Abstract
Introduction: Fibrolipoma of the median nerve is a rare benign lesion responsible for carpal tunnel syndrome. Fibrolipoma is often misdiagnosed.
This article aimed to review and summarize current knowledge regarding fibrolipoma of the median nerve. We emphasize the clinical and imaging features of this disease.
Methods: To examine the characteristics of fibrolipoma of the median nerve, we performed a litera-ture review using MEDLINE. The search included only English studies published from database in-ception to June 2021.
Results: Forty-six cases of fibrolipoma of the median nerve were included.
Fibolipoma is characterized by diffuse infiltration of peripheral nerves by normal-appearing fibrous and adipose tissues. The fibrolipoma of the median nerve can be responsible for macrodactyly, numbness, paresthesia, and weakness within the median nerve distribution. Ultrasonography shows a fusiform hyperechoic mass along the nerve containing hypoechoic bands corresponding to nerve fascicles.
Magnetic resonance imaging is the gold standard for the diagnosis of fibrolipoma. It typically shows a contrast between the low signal nerve fibers and the high signal fatty tissues, revealing a characteristic « cable-like » appearance on axial sections and a «spaghetti-like» appearance on coronal sections.
Conclusion: Fibrolipoma should be considered in young patients with carpal tunnel syndrome. This review emphasizes the clinical and radiological features of fibrolipoma. We highlight the images of ultrasonography in the diagnosis of rare structural causes of carpal tunnel syndrome.
Keywords: Fibrolipoma, median nerve, carpal tunnel syndrome, magnetic resonance imaging, ultrasonography, fibrous tissue.
Graphical Abstract
[1]
Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: Clinical features, diagnosis, and management. Lancet Neurol 2016; 15(12): 1273-84.
[http://dx.doi.org/10.1016/S1474-4422(16)30231-9] [PMID: 27751557]
[http://dx.doi.org/10.1016/S1474-4422(16)30231-9] [PMID: 27751557]
[2]
Louis DS, Dick HM. Ossifying lipofibroma of the median nerve. J Bone Joint Surg Am 1973; 55(5): 1082-4.
[http://dx.doi.org/10.2106/00004623-197355050-00019] [PMID: 4202462]
[http://dx.doi.org/10.2106/00004623-197355050-00019] [PMID: 4202462]
[3]
Rudolph R, Jaffe S. Painless fibro-fatty hamartoma of the median nerve. Br J Plast Surg 1975; 28(4): 301-2.
[http://dx.doi.org/10.1016/0007-1226(75)90038-7] [PMID: 1191876]
[http://dx.doi.org/10.1016/0007-1226(75)90038-7] [PMID: 1191876]
[4]
Abu Jamra FN, Rebeiz JJ. Lipofibroma of the median nerve. J Hand Surg Am 1979; 4(2): 160-3.
[http://dx.doi.org/10.1016/S0363-5023(79)80133-1] [PMID: 422826]
[http://dx.doi.org/10.1016/S0363-5023(79)80133-1] [PMID: 422826]
[5]
Patel ME, Silver JW, Lipton DE, Pearlman HS. Lipofibroma of the median nerve in the palm and digits of the hand. J Bone Joint Surg Am 1979; 61(3): 393-7.
[http://dx.doi.org/10.2106/00004623-197961030-00014] [PMID: 429410]
[http://dx.doi.org/10.2106/00004623-197961030-00014] [PMID: 429410]
[6]
Rusko RA, Larsen RD. Intraneural lipoma of the median nerve--case report and literature review. J Hand Surg Am 1981; 6(4): 388-91.
[http://dx.doi.org/10.1016/S0363-5023(81)80050-0] [PMID: 7252115]
[http://dx.doi.org/10.1016/S0363-5023(81)80050-0] [PMID: 7252115]
[7]
Paletta FX, Senay LC Jr. Lipofibromatous hamartoma of median nerve and ulnar nerve: Surgical treatment. Plast Reconstr Surg 1981; 68(6): 915-21.
[http://dx.doi.org/10.1097/00006534-198112000-00012] [PMID: 7301986]
[http://dx.doi.org/10.1097/00006534-198112000-00012] [PMID: 7301986]
[8]
Langa V, Posner MA, Steiner GE. Lipofibroma of the median nerve: A report of two cases. J Hand Surg [Br] 1987; 12(2): 221-3.
