Adipose lesions of nerve: the need for a modified classification

Clinical article

Restricted access

Object

Adipose lesions of nerve are rare and poorly understood. Their current classification, although not universally accepted, generally includes lipomatosis of nerve with or without localized macrodactyly, and intra- as well as extraneural lipoma. The authors believe that the spectrum of these lesions and their interrelationships are not currently appreciated. They propose an adaptation to the existing framework to illustrate the expanding spectrum of adipose lesions of nerve by considering lipomatosis and lipoma singly or in combination.

Methods

Fourteen representative cases are presented to demonstrate not only the intraneural and extraneural examples of lipomatosis and lipoma, but also their anatomical combinations.

Results

Based on the cases presented and a careful literature review, a conceptual approach to the classification of adipose lesions of nerve is generated. This approach incorporates the 2 essential lesions, lipomatosis of nerve and lipoma, in both their intra- and extraneural forms. This permits expansion to encompass combinations.

Conclusions

To press the concept that adipose tumors of nerve are a broad but interrelated spectrum of lesions, the authors propose modification of the present classification system. This approach provides an orderly platform for progress, reflects understanding of these interrelated lesions, and facilitates optimal treatment by distinguishing resectable from nonresectable components.

Abbreviations used in this paper: AFIP = Armed Forces Institute of Pathology; FLH = fibrolipomatous hamartoma; FSE = fast spin echo; LFH = lipofibromatous hamartoma.

Article Information

Address correspondence to: Robert J. Spinner, M.D., Mayo Clinic, Gonda 8S-214, Rochester, Minnesota 55905. email: spinner.robert@mayo.edu.

Please include this information when citing this paper: published online October 7, 2011; DOI: 10.3171/2011.8.JNS101292.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    A 3-circle Venn diagram with nonoverlapping circles (lower left) depicting the existing classification scheme, which includes lipomatosis of nerve with or without overgrowth (red), intraneural lipoma (yellow), and extraneural lipoma (blue), all in primary colors. These groups have been considered mutually exclusive. The 2 larger overlapping circles (right) highlight our current understanding, emphasizing the classic forms (lipomatosis and lipoma) and their combinations. A secondary color (green) reflects the joined lipoma categories. Subsets of combined intraneural and extraneural localizations are represented by horizontal shading of colors. The occurrence of combined lipomatosis and lipoma is represented by intersection of the circles (gray). The frequent association of overgrowth in lipomatosis of nerve within nerve territory (black arrow) and generalized lipomatosis in or outside nerve territories (gray arrow) are also represented (peripheral zone). This conceptual diagram, its vantage point being lipomatosis of nerve, accommodates all adipose lesions of nerve we have encountered in our practice. Printed with permission from Mayo, Copyright 2010.

  • View in gallery

    Case 1. Lipomatosis of nerve without overgrowth. This 54-year-old man presented with 15 years of progressive left lower-extremity numbness, weakness, and pain. A: Photograph showing atrophic tibial nerve–innervated muscles of the left calf. B: A T1-weighted FSE image obtained at the level of the upper thigh, showing marked enlargement of the sciatic nerve. Normal-appearing fascicles within the more obviously affected tibial and peroneal divisions are separated by adipose tissue (arrows), an appearance diagnostic of lipomatosis of nerve. The lipomatosis of nerve extended to the sciatic bifurcation. C: Schematic showing lipomatosis of nerve. Printed with permission from Mayo, Copyright 2010.

  • View in gallery

    Case 2. Lipomatosis of nerve with multiple nerve involvement and mild nerve territory overgrowth. This 26-year-old woman presented with paresthesias radiating into her left middle finger as well as moderate weakness and atrophy of the thenar muscles. Photograph (A) showing mild macrodactyly of the middle digit. Cutaneous papules (arrows) are noted extending in a linear fashion from the palm to the distal phalanx of that digit. A skin biopsy of one of the digital cutaneous lesions illustrated in panel A showed dermal nerves exhibiting pseudo–onion bulb formation. Nerve fibers were surrounded by multiple layers of perineurial cells (B) immunoreactive for epithelial membrane antigen (C). The same histological changes are seen in biopsies of lipomatosis affecting large nerves. Axial T1-weighted FSE image (D) obtained just distal to the carpal tunnel, showing adipose tissue separating mildly enlarged nerve fascicles in both the median (straight arrows) and ulnar (curved arrow) nerves. The features indicate lipomatosis of nerve. Sagittal T1-weighted image (E) of the distal forearm and wrist showing the proximal and distal extent of abnormality within the median nerve. Classic fusiform nerve enlargement and hypointense serpiginous fascicles are seen (black arrows). H & E (B). Original magnification × 200 (B) and × 600 (C).

