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Wang J, Wang H, Yu J, Han X. Madelung's disease with liver cancer:A case report. Asian J Surg 2024; 47:4042-4043. [PMID: 38724395 DOI: 10.1016/j.asjsur.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 09/05/2024] Open
Affiliation(s)
- Jinbao Wang
- Department of General Surgery I, Gansu Provincial Central Hospital, Lanzhou, 730070, China; The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Hongyu Wang
- Department of General Surgery I, Gansu Provincial Central Hospital, Lanzhou, 730070, China; The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Jianping Yu
- Department of General Surgery I, Gansu Provincial Central Hospital, Lanzhou, 730070, China.
| | - Xiaopeng Han
- Department of General Surgery I, Gansu Provincial Central Hospital, Lanzhou, 730070, China.
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Multiple Symmetric Lipomatosis: A Cross-Sectional Study to Investigate Clinical Features and Patients’ Quality of Life. Symmetry (Basel) 2021. [DOI: 10.3390/sym13101823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Within the subcutaneous adipose tissue diseases, multiple symmetric lipomatosis (MSL) (syn.: Launois Bensaude Syndrome, Morbus Madelung, benign symmetric lipomatosis) is rare. The pathogenesis of MSL remains unclear. We investigated the largest German cohort of MSL patients to obtain anamnestic data and quality of life with a standard questionnaire. Twenty-nine patients with confirmed MSL were included and filled in a questionnaire designed for this study. The questionnaire assessed common anamnestic factors, such as quality of life (EQ-5D-3L) and subjective treatment goals and success (“Patient-Benefit-Index-Lymphedema”, PBI-L). The gender distribution of the patients involved in the study was m/f: 1/4 (male: n = 6 (21%); female n = 23 (79%)). While the exact pathophysiology of MSL remains unclear, a subset of patients’ positive family history suggests a strong genetic factor, sometimes compatible with autosomal dominant inheritance. Patients with MSL showed lower health states (EQ VAS Score: m = 51, sd = 24, range = 0–90) than the German norm population (m = 77). Around two thirds (68%) of patients reported relevant benefits of therapy (liposuction/lipectomy). In our cohort about one third of the patients reported a positive family history for MSL-like features. Additionally, at least in some patients, a strong genetic factor, compatible with autosomal dominant inheritance, seems a possible major driver of MSL development. Alcohol consumption and MSL development has to be regarded as a controversial issue. Patients suffering from MSL have a clear decrease in quality of life and a marked wish for treatment.
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Segsarnviriya C, Chirakalwasan N. A case of Madelung's disease presenting with obstructive sleep apnea. J Clin Sleep Med 2021; 16:1603-1605. [PMID: 32515345 DOI: 10.5664/jcsm.8622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Madelung's disease is a rare condition characterized by diffuse, multiple, symmetric, nonencapsulated fatty accumulation predominantly in the neck and upper trunk, which can predispose to obstructive sleep apnea. This case report involves a 51-year-old man affected by Madelung's disease who complained of difficulty breathing and inability to sleep in a supine position. An overnight pulse oximetry was performed, and the result was suggestive of moderate to severe obstructive sleep apnea. After auto-titrating continuous positive airway pressure therapy, the patient was prescribed continuous positive airway pressure therapy at the pressure setting of 13 cm of water. Alcohol cessation was also advised. At the 6-month follow-up visit, a marked improvement in neck cosmetic appearance and alleviation of sleep disturbance-related symptoms were observed. Polysomnography finally confirmed the diagnosis of severe obstructive sleep apnea. This case illustrates that a patient with Madelung's disease may present with a clinical presentation of obstructive sleep apnea, which should be promptly diagnosed. Continuous positive airway pressure remains the treatment of choice.
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Affiliation(s)
- Charnsiri Segsarnviriya
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center of Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Naricha Chirakalwasan
- Excellence Center of Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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4
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Sanna M, Borgo C, Compagnin C, Favaretto F, Vindigni V, Trento M, Bettini S, Comin A, Belligoli A, Rugge M, Bassetto F, Donella-Deana A, Vettor R, Busetto L, Milan G. White Adipose Tissue Expansion in Multiple Symmetric Lipomatosis Is Associated with Upregulation of CK2, AKT and ERK1/2. Int J Mol Sci 2020; 21:ijms21217933. [PMID: 33114687 PMCID: PMC7662313 DOI: 10.3390/ijms21217933] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023] Open
Abstract
Multiple symmetric lipomatosis (MSL) is a rare disorder characterized by overgrowing lipomatous tissue (LT) in the subcutaneous adipose tissue (SAT). What LT is and how it expands are not completely understood; previous data suggested that it could derive from brown AT precursors. In six MSL type I patients, we compared LT morphology by histological and immunohistochemistry (IHC) analysis, gene expression, by qPCR, kinase activity, by Western Blot and in vitro assay to paired-control SAT using AT from patients with pheochromocytoma as a human browning reference. In the stromal vascular fraction (SVF), we quantified adipose stem cells (ASCs) by flow cytometry, the proliferation rate, white and beige adipogenic potential and clonogenicity and adipogenicity by a limiting dilution assay. LT displayed white AT morphology and expression pattern and did not show increased levels of the brown-specific marker UCP1. In LT, we evidenced AKT, CK2 and ERK1/2 hyperactivation. LT-SVF contained increased ASCs, proliferated faster, sprouted clones and differentiated into adipocytes better than the control, displaying enhanced white adipogenic potential but not increased browning compared to SAT. In conclusion, LT is a white AT depot expanding by hyperplasia through increased stemness and enhanced white adipogenesis upregulating AKT, CK2 and ERK1/2, which could represent new targets to counteract MSL.
