Lipofibromatous Hamartoma of the Median and Ulnar Nerves: A Case Report.

Abstract

Introduction: Lipofibromatous hamartoma (LFH) is a rare, benign tumor of peripheral nerves characterized by fibroadipose infiltration of the epineurium and perineurium. It most frequently involves the median nerve and is rarely seen with concomitant ulnar nerve involvement.

Case report: We report a 28-year-old male with a 13-year history of a slowly progressive mass over the volar aspect of the left hand and wrist, associated with persistent hypoesthesia in the thumb and intermittent paresthesia in the ring and little fingers. Magnetic resonance imaging (MRI) revealed the pathognomonic "coaxial cable" and "spaghetti" signs involving both the median and ulnar nerves. The patient underwent extended neurolysis of both nerves with carpal tunnel and Guyon's canal release. Histopathology confirmed LFH without atypia. At 12-month follow-up, he showed sustained improvement in pain and sensory symptoms, with complete return to work.

Conclusion: Concomitant LFH of the median and ulnar nerves is extremely rare. MRI provides pathognomonic diagnosis, and extended neurolysis without tumor resection can achieve favorable functional outcomes.