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Year : 2005  |  Volume : 15  |  Issue : 4  |  Page : 535-536
Cervico-Mediastinal neural fibrolipoma : Spiral Ct features


Government Medical college, Nagpur, India

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Keywords: Neural fibrolipoma, Computed tomography

How to cite this article:
Taori K, Gyanchandani M, Rohatgi S, Ghonge N, Solanke R. Cervico-Mediastinal neural fibrolipoma : Spiral Ct features. Indian J Radiol Imaging 2005;15:535-6

How to cite this URL:
Taori K, Gyanchandani M, Rohatgi S, Ghonge N, Solanke R. Cervico-Mediastinal neural fibrolipoma : Spiral Ct features. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Aug 9];15:535-6. Available from: http://www.ijri.org/text.asp?2005/15/4/535/28791

   Introduction Top


Neural fibrolipoma is a rare lesion appearing in early childhood, as a slowly growing fusiform swelling of a nerve, usually in the forearm or wrist (median nerve), associated with symptoms of compression neuropathy. Treatment is usually difficult and excision inevitably leads to neurologic deficit. We hereby report a rare case of cervico-mediastinal neural fibrolipoma involving the brachial plexus.


   Case report Top


A seven years old male child presented with a large fluctuant painless swelling in the neck region (left posterior triangle), since last two months. There was no neurological deficit. Plain radiographs of neck revealed a soft tissue density lesion on left side of neck with deviation of trachea to right side with diastasis of left sternoclavicular joint. CT study of neck and thorax showed a lobulated cervico-mediastinal mass lesion [Figure - 1] with negative CT attenuation (-150HU to -20HU) and few areas of soft tissue attenuation (30HU to 50HU) within it. Left internal jugular vein was displaced laterally and left common carotid artery was displaced anteriorly [Figure - 2]. The lesion extended from the level of thyroid cartilage upwards into the superior part of anterior mediastinum upto the level of aortic arch [Figure - 3]. The lesion also extended into the prevertebral space posteriorly and was found to have a small epidural component [Figure - 4]a,b. The vertebral body, pedicles and the transverse processes of C6 vertebrae were scalloped and the neural foramen between C5-C6 vertebrae was widened [Figure - 4]a. The diagnosis of a benign fatty tumor close to the neural elements was kept. Intra-operatively the lesion was found attached to the prevertebral fascia and brachial plexus. The lesion was excised completely and was sent for histopathology.

Patient developed ptosis of left eye with meiosis (Horner's syndrome) on the second post-operative day. Histopathology examination revealed abundant fat tissue with fibrous and neural element [Figure - 5]. Thus, the diagnosis of neural fibrolipoma was established.


   Discussion Top


Neural fibrolipoma is a rare tumor involving principally the volar aspect of hands wrist and forearm of young persons [1]. It usually manifests as a slow growing mass consisting of proliferating fibro-fatty tissue surrounding and infiltrating major nerves and their branches. Almost always, the lesion is seen during the first three decades of life and usually presents with pain, tenderness or diminished sensation. The median nerve is affected in great majority of cases [2]. Very rarely the lesion is found in other nerves such as ulnar or the nerves of toes [3]. To the best of our knowledge, only one case of cervico-mediastinal neural fibrolipoma involving the brachial plexus has been reported, till now [4]. There is no effective treatment of neural fibrolipoma. Complete excision is not feasible as it usually leads to neurological deficit.

Until now, CT features, characteristic of neural fibrolipoma were not described in the literature and it was difficult to make a pre-operative diagnosis. We hereby tend to describe the CT features of neural fibrolipoma based on the prospective and retrospective analysis of the CT images in this case. Cervico-mediastinal neural fibrolipoma presents as a lobulated mass lesion with negative CT attenuation and few areas of soft tissue attenuation within it. The lesion should have a posterior extension in the pre-vertebral space, and a small epidural component is a feature that further points towards the diagnosis. This proximity of the lesion to the neural foramina may suggest the possible origin of neural fibrolipoma in or around the neural foramina only. The widening of neural foramina is not as prominent as seen in the nerve-sheath tumor, possibly due to the soft fluctuant contents of the tumor. It may cause scalloping of the adjacent vertebral body and transverse process due to slow and gradual increase in the tumor bulk. Presence of multiple small rounded lucencies in the periphery of the lesion may suggest the engulfed and encased nerve roots, which may or may not be demonstrated on CT. Thus, the pre-operative CT diagnosis of cervico-mediastinal neural fibrolipoma warrants against the over-enthusiastic approach during the tumor excision and may avoid post-operative neurological deficit.

 
   References Top

1.Kronberger P, Rainer C, Hittmair A, Anderl H. Lipofibromatous hamartoma (neural fibrolipoma) of a flexor nerve of the index finger. Scand J Plast Reconstr Surg Hand Surg. 1998 Jun; 32(2): 237-9  Back to cited text no. 1    
2.Berry MG, Mallucci P, Banwell PE, Heywood AJ. Fibrolipoma of the median nerve. J R Soc Med. 1999 Aug; 92(8): 408-9.  Back to cited text no. 2    
3.Donley BG, Neel M, Mitias HM. Neural fibrolipoma of the foot: a case report. Foot Ankle Int. 1996 Nov; 17(11): 712-3.  Back to cited text no. 3    
4.Thornton MA, O'Leary G, Fitzgibbon J. Neural fibrolipoma: an unusual Case. J Laryngol Otol. 2000 Mar; 114(3): 231-2.   Back to cited text no. 4    

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Correspondence Address:
K Taori
Dept. Of Radio-Diagnosis, Govt. Medical College, Nagpur (M.S.). 440003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.28791

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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[Pubmed]



 

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    Introduction
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