[http://dx.doi.org/10.1016/0266-7681_87_90017-9] [PMID: 3624981]
[http://dx.doi.org/10.1016/0266-7681_87_90017-9] [PMID: 3624981]
[9]
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.
[http://dx.doi.org/10.1016/0363-5023(89)90195-0] [PMID: 2754205]
[http://dx.doi.org/10.1016/0363-5023(89)90195-0] [PMID: 2754205]
[10]
Walker CW, Adams BD, Barnes CL, Roloson GJ, FitzRandolph RL. Case report 667. Fibrolipomatous hamartoma of the median nerve. Skeletal Radiol 1991; 20(3): 237-9.
[PMID: 2057803]
[PMID: 2057803]
[11]
Cavallaro MC, Taylor JA, Gorman JD, Haghighi P, Resnick D. Imaging findings in a patient with fibrolipomatous hamartoma of the median nerve. AJR Am J Roentgenol 1993; 161(4): 837-8.
[http://dx.doi.org/10.2214/ajr.161.4.8372770] [PMID: 8372770]
[http://dx.doi.org/10.2214/ajr.161.4.8372770] [PMID: 8372770]
[12]
Ban M, Kamiya H, Sato M, Kitajima Y. Lipofibromatous hamartoma of the median nerve associated with macrodactyly and port-wine stains. Pediatr Dermatol 1998; 15(5): 378-80.
[http://dx.doi.org/10.1046/j.1525-1470.1998.1998015378.x] [PMID: 9796589]
[http://dx.doi.org/10.1046/j.1525-1470.1998.1998015378.x] [PMID: 9796589]
[13]
Berry MG, Mallucci P, Banwell PE, Heywood AJ. Fibrolipoma of the median nerve. J R Soc Med 1999; 92(8): 408-9.
[http://dx.doi.org/10.1177/014107689909200808] [PMID: 10656008]
[http://dx.doi.org/10.1177/014107689909200808] [PMID: 10656008]
[14]
Kameh DS, Perez-Berenguer JL, Pearl GS. Lipofibromatous hamartoma and related peripheral nerve lesions. South Med J 2000; 93(8): 800-2.
[http://dx.doi.org/10.1097/00007611-200093080-00012] [PMID: 10963513]
[http://dx.doi.org/10.1097/00007611-200093080-00012] [PMID: 10963513]
[15]
Gilet A, Jeremy M, Gould E. Fibrolipomatous hamartoma of the median nerve. Radiol Case Rep 2015; 3(3): 195.
[http://dx.doi.org/10.2484/rcr.v3i3.195] [PMID: 27303544]
[http://dx.doi.org/10.2484/rcr.v3i3.195] [PMID: 27303544]
[16]
Ulrich D, Ulrich F, Schroeder M, Pallua N. Lipofibromatous hamartoma of the median nerve in patients with macrodactyly: Diagnosis and treatment of a rare disease causing carpal tunnel syndrome. Arch Orthop Trauma Surg 2009; 129(9): 1219-24.
[http://dx.doi.org/10.1007/s00402-008-0695-6] [PMID: 18615252]
[http://dx.doi.org/10.1007/s00402-008-0695-6] [PMID: 18615252]
[17]
Pang HN, Puhaindran M, Yong FC. Fibrolipoma of multiple nerves in the wrist. Singapore Med J 2009; 50(8): e283-6.
[PMID: 19710960]
[PMID: 19710960]
[18]
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.
[http://dx.doi.org/10.1016/j.bjps.2007.11.061] [PMID: 18485849]
[http://dx.doi.org/10.1016/j.bjps.2007.11.061] [PMID: 18485849]
[19]
Venkatesh K, Saini ML, Rangaswamy R, Murthy S. Neural fibrolipoma without macrodactyly: A subcutaneous rare benign tumor. J Cutan Pathol 2009; 36(5): 594-6.
