Lipoma: radial nerve compression a purpose of a case

Abstract

Lipomas are frequent tumors of slow growth and asymptomatic. Within the classification of heterotopic benign lipomas are intramuscular or intermuscular, quite infrequent and large that predominate in men and are located in the trunk, thighs and shoulder joint. More infrequently, they appear in the upper extremities and when they grow around the nerves they cause compression with paresthesia and pain. Differential diagnosis with sarcomas is difficult both in their physical characteristics and in imaging studies.

The objective of our work is to review our experience regarding a case treated in the Orthopedics and Traumatology Service of the Hospital Nacional de Clínicas, relating it to those presented in other publications.

Case:

58-year-old female patient consults for pain and functional impotence. She refers at the level of the left arm a tumor that originated three years ago, without a clinic. Subsequently, it presents a progressive increase in size with paraesthesia and loss of limb strength.

Physical examination; Tumor that occupies two thirds of the outer face of the left arm, soft, depressible, without pain on palpation, sensitivity and temperature preserved, loss of muscle strength with contralateral limb.

MRI reports intramuscular lipoma of 65 mm anteroposterior by 45 mm transverse and 108 mm cephalocaudal of lobed edges with fine linear images inside.

Incisional biopsy is requested that fails to rule out cellular atypia. Exeresis indicated. During the procedure the radial nerve was wrapped inside the aponeurosis of the lipoma at the level of the lower third of the limb. He proceeded to a careful release. It was laterally retracted, separated from deep planes and bone tissue. Complete piece of lipoma was removed that measured 16 cm cephalocaudal by 9 cm transverse.

Post-operative patient presents mobility and conserved limb sensitivity. Pain and mild paraesthesia.

Conclusion:

The study of this case allowed us to verify that most of the lipomas treated surgically correspond to benign tumors of great growth; as in our experience the results of the pathological anatomy confirmed it. Post-surgical complications were similar to those observed in existing publications.