Hemant Saraiya
Palmar neurofibromas are rare peripheral nerve sheath tumors (PNSTs) that can radiologically mimic lipomas, posing a risk of unanticipated nerve injury during excision and creating diagnostic and surgical challenges. A retrospective analysis of prospectively maintained data from three consecutive patients with histopathologically confirmed palmar neurofibromas treated between 2017 and 2025 was performed after institutional ethical approval. Two female and one male patient, aged 28-68 years, presented with progressively enlarging and painful palmar swellings. Preoperative ultrasonography and/or magnetic resonance imaging suggested lipomatous lesions in all cases. All patients underwent magnification-assisted nerve-sparing excision, and histopathological evaluation supplemented with immunohistochemical markers, including S-100, SOX10, CD34, and Ki-67, established the diagnosis of neurofibroma in each case. Intraoperatively, a neural origin was identified in all lesions. Meticulous microsurgical interfascicular dissection was carried out to preserve nerve continuity. Despite misleading radiological appearance, complete excision with preservation of the involved nerves was achieved in all patients. During follow-up ranging from one to eight years, no recurrences were observed; one patient experienced transient postoperative digital numbness that resolved completely within three months. Palmar neurofibromas are uncommon lesions that may be difficult to distinguish from lipomas on imaging, and definitive diagnosis relies on histopathological examination supported by targeted immunohistochemistry to differentiate them from schwannoma, lipoma, and malignant PNSTs. Heightened preoperative suspicion, appropriate patient counseling, meticulous microsurgical technique, and nerve-sparing surgery are essential for optimizing functional outcomes. Surgeons should maintain a high index of suspicion for neural tumors when evaluating palmar soft-tissue masses with apparently benign lipomatous imaging characteristics.