  • View in gallery

    Case 3. Lipomatosis of nerve with marked nerve territory overgrowth. This 44-year-old man had persistent paresthesias and hypesthesias as well as weakness in the median nerve distribution. He had undergone several surgical procedures for sequelae related to the overgrowth. Left: Photograph showing persistent soft tissue overgrowth in the median nerve territory. This overgrowth was accompanied by osseous overgrowth (“banana” deformity) of the index finger. Right: Axial T1-weighted MR image obtained at the level of the distal forearm, showing fatty soft tissue overgrowth limited to the radial aspect (asterisks) and diffuse fatty infiltration of the median nerve (arrows). The latter is pathognomonic of lipomatosis of nerve. R = radius; U = ulna.

  • View in gallery

    Case 4. Lipomatosis of nerve with marked nerve territory overgrowth. This 44-year-old man presented with long-standing, right-sided sciatic neuropathy and a congenital right foot deformity. Fifteen years previously, complete foot drop developed. Photograph obtained on physical examination (A), showing marked soft tissue and prominent bony overgrowth affecting the right foot. The patient also had moderate tibial nerve dysfunction. Axial T1-weighted FSE image (B) obtained at the thigh level, demonstrating enlargement of the sciatic nerve with interfascicular fat (arrows) diagnostic of lipomatosis of nerve. The peroneal division was preferentially affected, but the tibial division was mildly involved as well. These imaging abnormalities extended from the spinal canal to the foot. Axial T1-weighted FSE image (C) of the proximal calf showing fatty atrophy of anterior and lateral compartment musculature. The same was true, albeit to a lesser degree, of the deep (tibialis posterior muscle) and superficial (medial gastrocnemius muscle) posterior compartments.

  • View in gallery

    Case 5. Isolated macrodactyly of the ring finger with unrecognized lipomatosis of nerve. This 2-year-old boy had macrodactyly of the entire ring finger, the most rarely affected digit. Initial interpretation of MR imaging did not reveal lipomatosis of nerve as an explanation for the overgrowth. However, lipomatosis of nerve involving both proper digital nerves but not the median or ulnar nerve was predicted based on the symmetric involvement of a digit typically innervated by 2 major nerves (median and ulnar). A: Anteroposterior radiograph of the right hand demonstrating macrodactyly of the fourth digit with overgrowth involving the phalanges and soft tissues. The fourth metacarpal is normal in size. B: Coronal T1-weighted MR image showing fibrofatty overgrowth of the subcutaneous tissues and bone of the fourth digit. C: Coronal T1-weighted MR image showing enlargement of the radial and ulnar digital nerves of the fourth finger with fatty interdigitation involving the nerve, better seen in this image in the radial digital nerve (arrows). D: Axial T1-weighted MR image obtained at the level of the carpal tunnel, showing normal median (straight arrow) and ulnar (curved arrow) nerves with no evidence of fatty interdigitation.

  • View in gallery

    Case 6. Extraneural (epineural) lipomatosis. Intraoperative photograph (A) of a 51-year-old obese man with bilateral, severe ulnar neuropathy localized to the elbow. The patient underwent staged ulnar nerve decompressions of the cubital tunnel. Photographs obtained at surgery, showing ulnar nerves that were significantly enlarged and encircled by a thickened rind of fat (B), which was peeled circumferentially (C, asterisks) off the nerve, fat in clamps, better revealing the longitudinal vein (C, arrow). Given the patient's body habitus, neither a CT nor an MR image could be obtained. Ultrasound (not shown) confirmed increased fatty tissue concentrically located around the ulnar nerves. Postoperatively, sensorimotor function improved. Illustration (D) showing a concentric epineural lipomatosis. Printed with permission from Mayo, Copyright 2010.

  • View in gallery

    Case 7. Intraneural lipoma. This 67-year-old woman presented with typical carpal tunnel syndrome and left wrist mass. Excision of the mass improved her neurological symptoms. Axial T1-weighted FSE image (A) obtained at the level of the radiocarpal joint, showing an intraneural lipoma (asterisk) of the median nerve, which is isointense to subcutaneous fat. Note displacement of the otherwise normal-appearing nerve fascicles (arrow). Axial T2-weighted FSE image with fat suppression (B) obtained at the same level, showing complete suppression of the mass (asterisk) and confirming its adipose nature. The displaced nerve fascicles (arrow) exhibit a very mild increase in T2 signal. Whole-mount microsection (C) of a portion of the intraneural lipoma showing the tenuous encapsulation. H & E, original magnification × 10. Schematic (D) depicting a discrete intraneural lipoma located within the epineurium, separate from and displacing the fascicles. Printed with permission from Mayo, Copyright 2010.

