EC Clinical and Medical Case Reports

Hand lipoma is a rare lesion, which can imitate symptoms of tumor syndrome and signs of compression of the median and ulnar nerves. Surgical resection is recommended to relieve the neurological manifestations of this disease. The surgeon must always suspect liposarcoma before considering large, atypical or recurrent tumors. We report the case of a 55-year-old woman with carpal tunnel syndrome. During the operation, it was found that the lipoma compresses the median nerve. We performed an anterior section of the annular ligament of the wrist carpus and removed the lipomas and median neurolysis. The histopathological study of the resected mass is consistent with lipoma. Two and a half months after the operation, the patient recovered all the functions of the hand and the symptomatology disappeared completely. Carpal tunnel syndrome caused by lesions occupying space is rare. Usually based on clinical research, the diagnosis of electrophysiology and magnetic resonance imaging (MRI) is difficult. The release of the transverse carpal ligament and the elimination of the lipoma can allow an excellent functional recovery.

Keywords: Lipoma; Carpal Tunnel Syndrome; Median Nerve; Nerve Compression

1. Amar MF., et al. “Anatomical snuffbox lipoma causing nervous compression: a case report”. Records of Plastic and Aesthetic Surgery4 (2012): 409-411.
2. Cristofaro RL and Maher JO. “Digital lipoma of the foot in a child: a case report”. The Journal of Bone and Joint Surgery American volume1 (1988): 128-130.
3. Higgs PE., et al. “Giant lipomas of the hand and forearm”. Southern Medical Journal8 (1993): 887-890.
4. Zahrawi F. “Acute compression ulnar neuropathy at Guyon's canal resulting from lipoma”. The Journal of Hand Surgery2 (1984): 238-239.
5. Hoehn JG and Farber HF. “Massive lipoma of the palm”. Annals of Plastic Surgery5 (1983): 431-433.
6. Brand MG and Gelberman RH. “Lipoma of the flexor digitorum superficialis causing triggering at the carpal canal and median nerve compression”. Journal of Hand Surgery American Volume3 (1988): 342-344.
7. Cribb GL., et al. “Giant lipomateus of the hand and forearm”. The Journal of Hand Surgery: British and European Volume5 (2005): 509-512.
8. Posch JL. “Tumors of the hand”. Journal of Bone and Joint Surgery3 (1956): 517-540.
9. T Pagonis., et al. “Complications arising from a misdiagnosed giant lipoma of the hand and palm: a case report”. Journal of Medical Case Reports 5 (2011): 552.
10. Bagatur AE and Yalcinkaya M. “Unilateral carpal tunnel syndrome caused by an occult palmar lipoma”. Orthopedics10 (2009).
11. Kang HJ., et al. “Carpal tunnel syndrome caused by space occupying lesions”. Yonsei Medical Journal 2 (2009): 257-261.
12. Chen CH., et al. “Unusual causes of carpal tunnel syndrome: space occupying lesions”. The Journal of Hand Surgery1 (2012): 14-19.
13. E Chronopoulos., et al. “Patient presenting with lipoma of the index finger: a case report”. Cases Journal1 (2010): 20.
14. JL Suk., et al. “Ultrasonography of peripheral nerves”. Current Neurology and Neuroscience Reports2 (2013): 328.
15. CH Chen., et al. “Unusual causes of carpal tunnel syndrome: space occupying lesions”. Journal of Hand Surgery: European Volume1 (2012): 14-19.
16. Capelastegui A., et al. “Masses and pseudomasses of the hand and wrist: MR findings in 134 cases”. Skeletal Radiology9 (1999): 498-507.
17. Laurino L., et al. “Well- differentiated liposarcoma (atypical lipomatous tumors)”. Seminars in Diagnostic Pathology4 (2001): 258-262.
18. H Kossoko., et al. “Fibrolipoma of the median nerve. A case report”. Hand Surgery6 (2008): 269-271.
19. G Chick., et al. “Benign tumors isolated from peripheral nerves”. Journal of Orthopedic Surgery and Repair of the Motor Apparatus8 (2000): 825-834.
20. MC Cavallaro., et al. “Imaging findings in a patient with brolipomatous hamartoma of the median nerve”. American Journal of Roentgenology4 (1993): 837-838.
21. Kooby DA., et al. “Atypical lipomatous tumor/well-differentiated liposarcoma of the extremity and trunk wall: Importance of histological subtype with treatment recommendations”. Annals of Surgical Oncology1 (2004): 78-84.
22. Sampson CC., et al. “Liposarcoma developing in a lipoma”. The Archives of Pathology 69 (1960): 506-510.
23. Drevelegas A., et al. “Lipomatous tumors of soft tissue MR appearance with histological correlation”. European Journal of Radiology3 (2004): 257-267.
24. S Fnini., et al. “Giant lipoma of the hand: case report and literature review”. Chirurgie de la Main1 (2010): 44-47.
25. O Myhre-Jensen. “A consecutive to 7-year series of 1331 benign soft tissue tumors. Clinicopathologic data. Comparison with sarcomas”. Acta Orthopedica Scandinavica3 (1981): 287-293.
26. A Rydholm and NO Berg. “Size, site and clinical incidence of lipoma. Factors in the differential diagnosis of lipoma and sarcoma”. Acta Orthopedica Scandinavica6 (1983): 929-934.