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|Year : 2021 | Volume
| Issue : 1 | Page : 234-235
Fibrolipomatous Hamartoma of Median and Ulnar Nerve: A Rare Combination
Arshed H Parry, Haseeb A Wani, Feroze A Shaheen
Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
|Date of Submission||08-Aug-2018|
|Date of Decision||15-Dec-2019|
|Date of Acceptance||19-Jul-2020|
|Date of Web Publication||24-Feb-2021|
Arshed H Parry
Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir - 190 011
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Parry AH, Wani HA, Shaheen FA. Fibrolipomatous Hamartoma of Median and Ulnar Nerve: A Rare Combination. Neurol India 2021;69:234-5
A 32-year-old male presented with complaints of pain and paresthesia in the left hand, in the distribution of median and ulnar nerve, associated with gradual enlargement of swelling over the volar aspect of the wrist for the last one year. Physical examination revealed a palpable swelling on the volar aspect of wrist and hypothenar eminence. The patient felt paresthesia in the fingers upon compression of the mass.
Magnetic resonance imaging (MRI) of wrist revealed bulky and enlarged median and ulnar nerves with fat bundles interspersed between the thickened axonal bundles with thick ensheathing epineurium [Figure 1]. Proximally, the median and ulnar nerves were involved upto pronator quadrates and Guyon's canal, respectively, while distally there was involvement of digital branches of both the nerves [Figure 2]. Based on these characteristic imaging findings, the diagnosis of fibrolipomatous hamartoma (FLH) of the median and ulnar nerves was made.
|Figure 1: Axial T1-weighted non-fat saturated (a and b) and axial T1-weighted fat-saturated (c and d) MRI images reveal thickened, bulky median nerve (white arrows), and ulnar nerve (black arrows) with interspersed lobules of fat within thickened epineurium with thick widely spaced axonal bundles|
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|Figure 2: Axial T1-weighted non-fat saturated (a) and axial T1-weighted fat-saturated (b) MRI images reveal thick digital branches of the ulnar and median nerve (white arrows) with proliferation of fat within the thickened epineurium|
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An FLH is a benign, slowly growing tumor typically affecting the peripheral nerves. The median nerve is the most commonly reported nerve to be affected, however, ulnar, radial, axillary, and peroneal nerves are also affected.,Simultaneous involvement of both median and ulnar nerves at the wrist is very rare. Toms et al. in a study of 15 patients of FLH of upper limb reported single nerve (median or ulnar) involvement in 12 patients whereas three patients had multiple nerve involvement among which two patients had simultaneous involvement of brachial plexus and its branches, including the median, ulnar, radial, axillary, and musculocutaneous nerves.
MRI is the diagnostic modality of choice. It is a widely held view that characteristic MRI appearance establishes the diagnosis of FLH without the need for histological diagnosis., The characteristic appearance is likened to a “coaxial cable” which represents thickened axonal bundles separated by the interspersed fat, together ensheathed in thick epineurium.,
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Toms AP, Anastakis D, Bleakney RR, Marshall TJ. Lipofibromatous hamartoma of the upper extremity: A review of the radiologic findings for 15 patients. Am J Roentgenol 2006;186:805-11.
Azeemuddin M, Waheed AA, Khan N, Sayani R, Ahmed A. Fibrolipomatous hamartoma of the median nerve with macrodystrophia lipomatosa. Cureus 2018;10:e2293.
[Figure 1], [Figure 2]