  • View in gallery

    Case 8. Extraneural lipoma. This 40-year-old man presented with the acute onset of right finger drop and mild wrist extensor weakness consistent with a posterior interosseous nerve palsy. His neurological deficit resolved after excision of the mass. Axial T1-weighted FSE image (A) of the proximal forearm showing a mass with the signal intensity of subcutaneous fat intimately associated with the radius. Consistent with a benign extraneural lipoma (asterisk), the mass displaces the deep (arrow) and superficial (arrowhead) branches of the radial nerve. Coronal T1-weighted image (B) showing the lobulated contours of the fatty extraneural mass (asterisk). Intraoperative photograph (C) of the extraneural lipoma (asterisk) and its relation to the radial nerve (curved arrow) and its superficial (arrowhead) and deep (straight arrow) branches. Schematic (D) depicting a well-encapsulated, eccentric extraneural lipoma causing compression of a peripheral nerve. Printed with permission from Mayo, Copyright 2010.

  • View in gallery

    Case 9. Extraneural lipoma with extensive longitudinal orientation to nerve. This 61-year-old man presented with a 6-year history of right buttock pain radiating to the thigh and foot, as well as an obvious right buttock mass. At surgery (posterior buttock approach), a plane was present between the sciatic nerve and the tumor. Complete resection was achieved. Pathology confirmed a lipoma. His symptoms resolved. Coronal reformatted CT image (left) without contrast shows the hypodense, 25-cm mass (asterisks) occupying the sciatic notch and extending from the proximal thigh into the pelvis to the level of S-1. The sciatic nerve is intimately associated with the mass and displaced by it (arrow). Axial T1-weighted FSE image (right) obtained at the level of the sciatic notch, showing an extensive fatty mass (asterisks) within the pelvis and extending peripherally through the sciatic notch along the course of the sciatic nerve. It displaces the rectosigmoid colon to the left of midline (white arrow). Note the anterior displacement and compression of the right sciatic nerve (black arrows).

  • View in gallery

    Case 10. Lipomatosis of nerve with extreme nerve territory overgrowth and pelvic lipomatosis. This 34-year-old woman presented with longstanding soft tissue and bony overgrowth of the right lower limb for which she had undergone multiple operations. She had progressive sciatic neuropathy. An early photograph (A) demonstrating the foot deformity. Plain radiograph (B) obtained 10 years before, showing bony overgrowth as well as postoperative effects. Note the absence of the fifth and distal fourth digits, as well as enlargement of the third distal phalanx. Photograph (C) showing gross soft tissue hypertrophy of the right calf and foot; the patient also had obvious hypertrophy of the thigh and buttock (not shown). Axial T1-weighted image (D) obtained at the level of the ischial tuberosity, showing marked enlargement of the sciatic nerve due to interfascicular fat (arrow), an appearance diagnostic of lipomatosis of nerve. Note the fatty enlargement of the adjacent gluteal muscles (asterisk). The changes extended to the S1–3 nerves as they exit the foramina and distally to involve the digital nerves (not shown). Axial T1-weighted FSE image (E) of the pelvis showing involvement of the lumbosacral plexus (arrow) just medial to the sciatic notch. There is also a marked increase of adipose tissue in the rectosigmoid mesentery, with the rectosigmoid colon being displaced (arrowhead) to the left of midline. The appearance is consistent with pelvic (extraneural) lipomatosis, albeit within the nerve territory. Photomicrograph (F) showing lipomatosis of nerve in a sural nerve at the time of neurectomy. Note multiple fascicles dispersed in mature adipose tissue. H & E, original magnification × 25.

  • View in gallery

    Case 11. Lipomatosis of nerve with generalized lipomatosis. This 13-year-old boy with a diagnosis of Proteus syndrome had massive left lower-limb soft tissue and bony overgrowth, which also resulted in a marked discrepancy in leg length. He had undergone a previous below-knee amputation. Axial T1-weighted MR image obtained at the level of the gluteal fold, showing lipomatosis of the sciatic nerve (arrows) as well as fatty infiltration of the adductor (white asterisks) and gluteus maximus muscles (black asterisk). The diffuse fatty overgrowth (plus signs) causes mass effect on the anterior compartment muscles of the thigh, which are atrophied.

