HAEMANGIOMA
OF THE L.
DIGITAL
NERVE:
A CASE
REPORT
NAGAY, S. J. MCCABEand T. W. WOLFF
From the Christine M. Kleinert Institutefor Hand and Micro Surgery, Louisville, Kentucky,
U.S.A.
An b&a-neural haemangiomi of the digital nerve of the left index finger is described, the first report of such a lesion in a digit. Treatment consisted of excision of the tumour and the affected portion of the nerve, followed by direct coaptation of the nerve ends. Journal of Hand Surgery (British Volume 1990) 15B: 487-488
A cavernous haemangioma involving the proper digital nerve on the radial side of the index finger is described. To our knowledge, this is the first time this tumour has been reported in a digit.
the nerve was not possible in this case, but coaptation of the nerve was performed to preserve as much fingertip sensation as possible.
Case report A 22-year-old woman presented with a five-year history of a mass on the radial side of the distal phalanx of her left index finger. Her only symptom was slight tenderness at the site of the lesion. She recalled occasional enlargement of the mass, but no trauma to the digit. On examination, the mass was soft and spherical, approximately 10 mm in diameter. It was not adherent to the overlying skin, which was normal in appearance. Radiographs were also normal. Following metacarpal block anaesthesia and the application of a digital tourniquet in the operating room, a midlateral incision was made directly over the lesion. The lesion looked like a haemangioma; it was purple in colour, multilobular and seemed engorged. On dissection, the digital nerve was found to enter the haemangioma (Fig. 1). Under the operating microscope, the haemangioma was seen to arise from the vessels within the digital nerve. A portion of the nerve was excised with the lesion, and the ends of the nerve were re-approximated and coapted. The lesion measured 5 x 5 mm. Microscopic examination revealed a cavernous haemangioma (Fig. 2). No areas of atypia were identified. The patient’s postoperative course was uneventful.
Fig. 1
Haemangioma
in continuity
with the digital nerve.
Fig. 2
Histological cross-section of haemangioma. Left arrow indicates enlarged capillary; right arrows indicate nerve tissue.
Discussion Intraneural haemangiomas belong to the class of intraneural benign tumours of non-neural origin, which also includes intra-neural lipoma, ganglion and lipofibromatous hamartoma (Strickland and Steichen, 1977). Of the seven previously described intra-neural haemangiomas of the upper extremity, five involved the median nerve, one the ulnar nerve, and one the common digital nerve in the palm (Kojima et al., 1976; Kon and Vuursteen, 1981; Losli, 1952; Pate1 et al., 1986; Peled et al., 1980; Wood, 1980). Microscopic dissection of the tumour from VOL. 15B No. 4 NOVEMBER
1990
481
L. NAGAY,
S. J. MCCABE
Acknowledgements Our thanks go to Lynn Ogden for histological Anne Domeck for editing.
analysis
and to Kell Julliard
and
References KOJIMA, T., IDE, Y., MARUMO, E., ISHIKAWA, E. and YAMASHITA, H. (1976). Haemangioma of median nerve causing carpal tunnel syndrome. The Hand, 8 : 62-65. KON, M. and VUURSTEEN, P. (1981). An intraneural hemangiomaof adigital nerve-Case report. Journal of Hand Surgery, 6: 4: 357-358. LOSLI, E. J. (1952). Intrinsic hemangiomas of the peripheral nerves. A report of two cases and a review of the literature. American Medical Association Archives of Pathology, 53: 226-232.
488
AND
T. W. WOLFF
PATEL, C. B., TSAI, T. M. and KLEINERT, H. E. (1986). Hemangiomaofthe median nerve: A report of two cases. Journal of Hand Surgery, 11A: 1: 7679. PELED, I., IOSIPOVICH, Z., ROUSSO, M. and WEXLER, M. R. (1980). Journal of Hand Surgery, 5 : 4: 363-365. STRICKLAND, J. W. and STEICHEN, J. B. (1977). Nerve tumors of the hand and forearm. Journal of Hand Surgery, 2: 4: 285-291, WOOD, M. B. (1980). Intraneural Hemangioma: Report of a Case. Plastic and Reconstructive Surgery, 65: 1: 74-76. Accepted: 28 April 1989 ;!;a~ W. Wolff, M.D.,
250 East
0
for Surgery
1990 The British
Society
Liberty
Street,
Suite
1Wl
Louisville,
Kentucky
40202,
of the Hand
02667681/90/0015-0487/%10.00
THE
JOURNAL
OF HAND
SURGERY
OF THE L.
