Angiomyoma (vascular leiomyoma) of the median nerve

Abstract

An 84-year-old left-handed man was referred for evaluation with an asymptomatic left anterior wrist mass. A diagnosis of an anterior wrist ganglion had been made and an aspiration had been performed. The fluid was serosanguineous, and the cell count, differential, Cytology, and culture did not reveal an infectious or malignant process. He also had failed to respond to a corticosteroid injection. When evaluated by us, a nontender 3 x 2 cm mass located just proximal to the distal wrist crease on the ulnar side of the palmaris longus tendon was found. The mass was firm and not fixed to the skin or underlying tissue. The mass did not transilluminate. The remainder of the examination and x-ray films were normal, without signs of a compression neuropathy of the median nerve. Surgical exploration for diagnosis and treatment was performed. Exploration revealed a 2.5 x 1 .5x 1.0 cm lobulated, firm, seemingly encapsulated intraneural tumor that caused the fascicles of the median nerve to disperse around the lesion (Fig. 1). Using loupe magnification and the operating microscope, the mass was entirely excised from the fascicles without injuring them. The patient's recovery was uncomplicated; twopoint discrimination and motor strength were normal. There has not been any recurrence at 2 years after surgery.