  • View in gallery

    Case 12. Lipomatosis of nerve with intraneural lipoma. This 63-year-old man presented with peroneal dysesthesias and multiple lipomatous lesions outside the nerve territory. A familial history of the latter was elicited. Sagittal T1-weighted FSE image (A) showing fat interdigitating between fascicles of the common peroneal nerve (CPN, arrow), the classic feature of lipomatosis of nerve. There is also a contiguous mass of adipose tissue within the epineurium (asterisk), a feature of intraneural lipoma. Axial T1-weighted FSE image (B) obtained at the level of the junction of the fibular head and neck, showing an intraneural lipoma associated with the articular branch of the deep peroneal nerve (asterisk). Axial T1-weighted FSE image (C) obtained at the level of the fibular neck, showing the superficial (black arrow), deep (white arrow), and articular branches (arrowhead) of the peroneal nerve separated by excessive fat, again consistent with lipomatosis. Photograph (D) obtained at the trifurcation of the CPN, showing protuberant fat (asterisk) intimately associated with the proximally enlarged nerve. The terminal branches have been identified and are preserved. Photograph (E) of the intraneural lipoma component (asterisk), which could be resected from the trifurcation of the CPN. Fascicles were protected during the epineurial dissection. The superficial (black arrow), deep (white arrow), and articular branches (arrowhead) of the CPN are visible. The proximal CPN shown in this picture remains diffusely enlarged. Postoperatively, symptoms improved. Microsection (F) of the periphery of the lipoma. Note the very delicate nature of the “capsule.” H & E, original magnification × 200. Schematic (G) of the hybrid tumor. Dashed line approximates the interface between the 2 components. Printed with permission from Mayo, Copyright 2010. F = fibular head.

  • View in gallery

    Case 13. Lipomatosis of nerve and mild nerve territory overgrowth with contiguous massive extraneural lipoma. This 47-year-old woman has both right sciatica and mild sciatic neuropathy. Her right limb was 1.5 cm longer than the left and her right foot was 1 cm larger than the left. She had calf hypertrophy. Axial T1-weighted image (A) obtained at the level of the upper thigh, showing fat interdigitating between sciatic nerve fascicles (arrows), the classic features of lipomatosis of nerve. Lipomatosis extended more distally to involve the sciatic nerve in the distal thigh and sural branches at the knee (not shown). More proximal axial T1-weighted image (B) showing the hybrid nature of the lesion, including lipomatosis of the sciatic nerve (arrow) and the point of origin of the contiguous extraneural lipoma (asterisk). More proximal still, an axial T1-weighted image (C) showing lipomatosis of nerve (arrow) and the contiguous, massive, dumbbell-shaped extraneural lipoma (asterisks). Operative view (D) at the level of the buttock showing the markedly enlarged sciatic nerve (SN) and the contiguous extraneural lipoma (asterisks). Another operative view (E) showing the extraneural lipoma (asterisks), which is attached posteriorly (arrows) to the lipomatosis of the SN. The extraneural lipoma was separable from the lipomatosis. Fourteen months after surgery the patient showed sustained improvement of pain and had mild progression of sciatic neuropathy. Schematic (F) showing this hybrid lesion. Printed with permission from Mayo, Copyright 2010.

  • View in gallery

    Case 10. Lipomatosis of nerve with contiguous small extraneural lipoma. Axial T1-weighted MR image (A) at the level of the upper thigh showing lipomatosis of nerve within the tibial and peroneal divisions of the SN. A well-formed epineurial layer is visible (arrowhead). There is a generous amount of fat immediately adjacent (plus sign) to the SN. Note fatty infiltration of the gluteus musculature. Axial T1-weighted MR image (B) just superior to that shown in panel A demonstrating lipomatosis of nerve within the tibial division. The epineurium (arrowheads) at this level is well defined near the take-off of a hamstring muscular branch of the nerve (arrow). Axial T1-weighted MR image (C) proximal to that featured in panel B showing no discrete epineurium demarcating the boundary of the tibial division (arrowheads). The hamstring branch is again visible (arrow). Axial T1-weighted MR image (D) showing a discrete extraneural lipoma component (asterisk) continuous with the intraneural lipomatosis seen in the tibial division in panels A–C, now outside the epineurium (arrowhead). These relationships are best seen with a review of these serial images in a “stack.”

  • View in gallery

    Case 14. Generalized lipomatosis and discrete intraneural and extraneural lipomas. Photograph (A) obtained in a 30-year-old woman with massive generalized lipomatosis affecting the left more than the right lower extremity as well as the abdomen. The patient also had juvenile polyposis, which had prompted a colectomy. Axial T1-weighted MR image (B) at the buttock level showing intraneural lipoma separating the tibial (black arrow) and peroneal (white arrow) divisions of the SNs. The fat is within the epineurium (arrowheads). Contrast the appearance of the SN with lipomatosis of nerve in Figs. 2, 5, 11, 12, 14, and 15 with fat between the fascicles. Note the diffuse fatty infiltration of the gluteal and quadriceps muscles and an intramuscular lipoma in the distal iliopsoas. Axial T1-weighted MR image (C) in the left mid-thigh showing displacement of the tibial (black arrow) and peroneal (white arrow) nerves and their sural branches by a lipoma with fat necrosis (white asterisk). A second discrete lipoma (black asterisk) is seen just deep to the first. Note the fatty infiltration of the quadriceps muscles. Coronal T1-weighted MR image (D) showing generalized lipomatosis, discrete lipomas (asterisks), and fatty infiltration of the muscles in the pelvis.

