Lipofibromatous Hamartoma of the Median Nerve in a Patient With Recurrent Disease and Preserved Neurological Function: A Case Report

Lipofibromatous hamartoma (LFH) is a rare benign tumor typically characterized by fibrofatty infiltration and proliferation within nerve fascicles, often having a predilection for the median and ulnar nerves. In this case, a 53-year-old woman presented with a painful mass of the left distal forearm that had been present for several years. She had intermittent tingling of the thumb, index, and middle fingers, and a limited range of motion (ROM) in wrist flexion and extension. The percussion test was positive, and magnetic resonance imaging (MRI) revealed a 3 cm lobulated lesion along the ulnar aspect of the flexor carpi radialis tendon. The patient underwent carpal tunnel release and incisional biopsy. Histopathologic examination demonstrated fibroadipose tissue with scattered nerve fibers consistent with LFH. This patient’s presentation reflects the considerable clinical heterogeneity reported in LFH. A lack of macrodactyly alongside preserved sensory function and reduced ROM exemplifies the unique characteristics of this specific case. The patient had undergone two previous surgical excisions at 18 and 25 years of age, illustrating the challenges associated with the management of this lesion. Operative records from the prior procedure were unavailable. The patient was followed for 11 weeks postoperatively, leading to difficulty in tracking the progression of the lesion. This case underscores the importance of individualized management strategies that balance symptom relief with preservation of nerve function.