Lipofibroma of the median nerve or its cutaneous branches is a rare
benign tumor. The diagnosis is usually made at surgical exploration of a
mass in the distal part of the forearm, the wrist, the palm, or the digits
of the hand, which may be asymptomatic or associated with symptoms of
carpal-tunnel syndrome. The diagnosis should be made when exploration
reveals fusiform enlargement of a segment of the median nerve or its
cutaneous branches without hypertrophy of the regional tissues. The tumor
is limited to within the epineurial sheath, which is intact, shiny,
orange-yellow, firm, thick, and non-resilient to dissection. The nerve
tumor does not infiltrate the surrounding tissues nor do the surrounding
tissues infiltrate the nerve. If the epineurium is opened, the nerve fibers
are found to be inseparably infiltrated by fibrous and fatty tissues.
Histologically, these are of epineurial, perineurial, and endoneurial
origin. A forzen-section biopsy of a palmar cutaneous branch is suggested
to confirm the diagnosis. Once the diagnosis is confirmed, the treatment
should be limited to release of the fascia over the involved nerve. The
tumorous part of the median nerve was partly or completely excised in seven
of twenty-six cases reviewed in the literature and this report. It is to
emphasize a conservative approach when such a tumor of the median nerve is
encountered at surgery that we describe two more cases.