References

  • 1

    Abu Jamra FNRebeiz JJ: Lipofibroma of the median nerve. J Hand Surg Am 4:1601631979

  • 2

    Al-Khawaja DSeex KEslick GD: Spinal epidural lipomatosis—a brief review. J Clin Neurosci 15:132313262008

  • 3

    Al-Qattan MM: Lipofibromatous hamartoma of the median nerve and its associated conditions. J Hand Surg Br 26:3683722001

  • 4

    Al-Qattan MMAl-Lazzam AMAl Thunayan AAl Namlah AMahmoud SHashem F: Classification of benign fatty tumours of the upper limb. Hand Surg 10:43592005

    • Search Google Scholar
    • Export Citation
  • 5

    Amadio PCReiman HMDobyns JH: Lipofibromatous hamartoma of nerve. J Hand Surg Am 13:67751988

  • 6

    Antonescu CRWoodruff JMScheithauer BW: AFIP Atlas of Tumor Pathology: Tumors of the Peripheral Nervous System WashingtonAmerican Registry of Pathology2012

    • Search Google Scholar
    • Export Citation
  • 7

    Aydos SEFitoz SBökesoy I: Macrodystrophia lipomatosa of the feet and subcutaneous lipomas. Am J Med Genet A 119A:63652003

  • 8

    Balakrishnan CSaini MSDemercurio J: Intraneural lipoma of the ulnar nerve: a case report and review of literature. Can J Plast Surg 14:49502006

    • Search Google Scholar
    • Export Citation
  • 9

    Bansal VPHarmit S: Monomelic macrodystrophia lipomatosa. A case report. Int Orthop 13:77791989

  • 10

    Barber KW JrBianco AJ JrSoule EHMacCarty CS: Benign extraneural soft-tissue tumors of the extremities causing compression of nerves. J Bone Joint Surg Am 44:981041962

    • Search Google Scholar
    • Export Citation
  • 11

    Berti ERoncaroli F: Fibrolipomatous hamartoma of a cranial nerve. Histopathology 24:3913921994

  • 12

    Biesecker LG: The multifaceted challenges of Proteus syndrome. JAMA 285:224022432001

  • 13

    Biesecker LGHapple RMulliken JBWeksberg RGraham JM JrViljoen DL: Proteus syndrome: diagnostic criteria, differential diagnosis, and patient evaluation. Am J Med Genet 84:3893951999

    • Search Google Scholar
    • Export Citation
  • 14

    Blacksin MBarnes FJLyons MM: MR diagnosis of macrodystrophia lipomatosa. AJR Am J Roentgenol 158:129512971992

  • 15

    Bonneau LADelatte SJBentz ML: Intraneural lipoma of the ulnar nerve. Plast Reconstr Surg 123:40e41e2009

  • 16

    Boren WLHenry RE JrWintch K: MR diagnosis of fibrolipomatous hamartoma of nerve: association with nerve territory-oriented macrodactyly (macrodystrophia lipomatosa). Skeletal Radiol 24:2962971995

    • Search Google Scholar
    • Export Citation
  • 17

    Campbell CSWulf RF: Lipoma producing a lesion of the deep branch of the radial nerve; case report. J Neurosurg 11:3103111954

  • 18

    Carvi y Nievas MNArchavlis EUnkel B: Delayed outcome from surgically treated patients with benign nerve associated tumors of the extremities larger than 5 cm. Neurol Res 32:5635712010

    • Search Google Scholar
    • Export Citation
  • 19

    Cavallaro MCTaylor JAGorman JDHaghighi PResnick D: Imaging findings in a patient with fibrolipomatous hamartoma of the median nerve. AJR Am J Roentgenol 161:8378381993

    • Search Google Scholar
    • Export Citation
  • 20

    Chan JYChang CJJeng CMHuang SHLiu YKHuang JS: Idiopathic spinal epidural lipomatosis - two cases report and review of literature. Chang Gung Med J 32:6626672009

    • Search Google Scholar
    • Export Citation
  • 21

    Châtillon CEGuiot MCJacques L: Lipomatous, vascular, and chondromatous benign tumors of the peripheral nerves: representative cases and review of the literature. Neurosurg Focus 22:6E182007

    • Search Google Scholar
    • Export Citation
  • 22

    Chen PMassengill AMaklad NRoder E: Nerve territoryoriented macrodactyly: unusual cause of carpal tunnel syndrome. J Ultrasound Med 15:6616641996

    • Search Google Scholar
    • Export Citation
  • 23

    Cherqui ASulaiman WAKline DG: Resection and nerve grafting of a lipofibrohamartoma of the median nerve: case report. Neurosurgery 65:4 SupplA229A2352009