[http://dx.doi.org/10.1111/j.1600-0560.2008.01088.x] [PMID: 19476532]
[http://dx.doi.org/10.1111/j.1600-0560.2008.01088.x] [PMID: 19476532]
[20]
Chandler EM, Chen CM, Spector JA. Bilateral fibrolipoma of the median nerve. J Plast Reconstr Aesthet Surg 2009; 62(5): e99-e100.
[http://dx.doi.org/10.1016/j.bjps.2008.08.068] [PMID: 19038593]
[http://dx.doi.org/10.1016/j.bjps.2008.08.068] [PMID: 19038593]
[21]
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.
[http://dx.doi.org/10.1055/s-0039-1699327] [PMID: 19881034]
[http://dx.doi.org/10.1055/s-0039-1699327] [PMID: 19881034]
[22]
Sirinoglu H, Sönmez A, Sav A, Numanoglu A. Lipofibromatous hamartoma of the median nerve. Ann Plast Surg 2010; 65(2): 174-6.
[http://dx.doi.org/10.1097/SAP.0b013e3181c9c41b] [PMID: 20606583]
[http://dx.doi.org/10.1097/SAP.0b013e3181c9c41b] [PMID: 20606583]
[23]
Louaste J, Zejjari H, Chkoura M, Houmadi A, Rachid K. Carpal tunnel syndrome due to fibrolipomatous hamartoma of the median nerve. Hand (N Y) 2011; 6(1): 76-9.
[http://dx.doi.org/10.1007/s11552-010-9290-8] [PMID: 22379443]
[http://dx.doi.org/10.1007/s11552-010-9290-8] [PMID: 22379443]
[24]
Ha JF, Teh BM, Abeysuriya DT, Luo DY. Fibrolipomatous hamartoma of the median nerve in the elbow: A case report. Ochsner J 2012; 12(2): 152-4.
[PMID: 22778681]
[PMID: 22778681]
[25]
Okubo T, Saito T, Mitomi H, et al. Intraneural lipomatous tumor of the median nerve: Three case reports with a review of literature. Int J Surg Case Rep 2012; 3(9): 407-11.
[http://dx.doi.org/10.1016/j.ijscr.2012.05.007.] [PMCID: 3397293]
[http://dx.doi.org/10.1016/j.ijscr.2012.05.007.] [PMCID: 3397293]
[26]
Murphy SM, Browne K, Tuite DJ, O’Shaughnessy M. Dual pathology proximal median nerve compression of the forearm. J Plast Reconstr Aesthet Surg 2013; 66(12): 1792-4.
[http://dx.doi.org/10.1016/j.bjps.2013.04.054] [PMID: 23707555]
[http://dx.doi.org/10.1016/j.bjps.2013.04.054] [PMID: 23707555]
[27]
Arora R, Arora AJ. Imaging features on sonography and MRI in a case of lipofibromatous hamartoma of the median nerve. Quant Imaging Med Surg 2014; 4(3): 207-9.
[http://dx.doi.org/10.3978/j.issn.2223-4292.2014.03.04] [PMID: 24914422]
[http://dx.doi.org/10.3978/j.issn.2223-4292.2014.03.04] [PMID: 24914422]
[28]
Senger J-L. Fibrolipomatous hamartoma of the median nerve: A cause of acute bilateral carpal tunnel syndrome in a three-year-old child: A case report and comprehensive literature review. Plasr Surg (Oakv) 2014; 22(3): 201-6.
[http://dx.doi.org/10.1177/229255031402200307]
[http://dx.doi.org/10.1177/229255031402200307]
[29]
Afshar A, Assadzadeh O, Mohammadi A. Ultrasonographic diagnosis of lipofibromatous hamartoma of the median nerve. Iran J Radiol 2015; 12(1): e11270.
[http://dx.doi.org/10.5812/iranjradiol.11270] [PMID: 25793084]
[http://dx.doi.org/10.5812/iranjradiol.11270] [PMID: 25793084]
[30]
Uchiyama D, Oshige T, Nakamura K, Koganemaru M. Carpal tunnel syndrome caused by neural fibrolipoma. BMJ Case Rep 2016; 2016: bcr2015212819.
[http://dx.doi.org/10.1136/bcr-2015-212819] [PMID: 26744535]
[http://dx.doi.org/10.1136/bcr-2015-212819] [PMID: 26744535]
[31]
Shekhani HN, Hanna T, Johnson J-O. Lipofibromatous hamartoma of the median nerve: A case report. J Radiol Case Rep 2016; 10(11): 1-7.
