PMC7701893_01
Physical examination of the right hand showing a thenar mass and scar from previous surgical procedure.
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On examination, there was a mass on the thenar eminence (Fig. 1).
T1-weigthed axial MRI image showing an occupying-space lesion with hypersignal.
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Ultrasound (US) and magnetic resonance image (MRI) of the hand revealed an occupying-space lesion of adipose density, capsulated with well-defined contours (Fig. 2, Fig. 3).
T1-weigthed coronal MRI image showing a capsulated adipose tumour without tendon involvement.
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MRI showed no signs of local aggressivity and presented a large homogenous tumour measuring approximately 46 x 31 x 17 mm, shaping the flexor tendons and median nerve, but laying independently from them (Fig. 4).
T1-weigthed sagittal MRI image showing a capsulated adipose tumour shaping the flexor tendons, with signs of invasion.
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The median nerve presented no focal lesions, but it was distally molded and rectified by the presence of the tumour (Fig. 5).
Intraoperative picture. Surgical standard palmar approach, with an intracanal lipoma.
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Through a standard palmar approach and anterior annular carpal ligament release, an intracanal giant lipoma was found (Fig. 6).
Intraoperative picture. Dissection of intracanal lipoma, laying above the median nerve.
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Tumour dissection was complete and an en bloc marginal resection carried out (Fig. 7, Fig. 8).
Excised lipoma before fixation.
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The histopathological analysis documented a nodular, elastic fragment of soft tissue, loculated and yellow in colour, weighting 13 g and measuring 51 x 35 x 25 mm (Fig. 9).
Histopathological analysis showing mature adipose tissue.
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The lesion was constituted by mature adipose tissue (Fig. 10) and the definitive diagnosis was a benign giant lipoma.