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Affiliation(s)
- Marta Sanna
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Christian Borgo
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy; (C.B.); (A.D.-D.)
| | - Chiara Compagnin
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Francesca Favaretto
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Vincenzo Vindigni
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padua, 35128 Padua, Italy; (V.V.); (F.B.)
| | - Mariangela Trento
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy; (M.T.); (M.R.)
| | - Silvia Bettini
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Alessandra Comin
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Anna Belligoli
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Massimo Rugge
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy; (M.T.); (M.R.)
| | - Franco Bassetto
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padua, 35128 Padua, Italy; (V.V.); (F.B.)
| | - Arianna Donella-Deana
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy; (C.B.); (A.D.-D.)
| | - Roberto Vettor
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Luca Busetto
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Gabriella Milan
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
- Correspondence: ; Tel.: +39-049-8218550; Fax: +39-049-8218555
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Madelung Disease: Analysis of Clinicopathological Experience in Taipei Veterans General Hospital. Ann Plast Surg 2020; 82:S66-S71. [PMID: 30461459 DOI: 10.1097/sap.0000000000001719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The main feature of Madelung disease (MD), a rare condition, is the growth of adipose tissue without a capsule. Usually, this disease is known for its prominent features with fat deposition around the neck, shoulder, back, or chest wall. Clinically, the patient is likely to exhibit alcohol, neuropathy, and metabolic disorders; however, no clear cause has been confirmed. AIMS The aim of this study was to analyze the morphological, pathophysiological, and various treatment methods of MD. We have presented and discussed 16 cases of treatment of this disease at our hospital and reviewed the literature on this subject. METHODS We carried out a retrospective chart review of 16 consecutive patients with MD treated from 1989 through 2017. Patient demographic data, tumor size and location, and follow-up data were evaluated. Patients usually seek treatment because of the disfigured appearance, restricted range of the motion of the head and neck, inconvenience in daily activity such as eating or speaking, and worry about the mass effect. All patients underwent surgical resection and/or combined liposuction. RESULTS Among the patients, 14 were men, aged 38 to 80 years, with a history of disease ranging from 6 months to 7 years. The mean duration from symptoms to diagnosis of MD was 4.4 years. The mean duration of follow-up was 82.8 months (range, 5-192 months). Three patients died of coronary artery disease at follow-up of 27, 78, and 141 months. The functional results were satisfactory in all patients. Severe complications were not observed. CONCLUSIONS According to our experience, surgical resection is the main method of improving the appearance, ensuring eradication of the tumor, and reducing the possibility of recurrence. In addition, we have a case in which atypical changes were confirmed by histological examination in fractional surgery. A long follow-up period is recommended considering the high propensity and mean time to recurrence. Although malignant transformation of MD is rare occurrence, it occurred in 1 of the 16 patients.
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Schiltz D, Tschernitz S, Ortner C, Anker A, Klein S, Felthaus O, Biermann N, Schreml J, Prantl L, Schreml S. Adipose Tissue in Multiple Symmetric Lipomatosis Shows Features of Brown/Beige Fat. Aesthetic Plast Surg 2020; 44:855-861. [PMID: 32157376 PMCID: PMC7280331 DOI: 10.1007/s00266-020-01666-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
Introduction Multiple symmetric lipomatosis (MSL) (syn.: Launois–Bensaude Syndrome, benign symmetric lipomatosis) is a rare disease of fatty tissue. The pathophysiology of MSL still remains unclear, although several approaches have been described in order to understand it. Beside morphological characteristics and some molecular cell biological approaches, little is known about the histological and immunohistochemical characterization of adipose tissue from patients with MSL. Methods From the 45 patients with MSL in our database, 10 were included in the study. Fat tissue samples were collected from affected and unaffected areas. The forearm served as a control area as this area is not affected in MSL. The specimens were analyzed after selected stainings were taken (hematoxylin–eosin = HE, Elastica van Gieson, Ladewig, CD200, CIDEA, myf5, p107, Prdm16, Sca-1, syndecan, UCP1, MAC387, Glut4).
Results In patients suffering from MSL, no macroscopic or microscopic morphological difference could be found between affected and unaffected adipose tissue in HE stainings. The majority of samples showed positivity for UCP1 (9/10 clinically affected tissues, 7/10 clinically unaffected tissues) and CD200. Conclusion Marker profiles support the hypothesis that affected adipose tissue derives from brown or beige adipose tissue rather than from white fat. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Electronic supplementary material The online version of this article (10.1007/s00266-020-01666-6) contains supplementary material, which is available to authorized users.
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Chen K, Wan X, Zhao L, Zhao S, Peng L, Yang W, Yuan J, Zhu L, Mo Z. Cbl Proto-Oncogene B (CBLB) c.197A>T Mutation Induces Mild Metabolic Dysfunction in Partial Type I Multiple Symmetric Lipomatosis (MSL). Diabetes Metab Syndr Obes 2020; 13:3535-3549. [PMID: 33116705 PMCID: PMC7547790 DOI: 10.2147/dmso.s273780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Multiple symmetric lipomatosis (MSL) is a rare disease showing chronic progression of multiple, symmetrical, and non-encapsulated subcutaneous lipoma. The cause of the disease remains unknown. PATIENTS AND METHODS This study reported and summarized 13 sporadic cases of Type I MSL patients in terms of histopathology and cellular and molecular biology and assessed the CBLB c.197A>T mutation in the IRS1-PI3K-Akt pathway. RESULTS The clinical data showed that these 13 Type I patients were all male with a mean age of 57.0 ± 6.6 years old and consumed alcohol heavily. The laboratory tests revealed that most of the patients had hyperuricemia, diabetes, hyperinsulinemia, or insulin resistance; however, their blood lipid levels were close to a normal range. The imaging data exhibited lipomas that only occurred subcutaneously but not viscerally, ie, Types Ia (15.4%), Ib (30.8%), and Ic (53.8%). The molecular analyses of adipocytes of isoprenaline stimulated human adipose tissue-derived mesenchymal stromal cells (hADSCs) isolated from the adipose tissue lipoma-like masses (ATLLM) demonstrated that these adipocytes did not express UCP-1. The Cbl proto-oncogene B (CBLB), an E3 ubiquitin-protein ligase, was associated with insulin resistance and obesity and was mutated (ie, CBLB c.197A>T) in four MSL patients after the whole genome and Sanger sequencing of the blood samples. Furthermore, the CBLB c.197A>T mutation induced hADSC resistance to insulin by inactivation of the IRS-1-PI3K-AKT pathway. CONCLUSION This study analyzed clinical, histopathological, and cellular and molecular biological characterizations of 13 Type I MSL patients and identified the CBLB c.197A>T heterozygous mutation that could be responsible for MSL metabolic dysfunction or even MSL development.
