Lipome compressif de la loge thenar. À propos d’une observation

Giant Thenar Lipoma Associated With a Carpal Tunnel Syndrome: A Case Report

“…The lipoma is a benign tumor, it is composed of lobules of mature fat cells. At the location of the palm of the hand it can be supra or subaponeurotic exceptionally intramuscular [2], the Giant lipomas are characterized by a size exceeding 5 cm,the are a few report of giant lipomas in this location [3],the first publication in 1956 reported 17 cases [4], it can cause, depending on its location, compression of the interosseous nerve at the forearm , carpal tunnel syndrome ,compression of the ulnar nerve in the guyon canal or the digital nerves [5], MRI is the examination of choice because of its high sensitivity, it specifies the nature of the lesion its local extension and its relationship with the vasculonervous elements, the characteristic image of the lipoma is a well-limited image in hypersignal on the T1 and T2 sequences with reduction of the signal on the fat suppression sequences [6] Histologically, [7]Giant lipomas are considered to be the critical size which can be suspect to be malignant hence it is necessary to perform a biopsy which will separate benign lipomas and liposarcomas from other soft tissue neoplasms., the well-differentiated liposarcoma constitutes the differential diagnosis which involves more risk for the patient its peak frequency is between 50 and 70 years it develops from subcutaneous fat or cellular spaces sometimes even from a preexisting or recurrent lipoma Marginal excision represents the treatment of choice, the dissection and identification of neurovascular elements must be careful to avoid iatrogenic lesions, Recurrences are extremely limited [8] and are usually caused by the defective excision of the tumor ,…”

Lipome géant de la main : présentation d’un cas clinique et revue de la littérature

“…Au niveau de la paume de la main, il peut être sus-ou sous-aponévrotique, exceptionnellement intramusculaire [1][2][3][4][5].…”

“…À la main, c'est l'apparition de signes de compression vasculonerveuse qui amène le malade à consulter. En fonction de sa localisation, le lipome entraîne un syndrome du canal carpien [2][3][4][5][7][8][9], une compression du nerf ulnaire dans le canal de Guyon [10], des nerfs digitaux [4], voire un doigt à ressaut [8]. Ce sont les lipomes sous-aponévrotiques qui compriment les branches du nerf médian et du nerf cubital.…”

“…Le lipome est qualifié de « géant », quand la pièce d'exérèse dépasse 5 cm de diamètre [1][2][3][4][5]. Ces lipomes géants sont surtout fréquents au membre inférieur, essentiellement à la cuisse.…”

“…Ces lipomes géants sont surtout fréquents au membre inférieur, essentiellement à la cuisse. La main représente 5 % de localisations des lipomes du membre supérieur [1,4]. Cependant, le lipome palmaire géant compressif du nerf médian est rare.…”