gms | German Medical Science

Background: Lipomatous tumours are common and represent 1 to 4% of benign tumors of the hand. Diagnosis and treatment managements could be sometimes non obvious. Very few studies on large series of patients have been published.

Objectives and interrogation: The goal of the present study was to analyze the specific characteristics of fat-like tumors located at the distal end of the upper limb and managed in our adult orthopedic surgery unit.

Methods: Among all the soft tissue tumors of the hand and wrist treated in the department over a period of 26 years, 28 tissue tumors of lipomatous nature with histological evidence were identified in 28 patients. The characteristics of the symptoms, their duration, the location and the size of the tumor, the therapeutic management and the results of the treatment with a possible recurrence were analyzed with an average follow-up of 5.4 years.

Results and Conclusions: For all 28 cases, there was a palpable tissue mass. This mass was troublesome or disabling in 20 cases and was associated with distal paresthesia in 5 cases: four cases were due to compression of the ulnar nerve in the Guyon canal and the remaining case was due to compression of the median nerve in the canal carpal. Seven tumor lesions were located on the wrist, 11 by hand and 10 with finger chains. The average length of the largest axis of the lesions was: 4.1 cm on the wrist, 3.4 cm on the hand and 2.6 cm on the fingers. In 19 cases, the tumor masses were deep and were often present for several years. Additional investigations have not been systematic. An MRI was performed in 17 cases, an ultrasound in 14 cases, an X-ray in 13 cases and an electromyogram in five cases. All tumor lesions were resected. A previous biopsy was performed in 4 cases. Routine pathological analysis confirmed the benign nature of all lesions. There was no case of liposarcoma. No recurrence was observed.

Patients often consulted late because of good initial tumor tolerance. The use of MRI had made it possible to diagnose localized lesions in the palm and had helped with the decision whether or not to perform the biopsy. Early surgery is preferable because of the risk of developing neurological compression.