CC BY
9
III. SURGERY
GIANT LIPOMA OF THE HAND. CASE REPORT
МРНТИ 76.29.41
Medeubekov U.Sh., Muradov M.I., Muhamedkerim K.B., Kazantayev K.E.
National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Kazakhstan
Medeubekov U.Sh -
orcid.org/ 0000-0003-2893-2996
Muradov M. I -
orcid.org/0000-0002-9168-8618
Muhamedkerim K. B. -
orcid.org/0000-0002-4343-0743
Kazantayev K.E -
orcid.org/0000-0002-3566-8719
Abstract
A 39-year-old man presented with a large mass on her left hand that was progressively enlarging over a period of a few years. He had pain syndrome, cosmetic concerns about the enlarging mass, and experienced interference with routine activity. Physical examination revealed a soft, mobile, non-tender, lobulated mass with well-defined margins. Ultrasound diagnostic showed the soft lump to be a lipomatous mass in the deep palmar space of the hand, which was subsequently surgically resected. The imaging features of deep palmar lipomas of the hand and other common benign lesions at this location are discussed.
Кол буынындаFы Yлкeн липома. ПpактикадаFы жаFдай
Мeдeубeков ¥.Ш., Мурадов М.И., МYхамeдкepим К.Б., Kaзантаeв K.E.
«А.Н. Сыз?анов атында?ы Улттык ?ылыми хирургия орталь™» АК, Алматы, Казакстан
Keywords
giant lipoma, nerve compression, pain syndrome
Ацдатпа
39жастагы ер адам бiрнеше жыл бойы 6ipTe-6ipTe ecin кележаткан, сол колындагы улкенжаца ecmiжвшндеп шагымымен б'зге жYгiндi. Физикалык карап-тексеру кез1нде жумсак, козгалмалы, ауырмайтын, шеттерi айкын квршетт бeлiкшелi масса аныкталды. Ультрадыбыстык диагностика кол буынындагы алакан кецiстiríнiц терещнде орналаскан липоманы кврсет, кейiннен ол хирургиялык жолмен алынып тасталды. Кол буынындагы алаканныц тере^нде орналаскан липомаларды визуализациялау ерекшелiктерi талкыланды жэне бул жерде баска кдтераз жаца вандшер аныкталган жок.
Туйш ce3Aep
улкен липома, жуйке компрессиясы, ауырсыну синдромы
Гигантская липома кисти. Случай из практики
Медеубеков У.Ш., Мурадов М.И., Мухамедкерим К.Б., Казантаев K.E.
АО «Национальный научный центр хирургии им. А.Н. Сызганова», Алматы, Казахстан
Аннотация
39-летний мужчина обратился с жалобой на большое образование на левой руке, которое постепенно увеличивалось в течение нескольких лет. Физикальное обследование выявило мягкую, подвижную, безболезненную, дольчатую массу с четко определенными краями. Ультразвуковая диагностика показала, что образование представляет собой липому в глубоком ладонном пространстве кисти, которое впоследствии было удалено хирургическим путем. Обсуждаются особенности визуализации глубоких ладонных липом кисти и других распространенных доброкачественных образований в этом месте.
Ключевые слова
гигантская липома, компрессия нерва, болевой синдром
Introduction
One of the most common soft tissue tumors of the our body - lipoma [1], but it is extremely rare in the hand [2], where it represents the 8% of benign tumors [3].
Giant lipoma sizing >5 sm should be removed due to the possibility of malignant transformation to sarcoma, despite the rare occurrence in the hand [4,5]. This pathology in the Kazakh population is observed for the first time.
We present a case report of a giant lipoma with pain syndrome of the deep palmar and dorsal space of the hand that was removed en bloc through a microsurgical technique.
Case report
The informed consent was obtained from the patient involved in this study according to the Institutional Review Board and all procedures were in accordance with the institutional and national ethical standards.
The patient was a seamstress, 39 -year-old,Kazakh male with a past medical history of alcohol addiction, hyperbilirubinemia,hyperlipidemia and chronic gastritis.
The man had a more than 5-year history of slow increasing painless mass involving both the dorsal and volar aspects of his left non-dominant hand. In 2015, he initially noticed the swelling in the central area of the palm, and then progressively enlarged
Figure 1.
Longitudinal echographic picture of a tumorformation of the palmar surface of the left hand
Figure 2.
Giant lipoma of the left hand
in dimensions over a period of 5 years, the last 2 months noted pain syndrome.
On physical examination: On the palmar surface of the left hand is a tumor formation. Size 5.5 * 4.1 cm. On palpation - mild soreness. Hypesthesia of the III, IV, V fingers of the left hand.
The surgical indication was given on the basis of the recent growth of the mass and on the patient's concerns upon the worsening of neurovascular symptoms or developing malignant transformation of the mass.
Ultrasound examination (Figure 1.) was deter-minedrounded formation, in the area of hypote-nar, homogeneousstructure, moderately increased echogenicity, characteristic
for adipose tissue, with clear, even contours, size5.1x4.2cm, avascular. The flexor tendons of the 5th finger are located above it.Preliminary diagnosis - lipoma.
Surgical procedure
The surgery was carried out under axillary block and by tourniquet hemostasis. After preliminary marking, as well as using a binocular magnifier with a magnification of 3.5x, the skin and underlying tissues are opened along the distal palm line. During the audit: lipoma 5 * 4 cm in size(Figure 2). Finger branches of the median and ulnar nerve are compressed throughout - nerve block is performed with a solution of 0.25% novocaine. Thorough hemostasis, drainage, sutures.
Histopathology and post-operative course
Histopathology reported a well-encapsulated tumor composed of mature adipose cells consistent with a benign lipoma.The pain was stopped. Re-growth of lipoma was not observed.
Discussion
Lipomas larger than 5 cm are called giant lipomas [6], as in the case presented. Lipomas usually grow very slowly, and the etiology of rapid growth in giant lipomas is debatable. It is suggested that blunt trauma can lead to rupture of the fibrous septum between the skin and the deep fascia, contributing to the growth of adipose tissue. There was no apparent relationship between tumor volume and patient symptoms. [7] Ridholm and Berg in a retrospective study of 428 cases of musculoskeletal lipomas found that the frequency of a single lipoma to sarcoma was 150/1 for lesions < 5 cm and 20/1 for lesions> 5 cm. [8] Therefore, patients should be informed that giant lipomas have an increased risk of developing malignant neoplasms.
History and clinical examination are usually sufficient to diagnose superficial lipomas if you use microsurgical technique. To date, there is no literature data on the prevalence of this pathology among the Kazakh population.
ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 4-2020
Disclosure statement
No potential conflict of interest was reported by the authors.
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