Intraneural fibrolipoma of the median nerve at the thumb. Apropos of a case and literature review]

The authors report the case of a rare tumor of the median nerve in a 67-year-old man. They provide a review of the literature, and discuss the original macroscopic and histologic characteristics, the etiological hypotheses and the possibilities of treatment of this tumor.     

Bilateral median nerve compression at the level of Struthers' ligament. Case report

Struthers' ligament syndrome is a rare cause of median nerve entrapment. Bilateral compression of the median nerve is even more rare. It presents with pain, sensory disturbance, and/or motor function loss at the median nerve's dermatomal area. The authors present the case of a 21-year-old woman with bilateral median nerve compression caused by Struthers' ligament. She underwent surgical decompression of the nerve on both sides. To the authors' knowledge, this case is the first reported bilateral compression of the median nerve caused by Struthers' ligament. The presentation and symptomatology of Struthers' ligament syndrome must be differentiated from median nerve compression arising from other causes.     

Neural fibrolipoma of the digital nerve: a case report

A 32-year-old woman underwent microsurgical resection of a neural fibrolipoma of the digital nerve of the ring finger. At the 6-month follow-up, the patient had good recovery, no recurrence, and preservation of neural function. Caution should be exercised while planning microsurgical dissection on soft-tissue masses of fingers and hands. Total resection of the lesion and nerve grafting should be avoided.     

Bilateral anomalous course of the ulnar nerve at the wrist causing ulnar and median nerve compression syndrome. Case report

The case of a patient with a bilateral compression syndrome of the ulnar and median nerves at the wrist is described. Both ulnar nerves, which were surgically explored at different times, followed an anomalous course and passed into the canalis carpi side by side with the median nerve. This variation in the course of the ulnar nerve is extremely rare and causes a unique syndrome with characteristic electromyographic patterns.     

周围神经纤维脂肪瘤的命名、诊断与治疗

目的确定周围神经纤维脂肪瘤这一新的名称,区别于其他疾病,探讨其临床特点、病理改变、命名和治疗方法。方法1987年～2001年共收治 15例,其中单独发病 5例,合并巨指症10例,行神经束部分切除、短缩手指长度、缩小手指周径、截指（趾）等手术治疗。结果 畸形得到部分纠正,肿瘤增长变慢。结论周围神经纤维脂肪瘤可单发或合并巨指（趾）症,是有别于神经纤维瘤、巨指（趾）症等疾病的一种独立性疾病。     

Hemangiopericytoma of the median nerve

This is a case report of a hemangiopericytoma located within the median nerve at the wrist in a 79-year-old man. The tumor was removed without loss of function.     

Fibrolipoma of the median nerve

Neural fibrolipoma or fibrolipomatous hamartoma is an uncommon benign tumor that usually arises in the median nerve. Fibrofatty tissue proliferates around the nerve and infiltrates the epineurium and perineurium. We report a case of fibrolipomatous hamartoma of the left median nerve in an 18-year-old woman. Our objective was to describe the pathognomonic magnetic resonance imaging features, whose presence obviates the need for a diagnostic biopsy.     

Split median nerve

Carpal tunnel syndrome is encountered frequently in the every day practice for many orthopaedic surgeons and neurosurgeons. However, the rate of recurrence or incomplete relief is high and difficult to treat. This may be related to the high percent of anomalies of the median nerve and its surrounding tissues. A case of a split median nerve entrapped by an abnormally inserted palmaris longus muscle is presented. The case is discussed and a conclusion of safer standard surgical release is recommended, especially in doubtful cases.     

Neural fibrolipoma of a digital nerve of the index finger without macrodactyly

Abstract

We present a case of neural fibrolipoma arising from the digital nerve in the index finger of the right hand. A 31-year-old man was referred with a soft tissue mass in the ulnar aspect of the index finger of his right hand, which had gradually enlarged during the past seven years. Histological examination of an excisional biopsy specimen identified a neural fibrolipoma, which is a differential diagnosis of a lipomatous lesion of the digits.     

Neurilemmoma of median nerve

Neurilemmomas constitute one of the most common tumors of peripheral nerves. Rarer amongst them is their occurrence in median nerve in the region of arm. A sixteen-year-old female presented with painless mass in right arm which was non-tender on palpation with positive Tinel''s sign and no motor or sensory deficit in the affected arm. Ultrasound examination revealed an eccentrically arising mass of size 19 × 11 mm along median nerve. MRI study revealed a mass homogenously isointense on T1 weighted images and hyperintense in T2 weighted images placed eccentrically in relation to median nerve in arm. Excisional biopsy under loupe magnification was carried out which revealed the mass to be neurilemmoma. This slowly growing benign tumor of peripheral nerves with an incidence of 5% with 14% involvement of Median nerve can be enucleated from the nerve with little or no damage. In spite of advanced imaging studies the mass cannot be differentiated preoperatively from another peripheral nerve sheath tumor neurofibroma. Both these tumors although bearing some clinical and imaging resemblance carry different intraoperative findings, histopathological features and post-operative results.     

Lipofibromatous hamartoma of the median nerve

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.     

Plexiform neurofibroma of the median nerve

Summary A case of plexiform neurofibroma of the median nerve is presented. This hamartomatous condition presented as a growth in the palm and in the distal third of the forearm, with symptoms of carpal tunnel syndrome. Treatment consisted of division of the volar carpal ligament for relief of pain and a neurolysis of the median nerve with partial resection of the tumour mass.     

Lipofibromatous hamartoma of the median nerve

Lipofibromatous hamartoma of the nerve is a very uncommon, congenital, benign, peripheral nerve tumor. It is mostly encountered in the extremities of young adults, involving the median nerve in the majority of cases. The nerve tissue is infiltrated by diffuse fibroadipose tissue which dissociates the fasciculi without invasion. Patients with lipofibromatous hamartoma of the median nerve usually present with symptoms of carpal tunnel syndrome, usually accompanied by marked macrodactyly. Lipofibromatous hamartoma of the median nerve was encountered in an 18-year-old female patient, involving the wrist, causing macrodactyly of the index finger, and resulting in symptoms of carpal tunnel syndrome. Median nerve release and partial excision of the adipose tissue along the mass were performed. Fourteen months postoperatively, the patient had no complaints and the mass decreased in size without any motor or sensory functional losses.     

Intraneural lipofibroma of the median nerve

A case of an intraneural lipofibroma of the median nerve is described. The patient was first seen with an enlarging mass on the flexor side of the wrist and in the palm. After interfascicular dissection of the tumor there was a permanent loss in sensibility and motor function. In most cases decompression of the nerve will suffice; resection by means of interfascicular dissection is rarely justified.     

Lipofibroma of the median nerve.

Tumors arising within the median nerve in the region of the distal forearm, wrist, and palm are rare and their exact pathological nature has not been well clarified. One case is reported in a 47-year-old woman, in whom a mass of 3 years' duration was located in the thenar eminence of the right hand without causing any sensory or motor deficit. The tumor was surgically excised, and the continuity of the nerve branches was preserved. The diagnosis of lipofibroma of the median nerve is recommended for this entity. Other pathological lesions of the median nerve are mentioned.