Lipofibromatous hamartoma of the median nerve

Journal of Orthopaedic Surgery and Research - Tập 5 - Trang 1-4 - 2010
Talal Al-Jabri1, Sunil Garg2, Ganapathyraman V Mani3
1Department of Plastic Surgery, East and North Hertfordshire NHS Trust, UK
2Upper Limb Unit, Southampton University Hospitals NHS Trust, Hampshire, UK
3Queen Mary's Hospital Sidcup, South London Healthcare Trust, UK

Tóm tắt

Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue. To the best of our knowledge, only approximately 88 cases are reported in the literature. We report a rare case of lipofibromatous hamartoma of the median nerve causing secondary carpal tunnel syndrome in a 25 year old patient. This patient was treated conservatively with decompression and biopsy and experienced a complete resolution of symptoms post-operatively. Magnetic resonance imaging may be used to diagnose this lesion as it has very distinctive characteristics. Multiple conditions have been associated with this lesion and a greater understanding of these associations may clarify the pathogenesis. The architecture of the tumour makes excision very challenging and the surgical management remains controversial. A review of the literature regarding the etiology, pathogenesis and surgical management of lipofibromatous hamartoma is included.

Tài liệu tham khảo

Mason ML: In presentation of cases: Proceedings of the American Society for Surgery of the hand. J Bone Joint Surge (Am). 1953, 35-A: 273-4. Nilsson J, Sandberg K, Søe Nielsen N, Dahlin LB: Magnetic resonance imaging of peripheral nerve tumours in the upper extremity. Scand J Plast Reconstr Surg Hand Surg. 2009, 43 (3): 153-9. 10.1080/02844310902734572. Silverman TA, Enzinger FM: Fibrolipomatous hamartoma of nerve: a clinicopathologic analysis of 26 cases. Am J Surg Pathol. 1985, 9: 7-14. 10.1097/00000478-198501000-00004. Warhold LG, Urban MA, Bora FW, Brooks JS, Peter SB: Lipofibromatous hamartoma of the median nerve. J Hand Surg. 1993, 18: 1032-7. 10.1016/0363-5023(93)90398-M. Frykman GK, Wood VE: Peripheral nerve hamartoma with macrodactyly in the hand: report of three cases and review of the literature. J Hand Surg [Am]. 1978, 3: 307-312. Amadio PC, Reiman HM, Dobyns JH: Lipofibromatous hamartoma of nerve. J Hand Surg [Am]. 1988, 13: 67-75. 10.1016/0363-5023(88)90203-1. Wong BZ, Amrami KK, Wenger DE, Dyck PJ, Scheithauer BW, Spinner RJ: Lipomatosis of the sciatic nerve: typical and atypical MRI features. Skeletal Radiol. 2006, 35: 180-184. 10.1007/s00256-005-0034-8. Louis DS, Hankin FM, Greene TL, Dick HM: Lipofibromas of the median nerve: Long-term follow-up of four cases. J Hand Surg (Am). 1985, 10: 403-408. Paletta FX, Senay LC: Lipofibromatous hamartoma of median nerve and ulnar nerve: Surgical treatment. Plast Reconstr Surg. 1981, 68: 915-921. 10.1097/00006534-198112000-00012. Johnson RJ, Bonfiglio M: Lipofibromatous hamartoma of the median nerve. J Bone Joint Surg (Am). 1969, 51: 984-990. Clavijo-Alvarez JA, Price M, Stofman GM: Preserved neurologic function following intraneural fascicular dissection and nerve graft for digital and median nerve lipofibromatous hamartoma. Plast Reconstr Surg. 2010, 125 (3): 120e-2e. 10.1097/PRS.0b013e3181cb66b7. Marom EM, Helms CA: Fibrolipomatous Hamartoma: pathognomic on MR Imaging. Skeletal Radiol. 1999, 28: 260-4. 10.1007/s002560050512. Giuliano V, Outwater EK, Mitchell DG, Burke MA: Median nerve hamartoma: MR imaging using chemical shift techniques. Magn Reson Imaging. 1997, 15: 1091-4. 10.1016/S0730-725X(97)00155-0. Haverbush TJ, Kendrick JI, Nelson CL: Intraneural lipoma of the median nerve-Report of two cases. Cleve Clin Q. 1970, 37: 145-149. Rowland SA: Lipofibroma of the median nerve in the palm. J Bone Joint Surg [Am]. 1967, 49: 1309-1313. Yeoman PM: Fatty infiltration of the median nerve at the wrist. J Bone Joint Surg [Br]. 1964, 46: 737-739. Nardella D, Sohawon S, Carlier A: Lipofibromatous hamartoma of the median nerve. Three case reports. J Plast Reconstr Aesthet Surg. 2009, 62 (9): e314-7. 10.1016/j.bjps.2007.11.061. Guthikonda M, Rengachary SS, Balko MG, van Loveren H: Lipofibromatous hamartoma of the median nerve: case report with magnetic resonance imaging correlation. Neurosurgery. 1994, 35 (1): 127-32. 10.1227/00006123-199407000-00019. Patil VS, Nagle S: Lipofibromatous hamartoma of the median nerve: A case report and review of the literature. Indian J Plast Surg. 2009, 42 (1): 122-5. 10.4103/0970-0358.53024. Friedlander HL, Rosenberg NJ, Graubard DJ: Intraneural lipoma of the median nerve. Report of two cases and review of the literature. J Bone Joint Surg Am. 1969, 51 (2): 352-62. Al-Qattan MM: Lipofibromatous hamartoma of the median nerve and its associated conditions. J Hand Surg Br. 2001, 26 (4): 368-72. 10.1054/jhsb.2001.0579. Houpt P, Storm van Leeuwen JB, van den Bergen HA: Intraneural lipofibroma of the median nerve. J Hand Surg Am. 1989, 14 (4): 706-9. 10.1016/0363-5023(89)90195-0.