    • Search Google Scholar
    • Export Citation
  • 24

    Chiang CLTsai MYChen CK: MRI diagnosis of fibrolipomatous hamartoma of the median nerve and associated macrodystrophia lipomatosa. J Chin Med Assoc 73:4995022010

    • Search Google Scholar
    • Export Citation
  • 25

    Chiao HCMarks KEBauer TWPflanze W: Intraneural lipoma of the sciatic nerve. Clin Orthop Relat Res 221:2672711987

  • 26

    Choi MLWey PDBorah GL: Pediatric peripheral neuropathy in proteus syndrome. Ann Plast Surg 40:5285321998

  • 27

    De Maeseneer MJaovisidha SLenchik LWitte DSchweitzer MESartoris DJ: Fibrolipomatous hamartoma: MR imaging findings. Skeletal Radiol 26:1551601997

    • Search Google Scholar
    • Export Citation
  • 28

    Dominici FGinanneschi FSpidalieri RRossi A: Multiple arm lipomatosis and posterior interosseus nerve palsy. Electromyogr Clin Neurophysiol 48:3733762008

    • Search Google Scholar
    • Export Citation
  • 29

    Fandridis EMKiriako ASSpyridonos SGDelibasis GEBourlos DNGerostathopoulos NE: Lipomatosis of the sciatic nerve: report of a case and review of the literature. Microsurgery 29:66712009

    • Search Google Scholar
    • Export Citation
  • 30

    Fletcher CDMUnni KKMertens F: World Health Organization Classification of Tumours Pathology and Genetics: Tumors of Soft Tissue and Bone Lyon, FranceIARC Press2002

    • Search Google Scholar
    • Export Citation
  • 31

    Flores LPCarneiro JZ: Peripheral nerve compression secondary to adjacent lipomas. Surg Neurol 67:2582632007

  • 32

    Friedlander HLRosenberg NJGraubard DJ: Intraneural lipoma of the median nerve. Report of two cases and review of the literature. J Bone Joint Surg Am 51:3523621969

    • Search Google Scholar
    • Export Citation
  • 33

    Fritz TRSwischuk LE: Macrodystrophia lipomatosa extending into the upper abdomen. Pediatr Radiol 37:127512772007

  • 34

    Frykman GKWood VE: Peripheral nerve hamartoma with macrodactyly in the hand: report of three cases and review of the literature. J Hand Surg Am 3:3073121978

    • Search Google Scholar
    • Export Citation
  • 35

    Galeano MColonna MRisitano G: Ulnar tunnel syndrome secondary to lipoma of the hypothenar region. Ann Plast Surg 46:83842001

  • 36

    Gates LK JrKeate RFSmalley JJ JrRichardson JD: Macrodactylia fibrolipomatosis complicated by multiple small bowel lipomas and intussusception. J Clin Gastroenterol 23:2412421996

    • Search Google Scholar
    • Export Citation
  • 37

    Ghahremani MSchepler H: Lipofibromatous hamartoma of the digital nerve without macrodactyly: follow-up of an unusual case. Eur J Plast Surg 32:3013042009

    • Search Google Scholar
    • Export Citation
  • 38

    Godquin BBrunelli MBasso M: [Giant lipoma of the sciatic nerve (author's transl).]. Chirurgie 104:2212241978. (Fr)

  • 39

    Goldman ABKaye JJ: Macrodystrophia lipomatosa: radiographic diagnosis. AJR Am J Roentgenol 128:1011051977

  • 40

    Gouldesbrough DRKinny SJ: Lipofibromatous hamartoma of the ulnar nerve at the elbow: brief report. J Bone Joint Surg Br 71:3313321989

    • Search Google Scholar
    • Export Citation
  • 41

    Guthikonda MRengachary SSBalko MGvan Loveren H: Lipofibromatous hamartoma of the median nerve: case report with magnetic resonance imaging correlation. Neurosurgery 35:1271321994

    • Search Google Scholar
    • Export Citation
  • 42

    Hsu YCShih YYGao HWHuang GS: Subcutaneous lipoma compressing the common peroneal nerve and causing palsy: sonographic diagnosis. J Clin Ultrasound 38:97992010

    • Search Google Scholar
    • Export Citation
  • 43

    Hueston JTMillroy P: Macrodactyly associated with hamartoma of major peripheral nerves. Aust N Z J Surg 37:3943971968

  • 44

    Hustead APMulder DWMacCarty CS: Nontraumatic, progressive paralysis of the deep radial (posterior interosseous) nerve. AMA Arch Neurol Psychiatry 79:2692741958

    • Search Google Scholar
    • Export Citation
  • 45

    Jebson PJSchock EJBiermann JS: Intraosseous lipoma of the proximal radius with extraosseous extension and a secondary posterior interosseous nerve palsy. Am J Orthop 31:4134162002

