Fibrolipoma of the Median Nerve: An Overview.

INTRODUCTION: Fibrolipoma of the median nerve is a rare benign lesion responsible for carpal tunnel syndrome. Fibrolipoma is often misdiagnosed. This article aimed to review and summarize current knowledge regarding fibrolipoma of the median nerve. We emphasize the clinical and imaging features of this disease. METHODS: To examine the characteristics of fibrolipoma of the median nerve, we performed a litera-ture review using MEDLINE. The search included only English studies published from database in-ception to June 2021. RESULTS: Forty-six cases of fibrolipoma of the median nerve were included. Fibolipoma is characterized by diffuse infiltration of peripheral nerves by normal-appearing fibrous and adipose tissues. The fibrolipoma of the median nerve can be responsible for macrodactyly, numbness, paresthesia, and weakness within the median nerve distribution. Ultrasonography shows a fusiform hyperechoic mass along the nerve containing hypoechoic bands corresponding to nerve fascicles. Magnetic resonance imaging is the gold standard for the diagnosis of fibrolipoma. It typically shows a contrast between the low signal nerve fibers and the high signal fatty tissues, revealing a characteristic « cable-like ¼ appearance on axial sections and a «spaghetti-like¼ appearance on coronal sections. CONCLUSION: Fibrolipoma should be considered in young patients with carpal tunnel syndrome. This review emphasizes the clinical and radiological features of fibrolipoma. We highlight the images of ultrasonography in the diagnosis of rare structural causes of carpal tunnel syndrome.

Epidural myeloid sarcoma as the presenting symptom of chronic myeloid leukemia blast crisis.

Epidural myeloid sarcoma revealing chronic myeloid leukemia is scarce. Herein, we describe a patient that presented with back pain and bilateral sciatica secondary to root compression due to epidural deposition of leukemic cells. The magnetic resonance imaging showed epidural masses, causing a slight restriction of the spinal canal with bilateral L5 root compression. Laboratory examinations showed hyperleukocytosis (white blood cell count: 83 × 109/L, absolute neutrophil count: 60 × 109/L). The bone marrow cytology and immunophenotypic findings confirmed the diagnosis of myeloid leukemia. The diagnosis of spinal myeloid sarcoma revealing chronic myeloid leukemia during the blast phase was established. The patient underwent induction chemotherapy. Then, bone marrow cytology revealed less than 3% of blasts, which correspond to cytological remission. Three months later, MRI showed complete disappearance of the epidural masses. A literature review was conducted by searching PubMed using these terms: "Leukemia, Myeloid" AND "Spine" AND "Sarcoma, Myeloid". We emphasize clinical and radiological findings of spinal myeloid sarcoma. This diagnosis should be considered when the MRI reveals epidural mass lesion. The early management of this disease is necessary, and the treatment of myeloid sarcoma is not codified. Our case highlighted that chemotherapy treatment could be sufficient to lead to the disappearance of myeloid sarcoma and the remission of leukemia.