Byeon Je Yeon, Hwang Yong Seon, Lee Ji Hye, Choi Hwan Jun
Plastic and Reconstructive Surgery, Soonchunhyang University Hospital, Cheonan-si 31151, South Korea.
Department of Pathology, Soonchunhyang University Hospital, Cheonan-si 31151, South Korea.
World J Clin Cases. 2023 Jan 26;11(3):684-691. doi: 10.12998/wjcc.v11.i3.684.
This report describes and discusses recurrent intramuscular lipoma (IML) of the extensor pollicis brevis (EPB). An IML usually occurs in a large muscle of the limb or torso. Recurrence of IML is rare. Recurrent IMLs, especially those with unclear boundaries, necessitate complete excision. Several cases of IML in the hand have been reported. However, recurrent IML appearing along the muscle and tendon of EPB on wrist and forearm has not been reported yet.
In this report, the authors describe clinical and histopathological features of recurrent IML at EPB. A 42-year-old Asian woman presented with a slow-growing lump in her right forearm and wrist area six months ago. The patient had a history of surgery for a lipoma of the right forearm one year ago with a scar of 6 cm on the right forearm. magnetic resonance imaging confirmed that the lipomatous mass, which had attenuation similar to subcutaneous fat, had invaded the muscle layer of EPB. Excision and biopsy were performed under general anesthesia. On histological examination, it was identified as an IML showing mature adipocytes and skeletal muscle fibers. Therefore, surgery was terminated without further resection. No recurrence occurred during a follow-up of five years after surgery.
Recurrent IML in the wrist must be examined to differentiate it from sarcoma. Damage to surrounding tissues should be minimized during excision.
本报告描述并讨论拇短伸肌（EPB）复发性肌内脂肪瘤（IML）。IML通常发生于四肢或躯干的大肌肉中。IML复发罕见。复发性IML，尤其是边界不清者，需要完整切除。手部IML的病例已有报道。然而，腕部和前臂沿EPB肌肉和肌腱出现的复发性IML尚未见报道。
在本报告中，作者描述了EPB复发性IML的临床和组织病理学特征。一名42岁亚洲女性6个月前出现右前臂和腕部区域缓慢生长的肿块。该患者1年前有右前臂脂肪瘤手术史，右前臂有6 cm瘢痕。磁共振成像证实，该脂肪瘤样肿块的衰减与皮下脂肪相似，已侵犯EPB肌层。在全身麻醉下进行切除和活检。组织学检查显示为IML，可见成熟脂肪细胞和骨骼肌纤维。因此，手术未进一步切除即终止。术后5年随访期间未复发。
腕部复发性IML必须进行检查以与肉瘤相鉴别。切除时应尽量减少对周围组织的损伤。