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Affiliation(s)
- Ke Chen
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Xinxing Wan
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Liling Zhao
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Shaoli Zhao
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Lin Peng
- Department of Nephrology, The First Hospital of Changsha, Changsha, Hunan410005, People’s Republic of China
| | - Wenjun Yang
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Jingjing Yuan
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Liyong Zhu
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Zhaohui Mo
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
- Correspondence: Zhaohui Mo Tel/Fax +86 731 88618006 Email
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Lindner A, Marbach F, Tschernitz S, Ortner C, Berneburg M, Felthaus O, Prantl L, Kye MJ, Rappl G, Altmüller J, Thiele H, Schreml S, Schreml J. Calcyphosine-like (CAPSL) is regulated in Multiple Symmetric Lipomatosis and is involved in Adipogenesis. Sci Rep 2019; 9:8444. [PMID: 31186450 PMCID: PMC6559987 DOI: 10.1038/s41598-019-44382-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/13/2019] [Indexed: 11/09/2022] Open
Abstract
Little is known on the causes and pathogenesis of the adipose tissue disorder (familial) Multiple Symmetric Lipomatosis (MSL). In a four-generation MSL-family, we performed whole exome sequencing (WES) in 3 affected individuals and 1 obligate carrier and identified Calcyphosine-like (CAPSL) as the most promising candidate gene for this family. Screening of 21 independent patients excluded CAPSL coding sequence variants as a common monogenic cause, but using immunohistochemistry we found that CAPSL was down-regulated in adipose tissue not only from the index patient but also in 10 independent sporadic MSL-patients. This suggests that CAPSL is regulated in sporadic MSL irrespective of the underlying genetic/multifactorial cause. Furthermore, we cultivated pre-adipocytes from MSL-patients and generated 3T3-L1-based Capsl knockout and overexpressing cell models showing altered autophagy, adipogenesis, lipogenesis and Sirtuin-1 (SIRT1) expression. CAPSL seems to be involved in adipocyte biology and perturbation of autophagy is a potential mechanism in the pathogenesis of MSL. Downregulation of CAPSL and upregulation of UCP1 were common features in MSL fat while the known MSL genes MFN2 and LIPE did not show consistent alterations. CAPSL immunostainings could serve as first diagnostic tools in MSL clinical care with a potential to improve time to diagnosis and healthcare options.
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Affiliation(s)
- Angie Lindner
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany
| | - Felix Marbach
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Tschernitz
- Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany
| | - Christine Ortner
- Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany
| | - Mark Berneburg
- Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany
| | - Oliver Felthaus
- Department of Plastic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Min Jeong Kye
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany
| | - Gunter Rappl
- Center for Molecular Medicine Cologne (CMMC) and Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Janine Altmüller
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany.,Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Holger Thiele
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Stephan Schreml
- Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany.
| | - Julia Schreml
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany.
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9
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Palacios E, Neitzschman HR, Nguyen J. Madelung Disease: Multiple Symmetric Lipomatosis. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556131409300304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Enrique Palacios
- Department of Radiology, Tulane University Hospital
and Clinics, New Orleans
| | | | - Jeremy Nguyen
- Department of Radiology, Tulane University Hospital
and Clinics, New Orleans
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10
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Affiliation(s)
- Saverio Cinti
- Professor of Human Anatomy, Director, Center of Obesity, University of Ancona (Politecnica delle Marche), Ancona, Italy
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11
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Abstract
Als Lipomatosen bezeichnet man gutartige, meist ohne eindeutige Auslöser auftretende Vermehrungen des Fettgewebes, oft mit typischem Verteilungsmuster. Im Gegensatz zu umschriebenen Lipomen entwickeln sie sich meist diffus-symmetrisch und sind nicht von einer fibrösen Pseudokapsel umgeben. Am häufigsten ist die benigne symmetrische Lipomatose (BSL; Launois-Bensaude-Syndrom), von der aufgrund des Verteilungsmusters des hyperplastischen Fettgewebes vier Typen unterschieden werden. Ätiologie und Pathogenese der Erkrankung sind noch weitgehend unbekannt, wobei manche Formen eine hereditäre Basis zu haben oder mit vermehrtem Alkoholkonsum assoziiert zu sein scheinen. In einigen Fällen wurden mitochondriale Fehlfunktionen nachgewiesen. Lipomatosen können isoliert, aber auch mit Begleitsymptomen oder -erkrankungen (Komorbidität) vergesellschaftet auftreten. Wirksame medikamentöse Therapien sind nicht bekannt; chirurgische Verfahren können hingegen zur Besserung der Symptome führen. Die von der BSL abzugrenzende Lipomatosis dolorosa tritt bevorzugt bei Frauen mittleren Alters auf und ist durch Vermehrung des Fettgewebes sowie starke Schmerzen in den betroffenen Bereichen gekennzeichnet. Verschiedene Differenzialdiagnosen und Begleiterkrankungen sind abzuklären, insbesondere Depressionen. Evidenzbasierte Therapieempfehlungen existieren nicht. Repetitive Lidocain-Infusionen können temporäre Besserungen bewirken; nach chirurgischen Interventionen treten häufig Rezidive auf, allerdings werden auch langfristige Erfolge erzielt.
