PMC6477462_01
A, B showed the clinical picture of the marked hypertrophy and enlargement of the middle finger. C, D intraoperative dissection of the digital nerve with the associated hypertrophied lipomatous tissue. E, F postoperative images showed complete removal of the mass and marked reduction in the size of the digit.
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F1
Full proximal and distal interphalangeal joint range of motion, fingernail neurovascular examination is within normal (Fig. 1A, B). The patient was on regular follow up in the clinic, and last clinical visit was two years following surgery and showed no tumor recurrence an excellent cosmetic as well as functional result with full finger joints range of motion (Fig.1E, F).
A, B showed MRI of the middle finger with ill-defined soft tissue mass inspirable from the surrounding fat, mainly at the palmar aspect of the middle and distal phalanx. This mass has fat signal intensity in the form of bright T1 and T2 weighted images. C, D images showed a drop of signal in the fat sat sequences and no solid enhancing nodule on contrast-enhanced images. It shows central striation with multiple blood vessels coursing through it rather than being displaced by it. The overall picture is suggestive of distal phalangeal lipomatosis (localized Macrodystrophica lipomatosa of the distal median nerve).
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F2
Furthermore, left hand MRI with IV contrast media showed a distal fatty overgrowth with striation and no capsulation surrounding the middle and distal phalanges of the middle finger, more at the palmer aspect (Fig. 2).
In histopathology, A Gross specimen consists of two fragments of fibrofatty tissue with skin ellipse measuring 7 x 3 x 2 cm and 2 x 0.5 x 0.5 cm respectively. The resected specimen submitted for microscopic examination. A, B H/E slides showing nerve bundles surrounded by dense collagen and mature adipose tissue. C S100 IHC staining the nerve bundles in trapped within mature adipose tissue.
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F3
Pathology report came back with the diagnosis of lipofibromatous hamartoma of the nerve, macrodystrophia lipomatosa of the finger (Fig. 3).