Giant Palmar Lipoma of the Dominant Hand Causing Functional Impairment: A Case Report

Giant Palmar Lipoma of the Dominant Hand Causing Functional Impairment: A Case Report

Wael Al-Sammak^*

*Correspondence to: Wael Al-Sammak.

Copyright
© 2026 Wael Al-Sammak is an open access article distributed under the Creative Commons Attribution   License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 22 June 2026

Published: 10 July 2026

DOI: https://doi.org/10.5281/zenodo.21289684

Abstract 

Lipomas are the most common benign tumors made up of mature fat cells. While they often occur in the trunk, neck, and upper limbs, lipomas in the hand are rare, making up less than 5% of all benign hand tumors. Giant lipomas in the hand are especially uncommon due to the limited space and dense nerves and blood vessels in the palm. We present the case of a 37-year-old woman with a large, slowly growing lipoma in her dominant right hand, which had been present for more than five years. Though it did not change significantly or affect the skin, the lesion gradually impacted her daily activities and hand function. An MRI showed a well-defined lipoma in the palmar compartment. The surgery was successful, with the removed mass measuring about 6 × 4 cm. Histopathology confirmed it as a benign lipoma. The patient reported complete relief of symptoms and maintained normal hand function. This case highlights the need to recognize giant palmar lipomas as a source of functional impairment and showcases the effectiveness of MRI and careful surgical removal in achieving positive results. 

Keywords: Hand lipoma, giant lipoma, palmar swelling, benign soft tissue tumor, hand surgery, MRI, adipose tissue tumor.

Introduction

Lipomas are benign tumors that develop from mature fat tissue and are the most common type of soft tissue tumor found in medical practice. They are usually slow-growing, painless, and well-defined lumps that might remain symptom-free for years. While lipomas can form anywhere fat tissue exists, they are rare in the hand due to the limited fat content in the small anatomical spaces of the palm and fingers. 

Hand tumors include a variety of lesions, with ganglion cysts, giant cell tumors of tendon sheath, epidermoid cysts, and vascular malformations being more frequently seen than lipomas. Palmar lipomas are especially rare and can present challenges in diagnosis and treatment due to their closeness to tendons, nerves, blood vessels, and intrinsic hand muscles. 

The label "giant lipoma" typically applies to lipomas larger than 5 cm in diameter. In the hand, even smaller lipomas can cause significant symptoms due to the restricted space. Large palmar lipomas can press on nearby nerves, restrict tendon movement, reduce grip strength, and interfere with everyday activities. 

This report discusses a giant palmar lipoma in a young woman involving her dominant hand, focusing on its clinical presentation, imaging results, surgical management, and functional recovery. 

Case Presentation 

A 37-year-old right-handed woman came to the hand surgery clinic with swelling on the palm of her right hand. 

She noticed the swelling around five years prior to her visit. During this time, the lump remained about the same size, with no rapid growth, injury, infection, skin changes, or preceding inflammation noted. 

Initially, the lump caused no symptoms, but over time it became bothersome due to its location. She reported discomfort when gripping tightly, writing for long periods, doing household chores, lifting objects, and using tools. These difficulties eventually led her to seek medical advice. 

She did not report any general symptoms like fever, weight loss, night sweats, or fatigue. There was no family history of soft tissue tumors or hereditary lipomatosis. 

Clinical Examination 

Physical examination showed a large, soft, mobile, and non-tender lump in the central palmar area of her right hand. 

Examination Findings.

The skin over the lump looked normal, with no redness, ulcers, or tethering. There were no sensory deficits. Blood flow and capillary refill were normal. 

Though finger movement was intact, the size of the lesion impacted normal gripping and handling of objects. 

Radiological Evaluation 

An MRI was done to better understand the lesion and its relationship with surrounding structures. 

MRI Findings 

The MRI showed a clearly defined, encapsulated lump in the palmar area with features consistent with fat tissue. 