    • Search Google Scholar
    • Export Citation
  • 46

    Jung SNYim YKwon H: Symmetric lipofibromatous hamartoma affecting digital nerves. Yonsei Med J 46:1691722005

  • 47

    Kenkare SAinapurapu B: Macrodactylia fibrolipomatosis presenting as a small bowel obstruction. South Med J 103:2482492010

  • 48

    Klein FASmith MJKasenetz I: Pelvic lipomatosis: 35-year experience. J Urol 139:99810011988

  • 49

    Louaste JZejjari HChkoura MHoumadi ARachid K: Carpal tunnel syndrome due to fibrolipomatous hamartoma of the median nerve. Hand (NY) 6:76792011

    • Search Google Scholar
    • Export Citation
  • 50

    Louis DNOhgaki HWiestler ODCavenee WK: World Health Organization Classification of Tumours of the Central Nervous System LyonIARC Press2007

    • Search Google Scholar
    • Export Citation
  • 51

    Marom EMHelms CA: Fibrolipomatous hamartoma: pathognomonic on MR imaging. Skeletal Radiol 28:2602641999

  • 52

    Mason ML: Tumors of the hand. Minn Med 37:6006071954

  • 53

    Matsubara MTanikawa HMogami YShibata SUchiyama SKato H: Carpal tunnel syndrome due to fibrolipomatous hamartoma of the median nerve in Klippel-Trénaunay syndrome. A case report. J Bone Joint Surg Am 91:122312272009

    • Search Google Scholar
    • Export Citation
  • 54

    Matsuo TSugita TShimose SKubo TYasunaga YOchi M: Intraneural lipoma of the posterior interosseous nerve. J Hand Surg Am 32:153015322007

    • Search Google Scholar
    • Export Citation
  • 55

    Mazziotti SSalamone IVinci SPandolfo A: Macrodactylia fibrolipomatosis associated with multiple small-bowel lipomas. AJR Am J Roentgenol 186:119511962006

    • Search Google Scholar
    • Export Citation
  • 56

    McFarland GB JrHoffer MM: Paralysis of the intrinsic muscles of the hand secondary to lipoma in Guyon's tunnel. J Bone Joint Surg Am 53:3753761971

    • Search Google Scholar
    • Export Citation
  • 57

    Meirer RHuemer GMShafighi MKamelger FSHussl HPiza-Katzer H: Sciatic nerve enlargement in the Klippel-Trenaunay-Weber syndrome. Br J Plast Surg 58:5655682005

    • Search Google Scholar
    • Export Citation
  • 58

    Meyer BURöricht S: Fibrolipomatous hamartoma of the proximal ulnar nerve associated with macrodactyly and macrodystrophia lipomatosa as an unusual cause of cubital tunnel syndrome. J Neurol Neurosurg Psychiatry 63:8088101997

    • Search Google Scholar
    • Export Citation
  • 59

    Meyer BURöricht SSchmitt R: Bilateral fibrolipomatous hamartoma of the median nerve with macrocheiria and late-onset nerve entrapment syndrome. Muscle Nerve 21:6566581998

    • Search Google Scholar
    • Export Citation
  • 60

    Morley GH: Intraneural lipoma of the median nerve in the carpal tunnel. Report of a case. J Bone Joint Surg Br 46:7347351964

  • 61

    Murphey MDSmith WSSmith SEKransdorf MJTemple HT: From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics 19:125312801999

    • Search Google Scholar
    • Export Citation
  • 62

    Park SELee JUJi JH: Intraneural chondroid lipoma on the common peroneal nerve. Knee Surg Sports Traumatol Arthrosc 19:8238242011

    • Search Google Scholar
    • Export Citation
  • 63

    Phalen GSKendrick JIRodriguez JM: Lipomas of the upper extremity. A series of fifteen tumors in the hand and wrist and six tumors causing nerve compression. Am J Surg 121:2983061971

    • Search Google Scholar
    • Export Citation
  • 64

    Price AJCompson JPCalonje E: Fibrolipomatous hamartoma of nerve arising in the brachial plexus. J Hand Surg Br 20:16181995

  • 65

    Rau CSHsieh CHLiu YWWang LYCheng MH: Meralgia paresthetica secondary to lipoma. Case report. J Neurosurg Spine 12:1031052010

    • Search Google Scholar
    • Export Citation
  • 66

    Rawlings CE IIIBullard DECaldwell DS: Peripheral nerve entrapment due to steroid-induced lipomatosis of the popliteal fossa. Case report. J Neurosurg 64:6666681986

