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Background: Upper extremity tumors (UETs) and their treatment may impair hand functions. Successful prediction of the histopathological examination before surgery will speed up the treatment process. The aim of this study is to determine the frequency and prediction accuracy of tumors encountered in the upper extremity. Patients and Methods: Records of patients operated for UETs between January 2010 and December 2019 were reviewed. Patient gender, initial complaint, the anatomic region of the tumor, comorbidities predisposing to malignancy, method of biopsy, preliminary diagnosis and predicted malignancy status after initial examination, definitive histopathological diagnosis, and malignancy status were extracted retrospectively. Prediction accuracy rates were calculated for each tumor group. Chi-square analysis was used for comparative analysis of prediction accuracy rates between cutaneous pigmented versus soft-tissue lesions and patients with/without a predisposition to malignancy. Results: The study included 416 pathological specimens from 290 patients. The most common tumors of the upper extremity were lipoma (20%), ganglion cyst (10.1%), and epidermoid cyst (5.8%). After pathological evaluation, 23 specimens were diagnosed as malignant (5.5%) and 32 specimens as premalignant (7.7%). The prediction of malignancy status was accurate in 390 specimens (93.7%). Soft-tissue sarcomas (67.7%) and vascular lesions (58.1%) have the lowest accuracy rates among all tumors. Conclusion: Definitive diagnosis and malignity status can be predicted after the initial examination in the majority of the cases. However, imaging studies or incisional biopsies are needed for soft-tissue sarcomas, vascular tumors, or tumors of patients with a predisposing condition to malignancy.

Congenital unilateral upper limb muscular hypertrophy is a rather new entity. Patients have unbalanced muscular forces on their upper extremities due to muscular hypertrophy. These unbalanced forces preclude physiological movements, and in the late course, cause joint deformities. Once joint deformities occur, benefit from surgery diminishes; botulinum toxin can be used for the prediction of a possible benefit from surgery. A 14-year-old girl presented with flexion and ulnar deviation contracture of the left wrist, narrowing of the first web space, flexion contracture of all fingers, and more evident on the first, third, and fourth fingers. After botulinum toxin injection, the most notable benefit was seen on the wrist contracture. In surgery, adductor myotomy, flexor carpi ulnaris transfer to palmar aponeurosis, and tendon transfers of flexor digitorum superficialis to flexor digitorum profundus in the third, fourth, and fifth fingers were made. The postoperative gain was similar to the outcome after botulinum toxin injection. Botulinum toxin may help the surgeon to understand if chronic joint deformities have occurred and predict possible benefit from surgery.

Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous malignancy with uncertain histogenesis. Here, we present an unusual presentation of giant MCC of the skin with concomitant intra-abdominal metastasis to pancreas. A 53-year-old man was admitted to our clinic with a giant ulcerated mass in the gluteal region. Incisional biopsy of the mass revealed primary poorly differentiated neuroendocrine tumor of the cutaneous origin and confirmed the diagnosis of MCC. Clinically, the patient complained of abdominal discomfort and weight loss of 15 kg over the past 4 months. Intra-abdominal computerized tomographic examination demonstrated a heterogenous-appearing giant mass of the right upper quadrant invading the superior mesenteric artery and leading to obstruction of common biliary duct and a second mass (6 cm Χ 6 cm) located at the inferior pole of pancreas extending toward the duodenum. As the gluteal mass was prone to trauma and leading to massive hemorrhage, excision of the gluteal mass with 2 cm of tumor-free margin was performed. V-Y advancement flap based on the perforators of the inferior gluteal and profunda femoris artery was elevated to cover the resulting defect (22 cm Χ 17 cm). Although the patient was referred to medical oncology for further therapeutic management, he could only survive for 11 months from his initial diagnosis. We would like to emphasize that MCC has the potential to spread to unusual organs in short intervals and prompt evaluation and proper management is essential for optimal survival of these patients.

Objective: The aim of this study was to evaluate the long-term results of a simultaneous application of botulinum toxin to the parotid gland in conjunction with the microsurgical repair of the duct in an acute setting and to encourage using botulinum toxin as a first-line option to prevent future complications associated with glandular involvement. Material and Methods: Three patients who were referred to the Plastic Surgery Clinic by the emergency room of the Hacettepe University Hospital after maxillofacial trauma are reviewed in this study. Exploration of the facial nerve and Stensen’s duct was planned for all patients within the first 72 hours after their injuries. After intraoral catheterization of the Stensen’s duct through the papilla using an epidural catheter, microsurgical end-to-end anastomosis was performed. Concurrently, 100 units of botulinum toxin A was injected at standardized eight points to the parotid gland. Results: Postoperative magnetic resonance (MR) sialography revealed patency in all patients at the end of postoperative first year. The mean postoperative parotid volume of the injured and non-injured sides were 19.82±10.55 cm3 and 17.79±10.98 cm3, respectively, and the results were found to be comparable. Fibrillation potentials in the postoperative electromyography recordings and clinical examination demonstrated nerve regeneration. Conclusion: Botulinum toxin A appears to be effective in treating duct injuries accompanied by glandular involvement in an acute setting, as well as in preventing long-term complications.

Ewing`s sarcoma (ES) is the second most common childhood primary malignant tumor of the bone. The most popular locations of ES are long bones and pelvis. The involvement of the mandible is very rare in childhood. In last 10 years, we met with three cases of ES of the mandible in our department. Initially the patients had symptoms similar to periodontal inflammation. The involvement of the mandible might be considered with periodontal inflammation in its initial stages, what frequently leads to delayed treatment. Although this tumor has an aggressive clinical behavior and rapid growth, early diagnosis can reduce patient`s morbidity and mortality and thus it is important to distinguish from periodontal inflammation.