Lipofibromatous hamartoma of the median nerve: A case report and review of the literature

Abstract

A case of lipofibromatous hamartoma of the median nerve in an adult is described in this article. A 33-year-old male presented with tingling, numbness and swelling in the palm of the left non dominant hand that had been present for a few months. Examination revealed that there was fullness in the volar aspect of the wrist and in the inter-thenar area. Another mass was present at the base of the index finger, which appeared to be involving subcutaneous tissues. The clinical diagnosis was carpal tunnel syndrome due to a space occupying tumor mass in the carpal tunnel. On exploration of the carpal tunnel, a large median nerve was seen 4 cm proximal to the wrist crease line and extending distally until it divided into its branches. Another mass was present at the base of the index finger, which was adherent to the skin. The radial digital nerve of the index finger was normal in size. For the enlarged nerve, an epineurotomy was performed and a biopsy was taken. Another biopsy was taken from the distal mass. His postoperative period was uneventful. In July 2004, at the end of 5 years, the patient had no symptoms and the size of the tumor had not increased.

Lipofibromatous Hamartoma of the Palmar Cutaneous Branch of the Median Nerve

“…Patil and Nagle in 2009 reviewed the literature and found that only approximately 88 cases of LFH have been reported and that 33 of these were associated with macrodactyly. 20 This association is well addressed in the literature and has prompted speculation that LFH may be associated with neurofibromatosis. Gigantism in patients with neurofibromatosis is associated with the development of osteochondromas, further seeding this speculation of a possible LFH of the Palmar Cutaneous Branch of the Median Nerve Hoellwarth, Goitz association.…”

Fibrolipomatous hamartoma of the median nerve: A cause of acute bilateral carpal tunnel syndrome in a three-year-old child: A case report and comprehensive literature review

“…The cause of these transformations, however, remains elusive. Some believe this neoplasm is congenital/developmental in origin, whereas others maintain it is an acquired/reactive process due to factors such as nerve irritation or trauma (1,4,5,10,24,40). Those who support the congenital theory, especially in relation to FLH of the median nerve in the carpal tunnel, propose that this patient population is born with an abnormally developed flexor retinaculum or an abnormally developed transverse carpal ligament (26,28,41).…”

“…Interfascicular dissection may additionally cause a disruption in the segmental vascular supply, which can cause ischemia and its resulting complications (26,29). A large tumour increases the risk of neurological deficit due to vascular compromise and the fibrotic healing response that occurs will further interrupt nerve function (19,22,24,27,29,32). The specific indications for this technique, however, remain controversial, with some authors further reporting that such attempts may downgrade nerve function, thereby further compromising outcome (27).…”

“…Other authors maintain vehemently that complete excision of this fibrofatty growth is contraindicated because it may cause intolerable sensory or motor disturbances and, therefore, should never be offered as a treatment option for FLH (18,26,43). However, others have suggested that it may be indicated in children younger than two years of age due to their ability to reeducate sensibility (24). This surgery is at a high risk for complications because the intraneural elements are intimately associated with the nerve tissue.…”

“…These patients are also at risk for postoperative neurogenic pain (26). Thus, surgical resection of FLH with or without nerve grafting is not routinely recommended (24).…”