Neural fibrolipoma without macrodactyly: a subcutaneous rare benign tumor

Neural fibrolipoma, also known as lipofibromatous hamartoma of nerves and neurolipomatosis, is a rare subcutaneous benign lesion involving the upper extremity with a marked predilection for median nerve. In one-third of the cases, it is associated with macrodactyly (enlargement of one or several digits of hands or feet), diminished sensation, paraesthesias and compression neuropathy. A 23-year-old male presented with a gradually increasing mass in the right palm without associated macrodactyly or neurodeficit. The surgical specimen showed a 20 x 18 x 3 cm, grey yellow fusiform mass. Cut section revealed presence of fibrofatty tissue within and around the enlarged nerve. Microscopy established the relation of nerve enlargement to infiltration of epineurium and perineurium by fibroadipose tissue separating normal nerve fascicles. Limited excision was the mainstay of conservative treatment. Neural fibrolipomas are a rare entity. Knowledge of characteristic histological and radiological findings is necessary for diagnosis and treatment.