Atypical swelling in the hand: Lipofibromatous hamartoma of the median nerve

Lipofibromatous hamartoma (LFH) is a rare, slow-growing, benign fibro-fatty tumor of peripheral nerves, most commonly affecting the median nerve and its digital branches. This entity is characterized by fibro-adipose proliferation within the epineurium and perineurium. Patients typically present with numbness, paresthesia, and, in advanced cases, motor deficits or features of carpal tunnel syndrome. This report describes a case of a 23-year-old patient presenting with a palpable mass and progressive sensory disturbances along the median nerve. Ultrasound and magnetic resonance imaging (MRI) were done, which demonstrated fusiform thickening of the median nerve with fibro-adipose tissue interspersed among the nerve fascicles. MRI facilitated preoperative diagnosis and surgical planning. The patient underwent nerve decompression and excision of the lesion, with histopathology confirming LFH. This case emphasizes the importance of MRI in diagnosis and surgical management and highlights the need for individualized treatment strategies in this rare condition.