Accurate diagnostic algorithm for patients with rare pathology of thenar intramuscular lipomas

Abstract

Intramuscular lipomas which are classified as the subgroup of infiltrative lipomas histologically, are seen rare in the hand. They often localized at the thenar eminence when they do occur in the hand. In such locations, lipomas must differentiate from ganglion cysts which is the most common hand mass. They may cause certain complications due to median nerve entrapment as ganglion cysts. Magnetic resonance imaging and histopathologic investigation are the most effective and reliable methods of confirming the diagnosis. Five patients with the symptoms of mild thumb pain, numbness in the radially innervated digits of hand, and difficulty while gripping objects were included in this study. Radiological assessment included plain radiography, ultrasonography (USG), magnetic resonance imaging (MRI) and electromyography (EMG). Excisional biopsy for all masses within marginal borders were performed. Pathological results revealed intramuscular lipomas. All symptoms were disappeared after excision of the masses. No recurrence and complication was observed at final follow-ups. Intramuscular lipomas are benign lesions with an excellent prognosis after adequate excisions and after clinical suspicious, algorithmic imaging approach in diagnosis can be used by any physician easily as we mentioned in the study.