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Affiliation(s)
- Philipp Al Ghazal
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Lisa-Lena Grönemeyer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Michael P Schön
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen.,Niedersächsisches Institut für Berufsdermatologie (NIB), Universitätsmedizin Göttingen und Universität Osnabrück
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12
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Al Ghazal P, Grönemeyer LL, Schön MP. Lipomatoses. J Dtsch Dermatol Ges 2018; 16:313-327. [PMID: 29431910 DOI: 10.1111/ddg.13460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/17/2018] [Indexed: 12/19/2022]
Abstract
Lipomatoses are benign proliferations of adipose tissue, often with typical distribution patterns, which usually occur without clear causes. In contrast to circumscribed lipomas, they develop diffusely and symmetrically and are not surrounded by a fibrous pseudocapsule. The most common form is benign symmetric lipomatosis (BSL; Launois-Bensaude syndrome), of which four types are distinguished based on the distribution pattern of hyperplastic adipose tissue. The etiology and pathogenesis of the disease are still largely unknown, although some forms appear to have a hereditary basis or to be associated with increased alcohol consumption. In some cases, mitochondrial dysfunctions have been detected. Lipomatoses may be solitary, but may also be associated with other symptoms or illnesses (comorbidity). Effective drug therapies are not known, but surgical procedures can alleviate the symptoms. Lipomatosis dolorosa, which can be distinguished from BSL, occurs predominantly in middle-aged women and is characterized by proliferation of adipose tissue and severe pain in the affected areas. Various differential diagnoses and concomitant illnesses need to be considered, in particular depression. There are no evidence-based recommendations for therapy. Repetitive lidocaine infusions can achieve temporary improvement. Recurrence after surgical intervention is not uncommon, but long-term success is also possible.
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Affiliation(s)
- Philipp Al Ghazal
- Department of Dermatology, Venerology and Allergology, University Medical Center, Göttingen, Germany
| | - Lisa-Lena Grönemeyer
- Department of Dermatology, Venerology and Allergology, University Medical Center, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venerology and Allergology, University Medical Center, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology (NIB), University Medical Center Göttingen and University of Osnabrück, Germany
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13
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Chen K, Wang L, Yang W, Wang C, Hu G, Mo Z. Profiling of differentially expressed genes in adipose tissues of multiple symmetric lipomatosis. Mol Med Rep 2017; 16:6570-6579. [PMID: 28901441 PMCID: PMC5865826 DOI: 10.3892/mmr.2017.7437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 07/04/2017] [Indexed: 12/15/2022] Open
Abstract
Multiple symmetric lipomatosis (MSL) is a rare disorder characterized by aberrant multiple and symmetric subcutaneous adipose tissue accumulation in the face, neck, shoulders, back, chest and abdomen, severely affecting the quality of life of patients. At present, precise MSL etiology and pathogenesis remain to be elucidated. The present study first utilized a digital gene expression technique with a next‑generation sequencing platform to profile differentially expressed genes in three cases of MSL vs. normal control tissue. cDNA libraries from these tissue specimens were constructed and DNA sequenced for identification of differentially expressed genes, which underwent bioinformatic analysis using the Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) and protein‑protein interaction (PPI) network analyses. As a result, a total of 859 differentially expressed genes were identified, including 308 upregulated genes (C19orf80, Apelin, C21orf33, FAM166B and HSD11B2 were mostly upregulated 6.984‑, 4.670‑, 4.412‑, 3.693‑ and 3.561‑fold, respectively) and 551 downregulated genes [FosB proto‑oncogene, AP‑1 transcription factor subunit (FOSB), selectin (SEL) E, RAR related orphan receptor (ROR) B, salt inducible kinase (SIK)1 and epidermal growth factor‑like protein (EGFL)6 were mostly downregulated ‑9.845, ‑8.243, ‑8.123, ‑7.702 and ‑7.664 fold, respectively). The GO functional enrichment analysis demonstrated these differentially expressed genes were predominantly involved in biological processes and cellular components, while the KEGG pathway enrichment analysis demonstrated that ribosome, non‑alcoholic fatty liver disease, human T‑lymphotropic virus type 1 (HTLV‑I) infection and Alzheimer's disease pathways were altered in MSL. The PPI network data demonstrated ubiquitin C (UBC), translocator protein (TSPO), Jun Proto‑Oncogene, AP‑1 Transcription Factor (JUN) and FOS were among these differentially expressed genes that participated in regulation of adipocyte differentiation, although no previous study has linked them to MSL. In conclusion, the present study profiled differentially expressed genes in MSL and identified gene pathways that may be associated with MSL development and progression.
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Affiliation(s)
- Ke Chen
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Linghao Wang
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Wenjun Yang
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Changfa Wang
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Gui Hu
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Zhaohui Mo
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
- Correspondence to: Professor Zhaohui Mo, Department of Endocrinology, The Third Xiangya Hospital of Central South University, 138 Tong Zi Po Road, Changsha, Hunan 410013, P.R. China, E-mail:
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Abstract
Madelung disease is an uncommon disease characterized by large subcutaneous adipose masses. Mediterranean countries show higher disease incidence. We review the current concepts concerning this pathology, including etiology, diagnosis, and treatment. Madelung disease usually affects the upper half of the body, but we describe a patient with scrotal lipomas. As this location is rare, we review the cases found in literature, as well as the specific nuances regarding local symptoms and treatment.
