Fibrolipomatous Hamartoma (FLH) of Median Nerve: A Rare Case Report and Review.

INTRODUCTION: Fibrolipomatous hamartoma (FLH) is a benign tumorous condition of adipose tissue. It is a slow growing, rare tumour involving peripheral nerves with uncertain aetiology. The clinical presentation varies as per presenting severity. The gold standard to diagnose this rare entity is MRI and its management is still controversial. In this report, we have described one such rare presentation of FLH involving Median Nerve in an adolescent male who successfully witnessed resolution of symptoms following our surgical intervention for the same. CASE
PRESENTATION: A 17-year-old male presented to our hospital with a history of swelling in his left hand since past 1 year. The detailed clinical evaluation revealed an irregular fusiform swelling extending from the ulnar aspect of wrist proximally to the thenar eminence along with involvement of the base of 2nd, 3rd and 4th fingers of left hand with consistency varying from soft to firm, tinel's sign positive and a terminal restriction of palmar and dorsiflexion movements. Notably, motor weakness and sensory loss were not elicited. The definitive diagnosis was established by MRI of the left hand. With due consent, the patient was undertaken for surgical intervention whereby his carpal tunnel was decompressed and biopsy of the lesion was sent for further histopathological evaluation as per the protocol. The absolute resolution in symptoms was reported by the patient following our intervention.
CONCLUSION: A meticulous clinical and radiological correlation is required to diagnose such rare clinical entity for improvising the functional quality of life. There is no definitive treatment for lipomatosis of nerve. However, a conservative approach is commonly advocated with successful results from decompression as in our patient. © Indian Orthopaedics Association 2020.