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Extra-Articular Lipoma Arborescens of the Dorsal Aspect of the Wrist with Invasion of the Extensor TendonsA Case Report
Jeffrey G. Stepan, BS1; Richard H. Gelberman, MD1; David A. Rubin, MD2; Daniel A. Osei, MD1
1 Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for D.A. Osei: oseid@wudosis.wustl.edu
2 Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8131, St. Louis, MO 63110
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Investigation performed at Washington University in St. Louis, St. Louis, Missouri

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Mar 27;3(1):e30 1-4. doi: 10.2106/JBJS.CC.L.00273
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Lipoma arborescens is a rare, benign proliferative condition affecting synovial-lined anatomic spaces. It is characterized by proliferation of subsynovial fat, responsible for its characteristic imaging findings: fronds of fat-containing villi projecting into a synovial space1-3. It is unclear whether this condition is postinflammatory, neoplastic, or metaplastic4-6. Since it is typically limited to the synovium without invasion of other structures, treatment is simple debridement with synovectomy. Lipoma arborescens commonly affects the knee and to a lesser extent the ankle and hip4-8. It is usually monoarticular, but there are reports of multiple sites involved synchronously and metachronously9-11. Lipoma arborescens rarely affects the upper extremity; a review of the published literature revealed only one previous case reporting the condition as an extra-articular lesion affecting the extrinsic tendons of the hand and wrist11-15. To the best of our knowledge, aggressive growth and invasion of structures outside of the synovium have been reported only twice. Both reports noted osseous erosion of the tumor: one in the shoulder joint and the other in the knee13,16. Disease has also been reported in the subacromial-subdeltoid bursa with an associated rotator cuff tear12. We present a case of extra-articular lipoma arborescens with direct invasion of the extensor tendons in a young patient with a chronic mass on the dorsal aspect of the wrist. The patient was informed that data concerning the case would be submitted for publication, and she provided consent.
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