title: Fibrolipomatous hamartoma of the median nerve: A cause of acute bilateral carpal tunnel syndrome in a three-year-old child: A case report and comprehensive literature review.
abstract: A three-year-old boy was investigated for inexplicable incessant crying. On examination, his left wrist was mildly swollen (three to four months) and sensitive. Exploration and carpal tunnel decompression of the left wrist with incisional biopsy was performed for the presence of a fusiform swelling intimately associated with the median nerve. Histopathology revealed the presence of enlarged nerve bundles admixed with mature fat cells and diffuse fibroblastic proliferation. Three months later, he underwent urgent contralateral carpal tunnel decompression for a similar presentation. The final diagnosis was bilateral fibrolipomatous hamartoma (FLH) of the median nerves causing acute bilateral compression neuropathy. FLH of the median nerve is an extremely unusual cause of acute bilateral carpal tunnel syndrome in a young child presenting with 'incessant crying'. A comprehensive review of FLH including epidemiology, etiology, clinical presentation, differential diagnosis, imaging, pathology, treatment and prognosis is discussed.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan;
authors.forename: Jenna-Lynn
authors.initials: JL
authors.lastname: Senger
authors.affiliation: Division of Plastic Surgery, University of Saskatchewan, Saskatoon, Saskatchewan; ; Plastic Surgeon, Parksville, British Columbia, University of Saskatchewan, Saskatoon, Saskatchewan.
authors.forename: Dale
authors.initials: D
authors.lastname: Classen
authors.affiliation: Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan.
authors.forename: Garth
authors.initials: G
authors.lastname: Bruce
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan;
authors.forename: Rani
authors.initials: R
authors.lastname: Kanthan
keywords: Acute bilateral carpal tunnel syndrome; Acute compression neuropathy; Fibrolipomatous hamartoma; Incessant crying; Median nerve; Pediatric hand lesions