Intraneural Lipoma of the Ulnar Nerve at Wrist-A Case Report

腕部尺神經內脂肪瘤－一案例報告及文獻回顧

Hsiang-Wei Hu(胡湘微) ； Shyh-Jou Shieh(謝式洲)

《臺灣整形外科醫學會雜誌》 31卷4期 (2022/12) Pp. 288-295

摘要

Background: Intraneural lipoma (INL) was reported in arm, wrist and hand as rare benign neoplasms. INLs can be mostly enucleated by interfascicular dissection without damaging to the surrounding nerve fibers and structures. Aims and Objectives: We review literature on clinical presentation, distinguishing imaging features, surgical concerns and functional outcome regarding this unique tumor. Materials and Methods: In this article, we presented a 46-year-old male patient with intraneural lipoma of the ulnar nerve at wrist without compression neuropathy. Complete enucleation of the mass was performed without damage to the neighboring neurovascular bundle. Results: Patient recovered with good ulnar nerve function without complication of ulnar neuropathy 3 month post-operatively. Conclusion: Lipomas are the most common soft tissue tumor found in trunk but intraneural involvement of peripheral nerves are rare. Although some may present with clinical neuropathy or motor disturbance through ulnar nerve compression, patients could also be asymptomatic. Clinical symptom along with the help of image tool such as sonography, CT scan and MRI are to confirm the diagnosis and surgical planning. Surgical treatment involves meticulous interfascicular dissection with complete enucleation of the mass. We reported a rare case of intraneural lipoma of ulnar nerve at the wrist.

關鍵字

intraneural lipoma ； ulnar nerve

並列摘要

背景：神經內脂肪瘤是一種罕見良性、且常於肢部及手部發現的腫瘤。這種腫瘤可以透過細膩的神經束間分割及不傷害神經血管的情況下完整切除。目的及目標：神經內脂肪瘤的臨床症狀、術前影像學對於術前用來診斷腕部腫瘤和區分其他病灶以及手術前的計畫都是重要的。材料及方法：本文報告一位46歲男性診斷為無神經壓迫症狀的腕部尺神經內脂肪瘤。經由手術完整切處腫瘤後並無傷及周遭神經或血管。結果：病人於術後恢復良好，持續三個月的追蹤並沒有出現尺神經病變症狀。結論：脂肪瘤是在軀幹和身體肢部中最常見的軟組織腫瘤，但是涉及於神經的個案則相對罕見。臨床上有些病人會出現一些神經壓迫的神經學及肌力改變的症狀，但有些病人則是以無症狀、單純摸到腫塊來表現。影像診斷如超音波、電腦斷層以及核磁共振可以幫助鑑別診斷不同的軟組織腫瘤並且擬定手術計畫。本文報告一個罕見的腕部尺神經內脂肪瘤的手術處理經驗。