[http://dx.doi.org/10.3941/jrcr.v10i11.2787] [PMID: 28580055]
[http://dx.doi.org/10.3941/jrcr.v10i11.2787] [PMID: 28580055]
[32]
Teles AR, Finger G, Schuster MN, Gobbato PL. Peripheral nerve lipoma: Case report of an intraneural lipoma of the median nerve and literature review. Asian J Neurosurg 2016; 11(4): 458.
[http://dx.doi.org/10.4103/1793-5482.181118] [PMID: 27695575]
[http://dx.doi.org/10.4103/1793-5482.181118] [PMID: 27695575]
[33]
Kitridis D, Dionellis P, Xarchas K, Givissis P. Giant median nerve due to hamartoma causing severe carpal tunnel syndrome. J Orthop Case Rep 2018; 8(4): 57-60.
[PMID: 30687665]
[PMID: 30687665]
[34]
Azeemuddin M, Waheed AA, Khan N, Sayani R, Ahmed A. Fibrolipomatous hamartoma of the median nerve with macrodystrophia lipomatosa. Cureus 2018; 10(3): e2293.
[http://dx.doi.org/10.7759/cureus.2293] [PMID: 29750134]
[http://dx.doi.org/10.7759/cureus.2293] [PMID: 29750134]
[35]
Aydin A. Carpal tunnel syndrome caused by intraneural lipoma of the median nerve and arteriovenous malformation. J Cutan Aesthet Surg 2018; 11(1): 29-32.
[http://dx.doi.org/10.4103/JCAS.JCAS_73_17] [PMID: 29731590]
[http://dx.doi.org/10.4103/JCAS.JCAS_73_17] [PMID: 29731590]
[36]
Mohammed Saeed MA, Dawood AA, Mahmood HM. Lipofibromatous hamartoma of the median nerve with macrodactyly of middle finger. J Clin Orthop Trauma 2019; 10(6): 1077-81.
[http://dx.doi.org/10.1016/j.jcot.2019.05.023] [PMID: 31708632]
[http://dx.doi.org/10.1016/j.jcot.2019.05.023] [PMID: 31708632]
[37]
Slouma M, Zarrouk Z, Maatoug F, et al. Carpal tunnel syndrome revealing a fibrolipoma of the median nerve. Clin Rheumatol 2021; Dec 40(12): 5115-7.
[http://dx.doi.org/10.1007/s10067-021-05851-z.] [PMID: 34247290]
[http://dx.doi.org/10.1007/s10067-021-05851-z.] [PMID: 34247290]
[38]
Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: A meta-analysis. Clin Orthop Relat Res 2011; 469(4): 1089-94.
[http://dx.doi.org/10.1007/s11999-010-1637-5] [PMID: 20963527]
[http://dx.doi.org/10.1007/s11999-010-1637-5] [PMID: 20963527]
[39]
Chen YT, Williams L, Zak MJ, Fredericson M. Review of ultrasonography in the diagnosis of carpal tunnel syndrome and a proposed scanning protocol. J Ultrasound Med 2016; 35(11): 2311-24.
[http://dx.doi.org/10.7863/ultra.15.12014] [PMID: 27629754]
[http://dx.doi.org/10.7863/ultra.15.12014] [PMID: 27629754]
[40]
Marom EM, Helms CA. Fibrolipomatous hamartoma: Pathognomonic on MR imaging. Skeletal Radiol 1999; 28(5): 260-4.
[http://dx.doi.org/10.1007/s002560050512] [PMID: 10424331]
[http://dx.doi.org/10.1007/s002560050512] [PMID: 10424331]
[41]
Marek T, Spinner RJ, Syal A, Wahood W, Mahan MA. Surgical treatment of lipomatosis of nerve: A systematic review. World Neurosurg 2019; 128: 587-592.e2.
[http://dx.doi.org/10.1016/j.wneu.2019.04.110] [PMID: 31009789]
[http://dx.doi.org/10.1016/j.wneu.2019.04.110] [PMID: 31009789]
Article Metrics
38
2