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Witmanowski H, Banasiak Ł, Kierzynka G, Markowicz J, Kolasiński J, Błochowiak K, Szychta P. The use of high tumescent power assisted liposuction in the treatment of Madelung's collar. Postepy Dermatol Alergol 2017; 34:366-371. [PMID: 28951714 PMCID: PMC5560187 DOI: 10.5114/ada.2017.69319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/26/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Henryk Witmanowski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
- Department of Physiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Banasiak
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Grzegorz Kierzynka
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Jarosław Markowicz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Jerzy Kolasiński
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Katarzyna Błochowiak
- Department of the Oral Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Szychta
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
- Department of Oncological Surgery and Breast Diseases, Polish Mother’s Memorial Hospital-Research Institute, Lodz, Poland
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Esposito ACC, Munhoz T, Abbade LPF, Miot HA. Do you know this syndrome? Type 2 benign symmetric lipomatosis (Launois-Bensaude). An Bras Dermatol 2017; 91:840-841. [PMID: 28099616 PMCID: PMC5193205 DOI: 10.1590/abd1806-4841.20164744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 06/25/2015] [Indexed: 02/08/2023] Open
Abstract
A 57-year-old female showed bulky, loose tumors, which progressively spread to
her arms, anterior chest, and back. She reported dysphagia and dyspnea after
mild exertion. She denied alcohol consumption. CT scan of her chest showed no
internal lesions. Benign symmetric lipomatosis is a rare syndrome, clinically
described as multiple nonencapsulated lipomas of various sizes and symmetrical
distribution. This syndrome has three known phenotypes; in type 2
(Launois-Bensaude syndrome), lesions occur primarily on the shoulders, upper
arms, and chest, and is unrelated to alcoholism. It causes aesthetic deformities
and might block the upper airways. Mediastinal invasion might occur as well.
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Affiliation(s)
| | - Tania Munhoz
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - Botucatu (SP), Brazil
| | | | - Hélio Amante Miot
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - Botucatu (SP), Brazil
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A case of severe obstructive sleep apnoea in Madelung's disease treated by lateral pharyngoplasty. The Journal of Laryngology & Otology 2017; 131:834-837. [PMID: 28532519 DOI: 10.1017/s0022215117001062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Madelung's disease is a rare disorder characterised by the presence of multiple, symmetric, non-capsulated fat masses in the face, neck and other areas of upper extremities. In some cases, severe clinical complications such as upper airway compression can occur. CASE REPORT A 56-year-old man affected by Madelung's disease complained of snoring and severe daytime sleepiness. Polysomnography revealed severe obstructive sleep apnoea. An attempt to treat sleep apnoea by continuous positive airway pressure failed because of poor compliance. Functional expansion pharyngoplasty was carried out as an initial treatment. Marked improvement of neck movements and normalisation of somnographic parameters were observed at six months' follow up. CONCLUSION Patients with Madelung's disease should be examined carefully for potential obstructive sleep apnoea. Although continuous positive airway pressure remains the treatment of choice, specific surgery can be used in those patients who cannot tolerate continuous positive airway pressure therapy.
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Transcription Profile in Sporadic Multiple Symmetric Lipomatosis Reveals Differential Expression at the Level of Adipose Tissue-Derived Stem Cells. Plast Reconstr Surg 2016; 137:1181-1190. [PMID: 27018673 DOI: 10.1097/prs.0000000000002013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The cause of the rare fat distribution disorder multiple symmetric lipomatosis is unknown. Independent reports suggest a higher proliferative activity, hormone resistance, and involvement of mitochondrial function in the disease. METHODS The authors performed morphologic comparison of affected and unaffected tissues in five unrelated patients and generated adipose-derived stem cell cultures from the tissue samples and characterized them as a possible cellular model of multiple symmetric lipomatosis evolution. The authors investigated proliferative activity and the expression of genes relevant to disease processes. RESULTS There was no difference in the morphologic appearance and the surface marker profile. Stem cells from lipomatous tissue showed significantly higher proliferative activity. Polymerase chain reaction arrays showed marked changes in genes associated with proliferation, hormonal regulation, and mitochondria. The authors show that multiple symmetric lipomatosis tissue is morphologically and histologically different from regular subcutaneous fat. CONCLUSIONS This study indicates an involvement of mesenchymal stem cells in the pathogenesis of multiple symmetric lipomatosis and that the evolution of multiple symmetric lipomatosis tissue is a process driven by an inherent defect of the respective cell clone(s). Further molecular genetics and functional analysis will be required to unravel the pathogenetic mechanism underlying the derailment in fat cell metabolism and proliferation. Here, the authors show for the first time that adipose-derived stem cells exhibit many characteristics previously described for native multiple symmetric lipomatosis fat tissue and propose that they are therefore an excellent tool for further functional investigations in multiple symmetric lipomatosis and other disorders of the fat tissue. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, V.
