Giant lipoma of the hand causing median nerve compression

Abstract

Lipomas are benign neoplasms derived from adipose tissue composed of mature adipocytes. They account for almost 50% of all soft-tissue neoplasms and occur in up to 2% of the population. They usually present asymptomatically as solitary discrete mobile lumps found most commonly on the neck, upper back, proximal limbs and chest. In less than 1% of cases, they can be found in the distal extremities.We discuss the case of a 65-year-old man who presented with a 2-year history of a slowly enlarging left palm swelling, with recent-onset numbness and loss of power in the distribution of the median nerve. MRI studies showed that the 5×4×2.7 cm lipoma had a component extending into the distal aspect of the carpal tunnel, compressing the median nerve. It was successfully excised, and at follow-up the patient reported complete resolution of his symptoms.

A giant hand lipoma as a rare cause of secondary carpal tunnel syndrome - A case report

“…Lipomas are the most common benign soft tissue neoplasm but only 1% of all lipomas present in the hand [ 9 ]. They are the most common tumour found in nerve entrapment syndromes despite nerve compression secondary to space-occupying tumours being rare [ 7 ].…”

Carpal tunnel syndrome caused by a giant lipoma of the hand: A case report

“…A lipoma is a common subcutaneous mesenchymal benign tumour, which occurs in 2% of the population. Localization in distal extremities is uncommon, occurring in less than 1% of cases [ 1 , 2 ]. It is classified as giant if it exceeds 5,0 cm [ [1] , [2] , [3] , [4] ].…”

“…A giant lipoma in the hand is usually asymptomatic. In 25% of cases it can cause compression of surrounding tissues [ 1 , 2 ].…”

“…Direct compression of the median or ulnar nerve can result in symptoms such as paraesthesia, pain and loss of strength [ 1 , 2 ]. In case of median nerve neuropathies, which account for 90% of entrapment neuropathies, paraesthesia is seen in the first three digits and radial half of the fourth digit; night-time pain and a positive flick sign are other commonly seen symptoms [ 5 ].…”

“…This type of examination has a 94% diagnosis rate in detecting masses in the hand and wrist [ 4 ]. Biopsy of the mass should be considered in case of malignant features preoperatively [ 2 ]. Only histopathological examination can confirm a definitive diagnosis of a benign giant lipoma [ 3 ].…”