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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
Musculoskeletal Radiology
Journal of the Korean Society of Radiology

Journal of the Korean Society of Radiology 2012; 67(6): 483-487.

Published online: 18 December 2012

DOI: https://doi.org/10.0000/jksr.2012.67.6.483

Fibrolipomatous Hamartoma of Digital Branch of the Median Nerve without Macrodystrophy: Two Case Reports with Magnetic Resonance Imaging Findings

Woosun Choi, MD1, Jee Young Jung, MD1, In Sub Song, MD1, Jae Sung Lee, MD2, Tae Jin Lee, MD3, Yoon Yang Jung, MD3

1Department of Radiology, Chung-Ang University Hospital, School of Medicine, Chung-Ang University, Seoul, Korea.

2Department of Orthopedic Surgery, Chung-Ang University Hospital, School of Medicine, Chung-Ang University, Seoul, Korea.

3Department of Pathology, Chung-Ang University Hospital, School of Medicine, Chung-Ang University, Seoul, Korea.

Corresponding author: Jee Young Jung, MD. Department of Radiology, Chung-Ang University Hospital, School of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul 156-755, Korea. Tel. 82-2-6299-3191, Fax. 82-2-6263-1557, jyj907075@naver.com

Received 6 August 2012       Accepted 3 October 2012

Copyright © 2012 The Korean Society of Radiology

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.

Keywords: Fibrolipomatous Hamartoma, Median Nerve, Magnetic Resonance Imaging, Hand

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).
jksr-67-483-g001
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).
jksr-67-483-g002

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