A 55-year-old male with no previous history of interest.
Ten months before the consultation she began with progressive but painless swelling in her fourth finger of her right hand.
Inflammation resulted in a functional deficit, with inability to perform the flexion-extension of the affected finger.
The radiographic study showed a loss of definition of the anterior cortical bone at the base of the proximal phalanx of the fourth finger, together with an increase in soft parts that seemed to present an incipient calcification that extended distally to palm.
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An incisional biopsy was performed, and the pathological diagnosis was reactive periosteum florida.
The patient was admitted to our service where the existence of a mass in the proximal phalanx of the fourth finger with swelling and swelling was verified.
No locoregional signs of infection were found.
The mobility of all fingertips was affected, an absolute functional impotence.
The patient complained of pain with paresthesia in the territory of the ulnar collateral nerve.
The radiographic study showed an evolutionary stage of the lesion with respect to the first study, in which the calcification of the soft parts of the palmar zone of proximal phalanx had become more ostensible, extending to the length.
A clear peristaltic reaction appeared at the base of the speech, which seemed to connect with the classification but also extended to the opposite side.
It is also interesting to note that there was a solid peristaltic reaction of irregular edge in the middlephalanx.
In the preoperative radiographic study, the calcification at the base of the middle phalanx became more defined and large, covering the entire length of the phalanx.
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Magnetic Resonance Imaging (MRI) revealed a soft-tissue lesion involving the flexor tendons and contacted the periosteum of the proximalphalanx.
It was hypointense at T1, hyperintense at T2, and homogeneously enhanced with Gadolinium.
On its palm margin, it presented a hypointense ridge that could represent calcification.
No internal signal gaps were observed, so the pattern of calcification should be linked to a cell matrix ( suggesting tumor or psedotumor).
Periosteal uplifts and a soft-tissue component displacing the extensor tendon were observed in the lateral margins of the scaffold.
Sagittal sections showed that the bone marrow was respected and that the anterior cortical bone was not tapered but showed a slight scalloped on its external surface.
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The lesion was excised by performing an aesthetic amputation of the fourth radius of the right hand due to functional deficit of the finger.
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The anatomopathological study of the amputation piece indicated the existence between the flexor tendon and the surface of the first phallenge, mature bone with intense phenomena of consolidation.
In the center of the bone there was a growth plate with almost total absence of mitosis, which differentiated small amounts of osteoid.
When comparing this biopsy with the previous or diagnostic one, a higher cellularity was observed, with discrete cellular atypia and higher mitotic activity.
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The evolution of the patient was satisfactory and the lesion has not recurred after 8 years of follow-up, currently maintaining good hand function.
