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On Coronal STIR image (C) it extends from distal carpal row ... Differential diagnosis The clinical and radiological findings in this instance point towards a benign fat containing mass, most likely a giant lipoma. However, the size of this lesion means that malignancy must be considered. The differential here therefore includes liposarcoma, of which well-differentiated liposarcomas are the most common type.1 This distinction is important as a different management approach and referral to a specialist sarcoma unit would be required in malignant disease.2 Treatment The patient underwent elective excision of the lesion. The carpal tunnel was decompressed and the surgical wound was extended distally using a modified Brunner's incision. An 8��6��3?cm lesion was dissected out from the surrounding tissues, preserving the local neurovascular structures. Outcome and follow-up Histology confirmed a lipoma composed of mature fatty cells, with no evidence of malignancy. At postoperative assessment the patient had a well-healed scar with no signs of infection, and importantly no neurovascular deficit was noted. The patient went on to have a trapeziectomy for first left carpometacarpal joint arthritis. Discussion Lipomas are benign tumours of mature adipocytes that can occur anywhere in the body where adipose tissue is present. They are the commonest soft tissue tumour, usually presenting between the ages of 40 and 60?years.3 They commonly occur in the trunk, neck, shoulder and upper arm and are rarely found in the hands or feet.4 Giant lipomas of the hand, greater than 5?cm in size, are extremely rare, with the extant literature limited to case reports and small case series.5 They present as slowly growing painless masses, although functional deficit and symptoms of nerve compression may be present depending on the size and location of the lesion.5 The presented case is one of the largest giant lipomas of the hand reported to date.1 5 6 The treatment of these giant lipomas is surgical, via marginal excision. The risk of malignant transformation in benign lesions is low, and therefore the Ruxolitinib concentration indication for surgery is usually cosmesis and functional impairment due to compression of local structures.5 Any soft tissue mass greater than 5?cm must be considered malignant until proven otherwise.2 The important distinction in cases such as this is between a benign lipoma and liposarcoma, which is the commonest form of soft tissue sarcoma.7 Of these, well-differentiated liposarcomas are the most common type, accounting for 40%.6 The identification of malignant disease is important, as more radical treatment may be required.5 The appropriate choice of investigation is therefore imperative when presented with a large soft tissue swelling. We believe that sonography has a valuable role to play in assessing large swellings of the hand.