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Tremp M, Menzi N, Tchang L, di Summa PG, Schaefer DJ, Kalbermatten DF. Adipose-Derived Stromal Cells from Lipomas: Isolation, Characterisation and Review of the Literature. Pathobiology 2016; 83:258-66. [PMID: 27225269 DOI: 10.1159/000444501] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/04/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The aim of this study was to characterize adipose-derived stromal cells (ADSCs) from patients diagnosed with multiple symmetric lipomatosis (MSL) in order to obtain potentially new insights into the pathophysiology, pathogenesis and treatment of this disease. METHODS Cells from the stromal vascular fraction were analysed by the colony-forming efficiency assay and flow cytometry using standard markers. Moreover, the power of adipogenic plasticity was evaluated. Finally, a literature review was performed from 1982 to 2015 using the US National Institutes of Health's PubMed database. RESULTS Three European-descent patients diagnosed with either MSL type I or II could be identified for analysis. The resulting mean colony-forming efficiency assay was 14.3 ± 5%. Flow-cytometric analysis of the ADSCs revealed high levels of CD34 (70 ± 9%), CD45 (37 ± 13%) and CD73 (55.8 ± 14%), whereas low levels of CD31 (16.8 ± 14%) and CD105 (5.8 ± 0.7%) were detected. Furthermore, ADSCs showed a strong adipogenic potential, which is in line with the literature review. The stem cell pool in lipoma shows several alterations in biological activities, such as proliferation, apoptosis and stemness. CONCLUSIONS ADSCs from lipoma may be interesting in the application of regenerative medicine. We discuss possible molecular treatment options to regulate their activities at the source of the MSL.
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Affiliation(s)
- Mathias Tremp
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
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20
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Kyaw H, Grillo M, Lin AN, Kapp DA. State of diagnostic quandary solved by modern technology: a rare case of Madelung's disease. BMJ Case Rep 2016; 2016:bcr-2015-213842. [PMID: 26851254 DOI: 10.1136/bcr-2015-213842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Madelung's disease is a neglected metabolic disease characterised by generalised multiple fatty tissue deposits. A 64-year-old Caucasian woman presented with generalised weakness and symptomatic hypoglycaemia with altered mental status. Physical examination showed very distinct physical characteristics with multiple lumps distributed over the upper body. Her neurological symptoms were solved by giving intravenous glucose and optimisation of medical treatment. Even though she had unique characteristics of Madelung's disease, many physicians, on several occasions, failed to recognise her 'hidden diagnosis'. This diagnostic uncertainty was able to be solved by searching the Internet for similar clinical features and images. This case demonstrates characteristics and unique features of a rare disease that can be seen in a female patient even though it is mostly found in males.
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Affiliation(s)
- Htoo Kyaw
- Department of Internal Medicine, Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Michael Grillo
- Department of Internal Medicine, Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Aung Naing Lin
- Department of Internal Medicine, Brooklyn Hospital Center, Brooklyn, New York, USA
| | - David A Kapp
- Department of Internal Medicine, Brooklyn Hospital Center, Brooklyn, New York, USA
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21
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22
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Surgical treatment of multiple symmetric lipomatosis with ultrasound-assisted liposuction. Ann Plast Surg 2015; 73:559-62. [PMID: 23657050 DOI: 10.1097/sap.0b013e31827f5295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Multiple symmetric lipomatosis (MSL) is a rare disease of unknown etiology, characterized by the presence of multiple, symmetrical, noncapsulated lipomas, mostly in the neck and upper trunk. To date, there is no effective medical treatment of MSL. Surgical treatment is based on 2 options, namely, lipectomy and/or liposuction. In this retrospective study, we compare traditional lipectomy with ultrasound-assisted liposuction. Our initial experience demonstrates that the ultrasound-assisted liposuction procedure can be applied to patients with MSL, allowing simultaneous treatment of multiple areas in a single session and the removal of a substantial amount of fat, thus improving aesthetic results. If lipomas are circumscribed and isolated, traditional lipectomy is probably to be preferred.
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23
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Enzi G, Busetto L, Sergi G, Coin A, Inelmen EM, Vindigni V, Bassetto F, Cinti S. Multiple symmetric lipomatosis: a rare disease and its possible links to brown adipose tissue. Nutr Metab Cardiovasc Dis 2015; 25:347-353. [PMID: 25770761 DOI: 10.1016/j.numecd.2015.01.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 02/06/2023]
Abstract
AIM Aim of this study is an updated review of our case series (72 patients) as well as available literature on the Multiple Symmetric Lipomatosis (MSL), a rare disease primarily involving adipose tissue, characterized by the presence of not encapsulated fat masses, symmetrically disposed at characteristic body sites (neck, trunk, proximal parts of upper and lower limbs). DATA SYNTHESIS The disease is more frequent in males, associated to an elevated chronic alcohol consumption, mainly in form of red wine. Familiarity has been reported and MSL is considered an autosomic dominant inherited disease. MSL is associated to severe clinical complications, represented by occupation of the mediastinum by lipomatous tissue with a mediastinal syndrome and by the presence of a somatic and autonomic neuropathies. Hyper-alphalipoproteinemia with an increased adipose tissue lipoprotein-lipase activity, a defect of adrenergic stimulated lipolysis and a reduction of mitochondrial enzymes have been described. The localization of lipomatous masses suggests that MSL lipomas could originate from brown adipose tissue (BAT). Moreover, studies on cultured pre-adipocytes demonstrate that these cells synthetize the mitochondrial inner membrane protein UCP-1, the selective marker of BAT. Surgical removal of lipomatous tissue is to date the only validated therapeutic approach. CONCLUSIONS MSL is supposed to be the result of a disorder of the proliferation and differentiation of human BAT cells.
