Deep palmar space lipoma: Case report and review of the literature

Background: Although lipoma is the commonest benign tumour in the body, it is rarely found in the hand. Subcutaneous lipomas have characteristic distinguishing features which place them among the most easily diagnosed cutaneous lesions. However, the diagnosis of deep lipomas of the hand are often missed because of the rarity of the condition and the inelastic aponeurosis of the hand which obscures the usually commonly distinguishing features of lipoma.
Case presentation: We present the case of a 55 year old right hand dominant woman who had an 18 month history of painless swelling on the right hand. The physical examination and plain radiograph were uncharacteristic and it was difficult making a definitive diagnosis. With a presumptive assessment of right palmar soft tissue swelling, an excision biopsy was planned which revealed a lipomatous mass diagnosed as right palmar lipoma on histology.
Conclusion: The rarity of lipoma of the hand makes the clinical preoperative diagnosis challenging. A high index of suspicion along with the use of appropriate imaging techniques such as magnetic resonance imaging becomes critical in the pre-operative diagnosis and management of deep lipoma of the hand.