PMC9731839_01
The Clinic picture showed a mass from the distal forearm to the palm of the left hand (yellow ring). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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A 6-years old girl presented to our outpatient orthopedic center for a slow growing mass in her left distal forearm on 30th August 2019 (Fig. 1). Tinel's sign and Phalen's test were both positive (Fig. 1).
Anteroposterior and lateral radiographs of the left forearm showed no abnormal findings.
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All laboratory investigations and Radiograph were normal (Fig. 2).
Magnetic resonance imaging findings. A: Axial T1 weighted image of shows thickened hypointense nerve fascicles surrounded by hyperintense fibroadipose tissue giving "coaxial cable" like appearance and the displacement of the flexor tendon and palmar protrusion of the flexor retinaculum due to an enlarged median nerve (red arrow).B and C: The coronal and sagittal sections shows "spaghetti" like appearance of the mass, fusiform or hourglass enlargement of the median nerve (white arrows) with low-signal intensity nerve bundles embedded in hyperintense adipose tissue. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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Magnetic resonance imaging (Fig. 3)demonstrated the median nerve was fusiform swelling from the distal forearm to the proximal palmar area and was pressed into an hourglass shape by the transverse carpal ligament.
A: intraoperative photographs of the girl with lipofibromatous hamartoma in her left distal forearm (red arrow). B: remove the epineural proliferation tissue, "spaghetti" like appearance of the mass. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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The outer membrane of the mass was formed along the epineurium of the median nerve and no infiltrations into the surrounding tissues (Fig. 4).
A: HE histopathological findings: normal nerve fascicle surrounded by fibroblasts and mature adipocytes and connective tissue B: Immunohistochemistry demonstrate: Desmin(-), Ki-67(-), SMA(+),S-100(-),Vim(+)highlights the hyperplasia of fibro-neural hyperplasia.
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The final histological examination showed the diagnosis of LFH (Fig. 5).