Lipoma

Kevin D. Plancher and Michael Bothwell

History and Clinical Presentation

A 40-year-old right hand dominant woman presents with a mass on her right little finger. The mass has grown in size and is now causing functional problems. The patient reports the mass is not painful. She also reports a recent weight gain, corresponding with the enlargement of the mass.

Physical Examination

The patient has full range of motion of the little finger and exhibits no strength deficits. The patient has a normal vascular examination. Swelling is present over the hypothenar eminence of the hand. A single round mass is palpated. The patient requests treatment due to functional problems and for cosmetic reasons.

Diagnostic Studies

Radiographic plain films are often useful for revealing the characteristic density of fat, facilitating diagnosis as well as evaluation of the extent of the lesion. Radiographs show an area of decreased density due to increased translucency of the adipose tissue, surrounded by the contrast of adjacent muscle. No calcification was present. Magnetic resonance imaging (MRI) and computed tomography (CT) are helpful if the lesion is deep. Electromyography (EMG) is performed if nerve symptoms are present.

Differential Diagnosis

Ganglions Synovitis

Rheumatoid nodules

Osteochondromas

Lipomas

Diagnosis

Lipoma

Lipomas are typically soft and lobular and vary from pale yellow to orange in appearance with a thin membrane surrounding the lesion. Lipomas are benign tumors that consist of mature fat cells (Fig. 85—1). This tumor commonly occurs in patients in their third to eighth decade often noted by the patients because of cosmetic concerns. Rare in the hand, they occur more frequently in the proximal upper extremity as an asymptomatic mass. When they do occur in the hand, they are usually large

Hand Lipoma

and located in the deep palm, where they may cause median nerve compression with a secondary nerve palsy or limit digital flexion. There are no predisposing factors, but it is believed that lipomas occur more frequently in obese people than in thin people. Pain and inflammation of the surrounding tissues are uncommon with the mass in the palm.

Surgical Management

Treatment consists of marginal excision of the mass. The surgical incision must be planned carefully because these tumors can be deceptively large. Identification of common digital arteries and nerves leads to low complication rates after excision of a lipoma (Fig. 85-2).

Complications

Stiffness and injury to the radial nerve are the most common complications after surgical excision. Recurrence rates after surgery are low, although they may coincide with weight gain.

Suggested Readings

Babins DM, Lubahn JD. Palmar lipomas associated with compression of the media nerve. J Bone Joint Surg [Am] 1994;76A:1360-1362.

Deshmukh N, Kelly CP. Giant lipoma of the hand. Hand Surg 1999;4:87-90.

Galeano M, Colonna M, Risitano G. Ulnar tunnel syndrome secondary to lipoma of the hypothenar region. Ann Plast Surg 2001;46:83-84.

Leffert RD. Lipomas of the upper extremity. J Bone Joint Surg [Am] 1972;54A: 1262-1266.

Miller TT, Potter HG, McCormack RR Jr. Benign soft tissue masses of the wrist and hand: MRI appearances. Skeletal Radiol 1994;23:327-332.

Pritchard DLL. Surgical management of common benign soft-tissue tumors. In: Surgery for Bone and Soft-Tissue Tumors. Philadelphia: Lippincott-Raven; 1998: 525-539.

Wong CH, Chow L, Yen CH, Ho PC, Yip R, Hung LK. Uncommon hand tumors. Hand Surg 2001;6:67-80.

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