Pagonis et al. Journal of Medical Case Reports 2011, 5:552 http://www.jmedicalcasereports.com/content/5/1/552 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Complications arising from a misdiagnosed giant lipoma of the hand and palm: a case report Thomas Pagonis*, Panagiotis Givissis and Anastasios Christodoulou Abstract Introduction: Lipomas are benign tumors which may appear in almost any human organ. Their diagnosis rate in the hand region is not known. Case Presentation: We present the case of a 63-year-old Greek Caucasian woman with a giant lipoma of the hand and palm which was not initially diagnosed. After repeated surgical decompression of the carpal tunnel the patient was referred with persisting symptoms of median and ulnar nerve compression and a prominent mass of her left palm and thenar eminence. Clinical examination, magnetic resonance imaging, nerve conduction study and biopsy, revealed a giant lipoma in the deep palmar space (8.0 × 4.0 × 3.75 cm), which was also infiltrating the carpal tunnel. She had already undergone two operations for carpal tunnel syndrome with no relief of her symptoms and she also ended up with a severed flexor pollicis longus tendon. Definitive treatment was performed by marginal resection of the lipoma and restoration of the flexor pollicis longus with an intercalated graft harvested from the palmaris longus. Thirty months after surgery the patient had a fully functional hand without any neurological deficit. Conclusion: Not all lipomas of the wrist and hand are diagnosed. Our report tries to emphasize the hidden danger of lipomas in cases with carpal tunnel symptoms. The need for a high index of suspicion in conjunction with good clinical evaluation and the use of appropriate investigative studies is mandatory in order to avoid unnecessary operations and complications. Marginal excision of these tumors is restorative. Introduction Lipomas are the single most common soft tissue tumor [1]. However, their presentation in the hand is infre- quent. Some lipomas can grow considerably and their presence in the hand is associated with a variety of symptoms. Giant lipomas exhibit a size of more than 5 cm. In this anatomical location they may cause a multi- tude of symptoms due to local compression of the sur- rounding tissues [2,3]. Grasping activities can be compromised due to the lipoma’s considerable size. Lipomas, however, may present as liposarcomas, which are the most common soft tissue sarcomas. Their largest subgroup is the well-differentiated liposarcomas, which account for 40% of cases and require a different thera- peutic approach. We report the case of a patient with a giant lipoma of the deep palmar space that was misdiag- nosed and mistreated leading to severe complications. * Correspondence: iatros1@yahoo.com 1st Orthopedic Department of Aristotle’s University of Thessaloniki, General University Hospital ‘Georgios Papanikolaou’, Thessaloniki, Greece We emphasize the need for marginal surgical removal due to complications from the lipoma’s occupation of palmar space that created subsequent nerve compres- sion symptoms. These misdiagnosed symptoms origin- ally led the first treating physicians to a false diagnosis of a regular carpal tunnel syndrome with two unsuccess- ful surgical decompressions further complicated by a severed flexor pollicis longus tendon. Case Presentation A 63-year-old Greek Caucasian woman was referred with symptoms of median and ulnar nerve compression and a prominent mass on her left palm and thenar emi- nence to the outpatient clinic of our upper limb and hand surgery unit. She already had had two operations for carpal tunnel release within the last three years in another hospital and despite that, her situation had worsened. Physical examination revealed a soft tissue mass which was slightly tender on palpation, with a diminished © 2011 Pagonis et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.