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Affiliation(s)
- G Enzi
- Department of Medicine, University of Padua, Italy
| | - L Busetto
- Department of Medicine, University of Padua, Italy.
| | - G Sergi
- Department of Medicine, University of Padua, Italy
| | - A Coin
- Department of Medicine, University of Padua, Italy
| | - E M Inelmen
- Department of Medicine, University of Padua, Italy
| | - V Vindigni
- Institute of Plastic Surgery, University of Padua, Italy
| | - F Bassetto
- Institute of Plastic Surgery, University of Padua, Italy
| | - S Cinti
- Department of Experimental and Clinical Medicine & Diagnostic Electron Microscopy, United Hospitals, University of Ancona (Politecnico delle Marche), Italy
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24
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Rajan S, Gupta A, Beg M, Shankar K, Srivastava A, Varshney S, Kumar D, Gaikwad AN. Adipocyte transdifferentiation and its molecular targets. Differentiation 2014; 87:183-92. [PMID: 25130315 DOI: 10.1016/j.diff.2014.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/02/2014] [Accepted: 07/24/2014] [Indexed: 01/19/2023]
Abstract
According to the World Health Organization obesity is defined as the excessive accumulation of fat, which increases risk of other metabolic disorders such as insulin resistance, dyslipidemia, hypertension, cardiovascular diseases, etc. There are two types of adipose tissue, white and brown adipose tissue (BAT) and the latter has recently gathered interest of the scientific community. Discovery of BAT has opened avenues for a new therapeutic strategy for the treatment of obesity and related metabolic syndrome. BAT utilizes accumulated fatty acids for energy expenditure; hence it is seen as one of the possible alternates to the current treatment. Moreover, browning of white adipocyte on exposure to cold, as well as with some of the pharmacological agents presents exciting outcomes and indicates the feasibility of transdifferentiation. A better understanding of molecular pathways and differentiation factors, those that play a key role in transdifferentiation are of extreme importance in designing novel strategies for the treatment of obesity and associated metabolic disorders.
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Affiliation(s)
- Sujith Rajan
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031 UP, India; Academy of Scientific and Innovative Research, CSIR-CDRI, India
| | - Abhishek Gupta
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031 UP, India
| | - Muheeb Beg
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031 UP, India
| | - Kripa Shankar
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031 UP, India
| | - Ankita Srivastava
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031 UP, India; Academy of Scientific and Innovative Research, CSIR-CDRI, India
| | - Salil Varshney
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031 UP, India
| | - Durgesh Kumar
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031 UP, India; Academy of Scientific and Innovative Research, CSIR-CDRI, India
| | - Anil Nilkanth Gaikwad
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031 UP, India; Academy of Scientific and Innovative Research, CSIR-CDRI, India.
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25
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Lam JKY, Lam KSL, Chow WS, Tan KCB. A middle-aged man with increasing body fat. Clin Obes 2014; 4:237-40. [PMID: 25826795 DOI: 10.1111/cob.12061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
A 51-year-old man was referred for evaluation of gradual increase in body fat over bilateral arms, chest and abdomen for 6 months. He was a non-smoker and he drank at least four bottles of beer daily since the age of 18. There was no significant past medical history or any family history of obesity or endocrine diseases. Physical examination showed localized large bulk of fat over the neck, both arms and mammary regions, abdomen, and back (Figs and ). The lower limbs and buttock were relatively spared. There was telangiectasia over the face and chest wall, but no palmar erythema nor finger clubbing. The liver span was normal, and the spleen tip was palpated 2 cm below the costal margin. Examination of the cardiovascular, respiratory and neurological system was normal. [Figure: see text] [Figure: see text] Blood tests showed thrombocytopenia (platelet 140 × 10(9) L(-1) [normal: 170-380 × 10(9) L(-1) ]) and liver function derangement (bilirubin 27 μmol L(-1) , ALP 298 U L(-1) , ALT 127 U L(-1) , AST 165 U L(-1) , GGT 1353 U L(-1) , albumin 33 g L(-1) and globulin 42 g L(-1) ). His clotting profile and renal functions were normal. His hepatitis B surface antigen was positive, but his HBV DNA was <60 copies per mL. Fasting glucose was 5.0 mmol L(-1) . HbA1c was 5.6%. His lipid profile was satisfactory with total cholesterol of 2.9 mmol L(-1) , triglycerides 1.0 mmol L(-1) , HDL-C 1.37 mmol L(-1) and LDL-C 1.1 mmol L(-1) . Ultrasound of the abdomen showed normal-sized liver with coarsened liver parenchymal echogenicity. The spleen was enlarged to 14 cm. This middle-aged man suffered from multiple symmetric lipomatosis and alcoholic liver disease. Dual-energy X-ray showed 1746 gm (40.1%), 1498 gm (32.8%) and 8322 gm (26.8%) fat over the left arm, right arm and trunk, respectively. The legs were unaffected with 1703 gm (19.4%) and 1627 gm (17.7%) fat over the left and right sides, respectively. The patient was advised to stop drinking and he declined surgical treatment.
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Affiliation(s)
- J K Y Lam
- Department of Medicine, Queen Mary Hospital, Hong Kong
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26
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Multiple Symmetrical Lipomatosis--a mitochondrial disorder of brown fat. Mitochondrion 2013; 13:269-76. [PMID: 23524250 DOI: 10.1016/j.mito.2013.03.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 02/08/2013] [Accepted: 03/05/2013] [Indexed: 12/27/2022]
Abstract
Multiple Symmetrical Lipomatosis (MSL) is an unusual disorder characterized by the development of axial lipomas in adulthood. The pathoetiology of lipoma tissue in MSL remains unresolved. Seven patients with MSL were followed for a mean period of 12 years (8-20 years). All patients had cervical lipomas ranging from subtle lesions to disfiguring masses; six patients had peripheral neuropathy and five had proximal myopathy. Myoclonus, cerebellar ataxia and additional lipomas were variably present. All patients showed clinical progression. Muscle histopathology was consistent with mitochondrial disease. Five patients were positive for mtDNA point mutation m.8344A>G, three of whom underwent lipoma resection--all samples were positive for uncoupling protein-1 mRNA (unique to brown fat). Lipoma from one case stained positive for adipocyte fatty-acid protein-2 (unique to brown fat and immature adipocytes). This long-term study hallmarks the phenotypic heterogeneity of MSL's associated clinical features. The clinical, genetic and molecular findings substantiate the hypothesis that lipomas in MSL are due to a mitochondrial disorder of brown fat.
