J Korean Orthop Assoc JKOA Journal of the Korean Orthopaedic Association 1226-2102 2005-8918 The Korean Orthopaedic Association 10.4055/jkoa.2012.47.4.316 Case Report Recurrent Lipofibromatous Hamartoma of the Median Nerve Kim Chul Hong M.D. Kim Bo Kun M.D. Lim Young Hoon M.D. Department of Orthopedic Surgery, Dong-A University College of Medicine, Busan, Korea. Correspondence to: Bo Kun Kim, M.D. Department of Orthopedic Surgery, Dong-A University Medical Center, 26, Daesingongwon-ro, Seo-gu, Busan 602-715, Korea. TEL: +82-51-240-5167, FAX: +82-51-243-6757, cusem9@daum.net 08 2012 27 08 2012 47 4 316 320 03 11 2011 16 12 2011 14 02 2012 Copyright © 2012 by The Korean Orthopaedic Association 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Lipofibromatous hamartoma is a rare tumor of the peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue and very few cases have been described and reported in the literature. Surgical treatments of lipofibromatous hamartoma include partial excision, debulking operation, nerve decompression and so on. We report a case of recurrent lipofibromatous hamartoma of the median nerve that partial excision was done previously but causing secondary carpal tunnel syndrome and a review of the literature regarding the etiology, pathogenesis and surgical management of lipofibromatous hamartoma.

 median nerve lipofibromatous hamartoma carpal tunnel syndrome Guthikonda M Rengachary SS Balko MG van Loveren H Lipofibromatous hamartoma of the median nerve: case report with magnetic resonance imaging correlation Neurosurgery 1994 35 127 132 Al-Jabri T Garg S Mani GV Lipofibromatous hamartoma of the median nerve J Orthop Surg Res 2010 5 71 Nilsson J Sandberg K Søe Nielsen N Dahlin LB Magnetic resonance imaging of peripheral nerve tumours in the up-per extremity Scand J Plast Reconstr Surg Hand Surg 2009 43 153 159 Johnson RJ Bonfiglio M Lipofibromatous hamartoma of the median nerve J Bone Joint Surg Am 1969 51 984 990 Houpt P Storm van Storm van Leeuwen JB Intraneural lipofibroma of the median nerve J Hand Surg Am 1989 14 706 709 Marom EM Helms CA Fibrolipomatous hamartoma: pathognomonic on MR imaging Skeletal Radiol 1999 28 260 264 Warhold LG Urban MA Bora FW Jr Brooks JS Peters SB Lipofibromatous hamartomas of the median nerve J Hand Surg Am 1993 18 1032 1037 Clavijo-Alvarez JA Price M Stofman GM Preserved neurologic function following intraneural fascicular dissection and nerve graft for digital and median nerve lipofibromatous hamartoma Plast Reconstr Surg 2010 125 120e 122e Louis DS Hankin FM Greene TL Dick HM Lipofibromas of the median nerve: long-term follow-up of four cases. J Hand Surg Am 1985 10 403 408 Paletta FX Senay LC Jr Lipofibromatous hamartoma of median nerve and ulnar nerve: surgical treatment Plast Reconstr Surg 1981 68 915 921

Magnetic resonance imaging scan showing the case of lipofibromatous hamartoma of the median nerve. (A, B) Low-intensity structures representing thickened nerve fascicles, surrounded by evenly distributed fat, high signal intensity on T1-weighted sequences and low signal intensity on T2-weighted sequences. T1 and T2 axial section at the base of metacarpals shows the typical 'cable-like appearance' (C) T1 coronal section of the wrist demonstrates 'fusiform-like enlargement' of the median nerve surrounded by fat.

Clinical photographs. (A) Tumor in the left palm of the patient. (B) Intra-operative view of the enlarged left median nerve with fibroadipose tissue proliferation. (C) Photograph after a partial excision of the mass with epineurolysis and bleeding control.

Charateristic histologic findings in lipofibromatous hamartoma (H&E stain, ×20): The mass is composed of large nerve bundles (black arrow) surrounded by intermingled fibrous (A) and adipose tissue (B).