Radiological features included: 

• Homogeneous fatty signal. 
• Well-defined margins. 
• Thin capsule. 
• No internal nodules. 
• No signs of invasion into nearby muscles. 
• No bone involvement. 
• No nerve or blood vessel encasement. 

The imaging results strongly suggested a benign lipoma

Differential Diagnosis 

Several soft tissue lesions were considered before surgery: 

MRI findings strongly suggested a benign lipoma. 

Surgical Technique 

Given the size of the lesion, its location in the dominant hand, and its impact on daily life, surgery was recommended. 

Under regional anesthesia with a tourniquet, an incision was made on the palm directly over the lesion. 

Careful dissection revealed a large, encapsulated fat mass in the palm's soft tissues. The tumor was meticulously separated from nearby tendons, nerves, and fascia. 

Complete removal was achieved without damaging surrounding structures. The wound was cleaned and closed in layers. 

Gross Pathology 

The specimen removed was a well-defined yellow, lobulated fat mass. 

Macroscopic Features

Histopathological Examination

Histopathological analysis of the excised specimen revealed a well-circumscribed lesion composed of mature adipocytes arranged in lobules separated by delicate fibrous septa. The adipose cells exhibited uniform morphology without evidence of cytological atypia. No lipoblasts, areas of necrosis, or increased mitotic activity were identified. These microscopic findings were consistent with a benign lipomatous neoplasm.

Histopathological Diagnosis

Based on the gross and microscopic features, a definitive diagnosis of benign lipoma was established. No histological evidence suggestive of malignancy or atypical lipomatous tumor was observed.

Postoperative Outcome

The postoperative course was uneventful, and the patient demonstrated satisfactory wound healing without complications. Clinical follow-up revealed complete healing of the surgical incision with preservation of full finger range of motion and hand function. The patient reported marked improvement in grip comfort and resolution of the functional limitations that had previously interfered with daily activities. No sensory disturbances, motor deficits, or vascular compromise were noted during follow-up evaluations. The patient successfully resumed normal activities of daily living and expressed high satisfaction with the functional and cosmetic outcome of the procedure.

Discussion 

Lipomas in the hand are rare tumors, making up a small portion of all hand masses. The scarcity of palmar lipomas results from limited fat tissue and the close packing of anatomical structures in the hand. 

Unlike lipomas elsewhere, hand lipomas often become symptomatic since even slight growth can affect nearby structures. Symptoms may include pain, decreased grip strength, numbness, limited tendon movement, and cosmetic concerns. 

MRI remains the best imaging method for evaluating deep hand lipomas. Typical lipomas show even high signal intensity on T1-weighted images and are suppressed on fat-saturated images. MRI is especially helpful in distinguishing benign lipomas from atypical lipomatous tumors and well-differentiated liposarcomas. 

In this case, surgery was indicated not because of rapid growth or the suspicion of cancer but due to progressive functional issues. Although the lesion remained steady in size for years, its position in the dominant hand hindered daily activities. 

Complete surgical removal is still the best treatment for symptomatic palmar lipomas. Careful dissection is crucial due to the close relationship between these tumors and important nerves and blood vessels. Recurrence rates are low with complete excision. 

This case illustrates how even a benign, slowly growing lump can significantly impact hand function and quality of life when situated in a confined space. 

Conclusion 

Giant palmar lipomas are rare benign tumors that can stay unnoticed for years before causing functional issues. MRI is crucial for diagnosis and surgical planning. Complete removal leads to excellent recovery and reduces the chance of recurrence. Doctors should consider lipomas in the list of possible causes for ongoing palmar swelling, especially when patients report growing difficulties with hand function, even if the lesion's size remains stable. 

Learning Points 

1. Lipomas in the hand are rare but should be considered in chronic palmar swellings. 
2. MRI is the best imaging method for diagnosis and planning surgery. 
3. Giant lipomas can cause significant disabilities despite their benign nature. 
4. Functional issues rather than tumor growth may prompt the need for surgery. 
5. Complete removal leads to great outcomes with low recurrence rates. 
6. Confirming histopathology is essential to rule out atypical lipomatous tumors and liposarcoma. 

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