor mass in the distal region of the 5th right metacarpal bone, after confirmation of the diagnosis of low-grade chondrosarcoma. The suspicion was due to the presence of a painful mass in the hand for more than 1.5 years with limited movement of the metacarpophalangeal joint, and was confirmed by bone scintigraphy, contrast-enhanced MRI and CT, and histopathological analysis after tumor biopsy. The lesion was removed with safe margins and bone cement was grafted to reconstruct the lost fragment. One month after the procedure, the patient returned to the clinic due to painful instability of the metacarpophalangeal joint, with subluxation visible at X-ray. MRI showed ligament rupture of the posterior hood of the joint, and the patient underwent a new surgery for ligament reconstruction. Patient followed postoperatively without further complications.

Discussão

Malignant tumors of the hand are extremely rare, chondrosarcoma being the most common. The presentation of this cartilage-producing tumor is most common in patients over 40 years of age, and the most frequent locations are the axial skeleton, pelvis, and femur. Low-grade chondrosarcoma is difficult to diagnose, because it can be confused with enchondromas, it is slow-growing, progressive, and rarely metastasizes. Conventional treatment is wide surgical excision, since recurrence rates are common, and there is a low response to radiotherapy. In the case presented, ligament disruption occurred due to difficulty in ligament adherence to the bone cement, and was corrected with the insertion of metal anchors for better fixation.

Comentários Finais

The case becomes relevant, since tumors of the hand are extremely rare, besides being uncommon in young patients. Moreover, the therapeutic approach used was conservative excision rather than wide local excision. The entire distal region of the right 5th metacarpal was removed and only the joint surface was maintained in order to preserve the functional viability of the metacarpophalangeal joint, reduce movement limitations, and avoid arthrodesis. Although there is a possibility of tumor recurrence, the risks-benefits were weighed and it was chosen to preserve the joint in order to provide the young woman with a better functional hand score in the coming years.

Palavras Chave

Chondrosarcoma; Sarcoma; Metacarpal