Free Paper HASTOMO Juara 1

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Lipofbromatous Hamartoma with

Macrodactyly o Third Digit Let Handin Soeharso Orthopaedic HospitalSurakarta

A Case Report

Hastomo Agung Tito Sumarwoto



CASE



!ase

• Female (student) 14 y.o with macrodactyly of

the third digit left hand since born

• Complained of clumsiness, tingling and her

third digit gradually increased in last 6 months• No history of trauma, no family history



Local Status "#

rd

digit$! ocali"ed gigantism

#eddish colour at distal partF! $oft mass, mobile,

%enderness (&)

'ipoesthesia () at distal part! #* still normal



Assesmentacrodactyly of third digit left hand,

suspect associated with +ascular malformation

%lan

lain -&rayC%&$can with contrast





Assesment &&acrodactyly of third digit left hand, suspect

associated with macrodystrophia lipomatous

%lan

$urgery



ig&"ag incision, we found yellow and cordli/e mass(16 cm in length, 0 mm in diameter) that

surrounded and enlarged by fibrofatty tissue

2e do the debul/ing procedure

&ntra'Operati(e



icrophotograph shows fibroadipose tissue around the lession(hematoxylin-eosin,original magnification 100x & 50x)



%ost'operati(e !are

• 3nalgetic antibiotic intra+enous treatment

(1st day post&op)

• #outine medication e+ery 45 hours, and

remo+ing suture after 14 days post&op

• 3cti+e #* e-ercise after second day post&op



# Months %ost'op)esults*

– decrease of the mass si"e

– motoric function and range of motion of the thirdfingger was normal

– returned to normal acti+ity 0 wee/s after surgery

–sensoric deficit of third fingger





DISCUSSION



Macrodatyly

Green's Operative Han !"rgery, #th e



Lipofbromatous Hamartoma

• 3 rare, fibrofatty benign tumor comprised of

proliferation of mature adipoctyes, mostly within

peripheral ner+es forming a palpable mass• 170 of cases associated with macrodactyly

• 8!1 female to male ratio, within first three decade

• %hought to be congenital or de+elopmental in origin



Lipofbromatous Hamartoma

• %he mass is usually slow&growing and may cause

ner+e compression sensory change, pain and

loss of motor function

• 9ifferential diagnosis! +ascular malformations,traumatic neuroma, ganglion cysts and lipomas

• Only rarely is the correct

diagnosis made preoperatively

$merican %o"rnal of Orthopaeics 00



Histologic +indings:iopsy has been needed as the standard approach

to establish the diagnosis

icrophotograph of the e"l*e lipofiromato"s hamartoma,

sho+s firoaipose tiss"e et+een nerve fascicles

Green's Operative Han !"rgery, #th e



Treatment

• )elated to macrodactyly debulking(s no treatment "contro(ersial$

• Mostly consider waiting tumorbecome symptomatic or cosmeticproblem

•Debulking

can impro(e unctionaloutcome but sensibility defcit ",$



!onclussion

• A rare case and preoperati(e diagnosis isdi-cult

• Our treatment is to do debulking

procedurewith consideration* symptomatic masswith cosmetic problem

• )esults* decrease the mass si.e normalmotoric unction and )OM ne(erthelesssensoric defcit according ner(edistribution



Thank /ou Thank /ou

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