    • Search Google Scholar
    • Export Citation
  • 67

    Resende LASilva MDKimaid PASchiavão VZanini MAFaleiros AT: Compression of the peripheral branches of the sciatic nerve by lipoma. Electromyogr Clin Neurophysiol 37:2512551997

    • Search Google Scholar
    • Export Citation
  • 68

    Rodriguez FJErickson-Johnson MRScheithauer BWSpinner RJOliveira AM: HMGA2 rearrangements are rare in benign lipomatous lesions of the nervous system. Acta Neuropathol 116:3373382008

    • Search Google Scholar
    • Export Citation
  • 69

    Romero-Ortega MIEzaki M: Nerve pathology in unregulated limb growth. J Bone Joint Surg Am 91:Suppl 453572009

  • 70

    Ruppert VFriedel RMentzel TMarkgraf E: [Fibrolipomatous hamartoma of the nerve—a rare etiology of macrodactyly. A case report.]. Handchir Mikrochir Plast Chir 31:53561999. (Ger)

    • Search Google Scholar
    • Export Citation
  • 71

    Rusko RALarsen RD: Intraneural lipoma of the median nerve—case report and literature review. J Hand Surg Am 6:3883911981

  • 72

    Sabapathy SRLanger VBhatnagar A: Intraneural lipoma associated with a branch of the superficial peroneal nerve. J Foot Ankle Surg 47:5765782008

    • Search Google Scholar
    • Export Citation
  • 73

    Salon AGuero SGlicenstein J: [Fibrolipoma of the median nerve. Review of 10 surgically treated cases with a mean recall of 8 years.]. Ann Chir Main Memb Super 14:2842951995. (Fr)

    • Search Google Scholar
    • Export Citation
  • 74

    Scheithauer BWWoodruff JMErlandson RAThe normal peripheral nervous system (chapter 2). Rosai JSobin LH: Atlas of Tumor Pathology-Tumors of Peripheral Nervous System Third Series Fascicle 24 WashingtonArmed Forces Institute of Pathology1999. 728

    • Search Google Scholar
    • Export Citation
  • 75

    Silverman TAEnzinger FM: Fibrolipomatous hamartoma of nerve. A clinicopathologic analysis of 26 cases. Am J Surg Pathol 9:7141985

    • Search Google Scholar
    • Export Citation
  • 76

    Sotos JF: Overgrowth. Section VI. Genetic syndromes and other disorders associated with overgrowth. Clin Pediatr (Phila) 36:1571701997

    • Search Google Scholar
    • Export Citation
  • 77

    Sunderland S: The adipose tissue of peripheral nerves. Brain 68:1181221945

  • 78

    Terrence Jose Jerome J: Superficial peroneal nerve lipoma. Rom J Morphol Embryol 50:1371392009

  • 79

    Terzis JKDaniel RKWilliams HBSpencer PS: Benign fatty tumors of the peripheral nerves. Ann Plast Surg 1:1932161978

  • 80

    Toms APAnastakis DBleakney RRMarshall TJ: Lipofibromatous hamartoma of the upper extremity: a review of the radiologic findings for 15 patients. AJR Am J Roentgenol 186:8058112006

    • Search Google Scholar
    • Export Citation
  • 81

    Valbuena SEO'Toole GARoulot E: Compression of the median nerve in the proximal forearm by a giant lipoma: a case report. J Brachial Plex Peripher Nerve Inj 3:172008

    • Search Google Scholar
    • Export Citation
  • 82

    Van Breuseghem ISciot RPans SGeusens EBrys PDe Wever I: Fibrolipomatous hamartoma in the foot: atypical MR imaging findings. Skeletal Radiol 32:6516552003

    • Search Google Scholar
    • Export Citation
  • 83

    Watson-Jones R: Encapsulated lipoma of the median nerve at the wrist. J Bone Joint Surg Br 46:7367371964

  • 84

    White WLHanna DC: Troublesome lipomata of the upper extremity. J Bone Joint Surg Am 44-A:135313591962

  • 85

    Wong BZAmrami KKWenger DEDyck PJScheithauer BWSpinner RJ: Lipomatosis of the sciatic nerve: typical and atypical MRI features. Skeletal Radiol 35:1801842006

    • Search Google Scholar
    • Export Citation
  • 86

    Zahrawi F: Acute compression ulnar neuropathy at Guyon's canal resulting from lipoma. J Hand Surg Am 9:2382391984

  • 87

    Zhang HErickson-Johnson MWang XOliveira JLNascimento AGSim FH: Molecular testing for lipomatous tumors: critical analysis and test recommendations based on the analysis of 405 extremity-based tumors. Am J Surg Pathol 34:130413112010

    • Search Google Scholar
    • Export Citation

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 287 287 22
Full Text Views 315 274 0
PDF Downloads 87 81 0
EPUB Downloads 0 0 0

PubMed

Google Scholar