Journal List > J Korean Soc Radiol > v.67(6) > 1087202

Choi, Jung, Song, Lee, Lee, and Jung: Fibrolipomatous Hamartoma of Digital Branch of the Median Nerve without Macrodystrophy: Two Case Reports with Magnetic Resonance Imaging Findings

Abstract

Fibrolipomatous hamartoma (FLH) of the nerve is a rare, benign tumor that most commonly originates from the median nerve of the hand. Fibrofatty tissue proliferates around the nerve and infiltrates the epineurium and perineurium. We present two cases of pathologically proven FLH of a digital branch of the median nerve, without macrodystrophy with magnetic resonance imaging, surgical and pathologic findings. Magnetic resonance images of both cases show well-circumscribed mass with fat signal intensity around an enlarged digital branch of the median nerve and characteristic coaxial-cable-like appearance on axial images and spaghetti-like appearance on coronal images.

Figures and Tables

Fig. 1
A 39-year-old man with pathologically proven fibrolipomatous hamartoma involving digital branch of median nerve at right second finger. Radiograph (A) shows soft tissue bulging in radial aspect of right second finger (arrow) without bony abnormality. Axial T1-weighted (B) and coronal T2-weighted images (C) show enlargement of the digital branch of the median nerve and hypointense nerve bundles embedded within fat (arrows). Axial fat-suppressed T1 weighted image with gadolinium enhancement (D) shows non-enhancing hypointense fat tissue (arrow) around the digital branch of the median nerve. Intraoperative photograph (E) shows fusiform shaped mass and digital nerve fiber (arrow) at the distal ends of the mass. Photomicrograph (F) shows fibrofatty tissue growth surrounding the nerve trunk. Septation of nerve fascicles and concentric perineural fibrosis are noted (Hematoxylin & Eosin staining, × 100).
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Fig. 2
A 31-year-old man with pathologically proven fibrolipomatous hamartoma involving digital branch of median nerve at left second finger. Axial T2-weighted images (A) shows marked enlargement of the digital branch of the median nerve (arrow) surrounded by prominent fat tissue. Coronal T2-weighted images (B) shows hypointense nerve bundles embedded within fat (arrows). Intraoperative photograph (C) shows a yellowish fusiform shaped mass involving digital branch of median nerve at left second finger. Another intraoperative photograph (D) shows that the continuity of the digital nerve (arrow) was preserved after debulking of the fibrolipomatous hamartoma of the nerve. Photomicrograph (E) shows adipose and fibrous tissue surrounds and infiltrates the nerve trunk, causing enlargement of the nerve (Hematoxylin & Eosin staining, × 40).
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