Neural fibrolipoma of the digital nerve: a case
Hakan Gundes, Tugrul Alici, Mustafa Sahin
Department of Orthopedic Surgery, School of Medicine, Maltepe University, Istanbul, Turkey
Address correspondence and reprint requests to: Prof Hakan Gundes, Department of Orthopedic Surgery, Maltepe Universitesi, Tip
Fakultesi Hastanesi, Feyzullah Cad, No: 39. 34843 Maltepe, Istanbul, Turkey. E-mail: firstname.lastname@example.org
Journal of Orthopaedic Surgery 2011;19(1):123-5
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.
Key words: fingers; hamartoma; nerve tissue
Most soft-tissue lesions of the hand are benign, and
about 5% originate from peripheral nerves.1,2 Neural
fibrolipoma or lipofibromatous hamartoma is a rare,
benign, nerve-related tumour that most commonly
originates from the median nerve.3–6 This report is of
a neural fibrolipoma of the digital nerve of the ring
finger treated with microsurgical resection.
In November 2009, a 32-year-old woman presented
with a mass (30x15 mm) on the radial side of the ring
finger that had slowly developed for one year. The
mass was fusiform in shape, mobile, and painless, and
was situated close to the web space (Fig. 1). There was
a tingling sensation with gentle tapping attributed
to the mass. Radiography yielded normal findings.
An initial diagnosis of lipoma was made based on
findings of magnetic resonance imaging (Fig. 2). Under
axillary block anaesthesia and loop magnification, the
mass was exposed with Brunner incision. The mass
was fatty in consistency and infiltrated the digital
nerve for about 40 mm (Fig. 1). Digital nerve fibres
were identified at the proximal and distal ends of
the mass (Fig. 1). Under microscopic magnification,
microsurgical intraneural dissection was carried out.
The mass was removed from the digital nerve, and
the nerve fibres were preserved (Fig. 1). The mass
was confirmed to be a neural fibrolipoma. There was
numbness around the finger postoperatively. At the
6-month follow-up, the numbness had resolved and
the 2-point discrimination was 8 mm. There was no
124 H Gundes et al.
Journal of Orthopaedic Surgery
The 3 most common soft-tissue lesions of the hand
are ganglion cysts, giant cell tumours of the tendon
sheath, and hemangiomas.1 Peripheral nerve tumours
account for <5% of all tumours of the hand.2 The most
common peripheral nerve tumours of the hand are
schwannomas (neurilemmomas) and neurofibromas.2
Neural fibrolipoma or lipofibromatous hamartoma
of the nerve is a rare benign tumour of unknown
origin.7 This tumour has a predilection for the median
nerve, but involvement of various nerves has been
reported.7–13 Macrodactyly has been associated in one
third of patients with median nerve involvement.5,6
Neural fibrolipomas are most frequently seen
during the first 3 decades of life and may sometimes
be considered as congenital lesions.7 T1- and T2-
weighted spin echo magnetic resonance imaging
sequences reveal serpiginous structures with low
signal intensity.5 The mass in our patient was
initially misdiagnosed as a lipoma as no serpiginous
structures were noted, probably because of its small
size. On histological examination, neural fibrolipoma
is characterised by fibrofatty tissue proliferation with
infiltration of the epineurium and perineurium.7,10
This tumour may cause thickening of the perineurium
and perivascular fibrous tissues.7,10 Complete excision
of the fibrofatty growth is contraindicated because it
may cause severe sensory or motor disturbances.7
Neural fibrolipoma involving a digital nerve has
been reported.14 Caution should be exercised while
planning microsurgical dissection on soft-tissue
masses of fingers and hands. If there is any doubt
about the diagnosis, a frozen section examination of
the mass should be performed before carrying out
any reconstructive surgery such as total resection
and nerve grafting. The treatment goal should be
careful microsurgical intrafascicular excision of the
lesion with preservation of nerve continuity to avoid
severe sensory disturbance. Based on our experience,
microsurgical dissection is associated with good
recovery, low recurrence, and preservation of neural
function. Total resection of the lesion and nerve
grafting should be avoided. Using a routine axillary
block technique and microscope are simple but
important measures that might prevent unwanted
complications such as incomplete removal, neural
sequelae, and inability to check hemostasis.
nerve for about 40 mm (arrow). The radial digital nerve is identified at the proximal end of the lesion (arrow). (b) The excised
(a) The mass is located on the radial side of the ring finger (*), and is fatty in consistency and infiltrated the digital
homogenous mass on the radial side of the ring finger.
Magnetic resonance image showing a
Vol. 19 No. 1, April 2011 Neural fibrolipoma of the digital nerve 125 Download full-text
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