Giant Palmar Lipoma: A Rare Presentation

Lipomas are common tumors that arise from mesenchymal fibrofatty tissue. They are the single most common soft tissue tumor1 and can involve any part of the body. The most common clinical presentation is a gradually progressive, soft and nontender mass. However, their presentation in the hand is infrequent. 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. We present a case report of a massive painless lipoma of the deep palmar space. A 55 year old housewife presented with a one year history of an almost painless swelling over her right palm. She first noticed the swelling in the central aspect of her palm which gradually increased in size and over a period of one year, it has attained its present size. She had occasional pain while doing her daily activities and difficulty in holding any object. She had no tingling sensation or numbness over the palm or the fingers. On clinical examination, the swelling started from the wrist crease and involved both the thenar and the hypothenar region, extending up to the distal palmar crease (Figure 1). It also encroached into the first web space. On palpating the swelling, it was non-tender, soft and non-compressible with illdefined margins and smooth surface. Patient was able to flex and extend her fingers and thumb without any restriction and there was no sensory loss. She already had a high resolution ultrasonography done for her swelling which was suggestive of lipoma. Our patient was poor and could not afford MRI scan. Hence, based on the clinical and radiological examination, we made a provisional diagnosis of lipoma and an excisional biopsy was planned. 1. Department of Plastic and Reconstructive Surgery, AIIMS PATNA, Phulwarisharif, Patna, Bihar, India; 2. Department of Plastic and Reconstructive Surgery, King George Medical University, Lucknow, Uttar Pradesh, India