DIGITAL
NERVE:
A CASE
REPORT
NAGAY, S. J. MCCABEand T. W. WOLFF
From the Christine M. Kleinert Institutefor Hand and Micro Surgery, Louisville, Kentucky,
U.S.A.
An b&a-neural haemangiomi of the digital nerve of the left index finger is described, the first report of such a lesion in a digit. Treatment consisted of excision of the tumour and the affected portion of the nerve, followed by direct coaptation of the nerve ends. Journal of Hand Surgery (British Volume 1990) 15B: 487-488
A cavernous haemangioma involving the proper digital nerve on the radial side of the index finger is described. To our knowledge, this is the first time this tumour has been reported in a digit.
the nerve was not possible in this case, but coaptation of the nerve was performed to preserve as much fingertip sensation as possible.
Case report A 22-year-old woman presented with a five-year history of a mass on the radial side of the distal phalanx of her left index finger. Her only symptom was slight tenderness at the site of the lesion. She recalled occasional enlargement of the mass, but no trauma to the digit. On examination, the mass was soft and spherical, approximately 10 mm in diameter. It was not adherent to the overlying skin, which was normal in appearance. Radiographs were also normal. Following metacarpal block anaesthesia and the application of a digital tourniquet in the operating room, a midlateral incision was made directly over the lesion. The lesion looked like a haemangioma; it was purple in colour, multilobular and seemed engorged. On dissection, the digital nerve was found to enter the haemangioma (Fig. 1). Under the operating microscope, the haemangioma was seen to arise from the vessels within the digital nerve. A portion of the nerve was excised with the lesion, and the ends of the nerve were re-approximated and coapted. The lesion measured 5 x 5 mm. Microscopic examination revealed a cavernous haemangioma (Fig. 2). No areas of atypia were identified. The patient’s postoperative course was uneventful.
Fig. 1
Haemangioma
in continuity
with the digital nerve.
Fig. 2
Histological cross-section of haemangioma. Left arrow indicates enlarged capillary; right arrows indicate nerve tissue.
Discussion Intraneural haemangiomas belong to the class of intraneural benign tumours of non-neural origin, which also includes intra-neural lipoma, ganglion and lipofibromatous hamartoma (Strickland and Steichen, 1977). Of the seven previously described intra-neural haemangiomas of the upper extremity, five involved the median nerve, one the ulnar nerve, and one the common digital nerve in the palm (Kojima et al., 1976; Kon and Vuursteen, 1981; Losli, 1952; Pate1 et al., 1986; Peled et al., 1980; Wood, 1980). Microscopic dissection of the tumour from VOL. 15B No. 4 NOVEMBER
1990
481
L. NAGAY,
S. J. MCCABE
Acknowledgements Our thanks go to Lynn Ogden for histological Anne Domeck for editing.
analysis
and to Kell Julliard
and
References KOJIMA, T., IDE, Y., MARUMO, E., ISHIKAWA, E. and YAMASHITA, H. (1976). Haemangioma of median nerve causing carpal tunnel syndrome. The Hand, 8 : 62-65. KON, M. and VUURSTEEN, P. (1981). An intraneural hemangiomaof adigital nerve-Case report. Journal of Hand Surgery, 6: 4: 357-358. LOSLI, E. J. (1952). Intrinsic hemangiomas of the peripheral nerves. A report of two cases and a review of the literature. American Medical Association Archives of Pathology, 53: 226-232.
488
AND
T. W. WOLFF
PATEL, C. B., TSAI, T. M. and KLEINERT, H. E. (1986). Hemangiomaofthe median nerve: A report of two cases. Journal of Hand Surgery, 11A: 1: 7679. PELED, I., IOSIPOVICH, Z., ROUSSO, M. and WEXLER, M. R. (1980). Journal of Hand Surgery, 5 : 4: 363-365. STRICKLAND, J. W. and STEICHEN, J. B. (1977). Nerve tumors of the hand and forearm. Journal of Hand Surgery, 2: 4: 285-291, WOOD, M. B. (1980). Intraneural Hemangioma: Report of a Case. Plastic and Reconstructive Surgery, 65: 1: 74-76. Accepted: 28 April 1989 ;!;a~ W. Wolff, M.D.,
250 East
0
for Surgery
1990 The British
Society
Liberty
Street,
Suite
1Wl
Louisville,
Kentucky
40202,
of the Hand
02667681/90/0015-0487/%10.00
THE
JOURNAL
OF HAND
SURGERY
