Extensive Interosseous Lipoma of the Hand - A Rare Case Report

發於手掌之廣泛性骨間脂肪瘤之－罕見個案報告

李京軒(Jing-Syuan Lee) ； 謝式洲(Shyh-Jou Shieh)

《臺灣整形外科醫學會雜誌》 26卷2期 (2017/06) Pp. 238-246

摘要

Background: Although lipoma is a common benign tumor, the location determines the difficulty in excising the tumor. Especially in the hand, the delicate structure and the importance of hand function render the tumor within very challenging for surgeons to remove. Aim and Objectives This report presents an extensively distributed palmar interosseous lipoma. The complete excision with excellent post-operative hand-function recovery is described. Materials and Methods A 64-year-old woman had a palmar lipoma in the left hand. A preoperative computed tomography study revealed the extensive distribution of the lesion. Complete excision of the lesion was performed; meanwhile, adjacent vital structures were well persevered. Excellent functional and cosmetic results were observed at the one-year follow-up. Conclusions Palmar interosseous lipoma has subtle clinical presentation. Accordingly, advanced image study is recommended to reveal important information about the tumor and adjacent structures. Surgeons are suggested to be mindful of the lesion characteristics for the proper perioperative management. Complete excision of the lesion with preservation of all vital structures is important for achieving a good functional outcome.

關鍵字

interosseous lipoma ； palmar lipoma

並列摘要

背景：脂肪瘤是常見之良性腫瘤。處理脂肪瘤的困難程度往往取決於所在位置。特別是在手部，許多精細且重要的構造在此，加上考量手術可能對於手部功能的影響，讓位於手部侵犯廣泛範圍及深部的脂肪瘤對整形外科醫師而言是一個挑戰。目的及目標：透過這個案了解手掌骨間脂肪瘤之型態與分佈，以及如何透過審慎的術前檢查及評估進行完整之切除，最終達到良好的復原狀況。材料及方法：一位64歲的女性被診斷有手掌脂肪瘤，然而其外觀並不明顯。但術前電腦斷層檢查發覺其腫瘤卻廣泛性的分佈在手掌內，並且從骨間往手掌側及手背側分佈。在全身麻醉的狀況下，腫瘤得以被完整的切除，在此同時周邊的神經血管肌腱也都被妥善的保留下來。長時間的追蹤結果也展現了良好的復原狀況。結論：手掌骨間脂肪瘤有著不明顯的臨床表現，透過現今影像學檢查能夠提供足夠的訊息，讓我們可以在術前了解腫瘤位置及其周邊構造。外科醫師應謹記這腫瘤的分佈特色，才能在下次再遇到這樣病患時能夠審慎的評估與安排治療。