Management of a rare, giant multicompartmental lipoma of the hand: a case report and review of the literature

Abstract

Lipomas are the commonest benign tumour, made up exclusively of adipose tissue, and can arise anywhere in the body. However, giant lipomas of the hand, defined as >5 cm in diameter, are rare. They have the potential to invade into surrounding areas and cause a multitude of symptoms due to the compression and proximity of underlying structures. We describe a case of a 64-year-old woman who presents with a swelling of the left thenar eminence, associated with numbness and tingling in all fingers. Magnetic resonance imaging and nerve conduction studies confirmed the diagnosis of a lipoma causing median nerve compression. The patient underwent elective surgical excision with good postoperative recovery. The excised lesion, measuring 12 × 7 × 2.4 cm, is one of the largest giant lipomas of the hand reported in literature, and the first to demonstrate invasion from the mid palmar space into both the dorsal sub-aponeurotic space and carpal tunnel.

A giant multi-compartment lipoma of the hand causing median nerve compression: A case report and review of literature

“…Lipomas comprise of mature adipocytes and are the most common benign soft tissue mass seen in the body [ [7] , [8] , [9] ]. They commonly have a shawl like distribution in the body and are seen rarely in the upper limbs and hand with hand lipomas accounting for 1–3.8 % of all lipomas [ 9 ].…”

“…Deep lipomas of the hand are occasional and seen in the Guyon's canal, carpal tunnel or deep palmar space [ 1 , 2 ]. Differential diagnosis for hand lipoma includes ganglion cysts, giant cell tumors, fibrolipomas [ 9 ].…”

“…Size>5 cm, deep location, rapid growth and pain are 4 red flag signs that should raise suspicion of a possible liposarcoma. When all 4 features are present, there is a 86 % likelihood of the mass being malignant and MRI is mandatory in such cases to look for evidence of local infiltration [ 9 ]. Malignant transformation of a lipoma is rare although it has been reported.…”