Most stress fractures occur in the lower limbs and are rarely observed in the upper limbs. The second metacarpal is the longest of all the metacarpals and has the largest base, articulating with the trapezium, trapezoid, capitate, and third metacarpal. In athletes, stress fractures in non-weight bearing joints are uncommon. Therefore, the shaft of the second metacarpal bone undergoes a higher load – the maximum tension at the base of the second metacarpal is amplified when the hand grasps a tool such as a tennis racquet.

A 42-year-old man presented with a 3-year history of headache. Neurologic examination was unremarkable. Brain MRI showed multiple peripheral cerebellar nodules, some containing fat (figure). Biopsy revealed neurocytic cancer cells scattered with mature fat tissue. The approach was conservative with serial imaging follow-up. Cerebellar liponeurocytoma is a rare tumor classified as grade II by the World Health Organization, 1 now considered a clinicopathologic entity distinct from medulloblastoma.1 It is almost always solitary and almost always cerebellar. The clear multifocality of the MRI findings makes this case unusual. 2Thiago Luiz

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