Recurrent Lipofibromatous Hamartoma of the Median Nerve

Chul Hong Kim; Bo Kun Kim; Young Hoon Lim

doi:10.4055/jkoa.2012.47.4.316

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Kim, Kim, and Lim: Recurrent Lipofibromatous Hamartoma of the Median Nerve

Case Report

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(4): 316-320.

Published online: 27 August 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.4.316

Recurrent Lipofibromatous Hamartoma of the Median Nerve

Chul Hong Kim, M.D., Bo Kun Kim, M.D., Young Hoon Lim, 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

Received 3 November 2011 Revised 16 December 2011 Accepted 14 February 2012

(open-access):

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.

Abstract

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.

Keywords: median nerve, lipofibromatous hamartoma, carpal tunnel syndrome

Figures and Tables

Figure 1

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.

Figure 2

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.

Figure 3

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).

References

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