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27
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Sullo N, Roviezzo F, Matteis M, Spaziano G, Del Gaudio S, Lombardi A, Lucattelli M, Polverino F, Lungarella G, Cirino G, Rossi F, D'Agostino B. Skeletal muscle oxidative metabolism in an animal model of pulmonary emphysema: formoterol and skeletal muscle dysfunction. Am J Respir Cell Mol Biol 2012; 48:198-203. [PMID: 23144332 DOI: 10.1165/rcmb.2012-0167oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Skeletal muscle dysfunction is a significant contributor to exercise limitation in pulmonary emphysema. This study investigated skeletal muscle oxidative metabolism before and after aerosol exposure to a long-acting β-agonist (LABA), such as formoterol, in the pallid mouse (B6.Cg-Pldnpa/J), which has a deficiency in serum α(1)-antitrypsin (α(1)-PI) and develops spontaneous pulmonary emphysema. C57 BL/6J and its congener pallid mice of 8-12 and 16 months of age were treated with vehicle or formoterol aerosol challenge for 120 seconds. Morphological and morphometric studies and evaluations of mitochondrial adenosine diphosphate-stimulated respiration and of cytochrome oxidase activity on skeletal muscle were performed. Moreover, the mtDNA content in skeletal muscle and the mediators linked to muscle mitochondrial function and biogenesis, as well as TNF-α and peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), were also evaluated. The lungs of pallid mice at 12 and 16 months of age showed patchy areas of airspace enlargements, with the destruction of alveolar septa. No significant differences were observed in basal values of mitochondrial skeletal muscle oxidative processes between C57 BL/6J and pallid mice. Exposure to LABA significantly improved mitochondrial skeletal muscle oxidative processes in emphysematous mice, where the mtDNA content was significantly higher with respect to 8-month-old pallid mice. This effect was compared with a significant increase of PGC-1α in skeletal muscles of 16-month-old pallid mice, with no significant changes in TNF-α concentrations. In conclusion, in emphysematous mice that showed an increased mtDNA content, exposure to inhaled LABA can improve mitochondrial skeletal muscle oxidative processes. PGC-1α may serve as a possible mediator of this effect.
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Affiliation(s)
- Nikol Sullo
- Section of Pharmacology, Department of Experimental Medicine, Faculty of Medicine and Surgery, Second University of Naples, Via Costantinopoli 16, 80136 Naples, Italy
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Sanchez-Gurmaches J, Hung CM, Sparks CA, Tang Y, Li H, Guertin DA. PTEN loss in the Myf5 lineage redistributes body fat and reveals subsets of white adipocytes that arise from Myf5 precursors. Cell Metab 2012; 16:348-62. [PMID: 22940198 PMCID: PMC3488151 DOI: 10.1016/j.cmet.2012.08.003] [Citation(s) in RCA: 260] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/16/2012] [Accepted: 08/09/2012] [Indexed: 02/07/2023]
Abstract
The developmental origin of adipose tissue and what controls its distribution is poorly understood. By lineage tracing and gene expression analysis in mice, we provide evidence that mesenchymal precursors expressing Myf5--which are thought to give rise only to brown adipocytes and skeletal muscle--also give rise to a subset of white adipocytes. Furthermore, individual brown and white fats contain a mixture of adipocyte progenitor cells derived from Myf5(+) and Myf5(neg) lineages, the number of which varies with depot location. Subsets of white adipocytes originating from both Myf5(+) and Myf5(neg) precursors respond to β(3)-adrenoreceptor stimulation, suggesting "brite" adipocytes may also have multiple origins. We additionally find that deleting PTEN with myf5-cre causes lipomatosis and partial lipodystrophy by selectively expanding the Myf5(+) adipocyte lineages. Thus, the spectrum of adipocytes arising from Myf5(+) precursors is broader than previously thought, and differences in PI3K activity between adipocyte lineages alter body fat distribution.
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Affiliation(s)
- Joan Sanchez-Gurmaches
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
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29
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Borriello M, Lucidi A, Carbone A, Iannone V, Ferrandina G. Malignant transformation of Madelung's disease in a patient with a coincidental diagnosis of breast cancer: a case report. Diagn Pathol 2012; 7:116. [PMID: 22937763 PMCID: PMC3449177 DOI: 10.1186/1746-1596-7-116] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 08/26/2012] [Indexed: 12/13/2022] Open
Abstract
Abstract Madelung’s disease or multiple symmetric lipomatosis (MSL) is a rare disorder of unknown etiology which typically presents symmetrically subcutaneous accumulation of non-encapsulated adipose tissue which slowly grows around the neck, upper part of the arms, pelvis, back and thigh. This disease is also frequently associated with hepatopathy, glucose intolerance, hyperuricemia, and malignant tumors of the upper airways. Nevertheless, only one description of malignant transformation of Madelung’s disease has been presented in literature. Here, we report a case of liposarcomatous transformation of Madelung’s disease in a 59-year-old Italian woman with a coincidental diagnosis of breast cancer. Virtual slide The virtual slide for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3480884087499351
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Affiliation(s)
- Maddalena Borriello
- Department of Oncology, Gynecologic Oncology Unit, Catholic University, Campobasso, Italy
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Affiliation(s)
- Fang-ying Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taiwan
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Malattia di Madelung: descrizione di un caso clinico. ITALIAN JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.itjm.2011.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Olsen AB, Grebe TA, Joganic E. Multiple symmetric lipomatosis as a genetic disorder: a review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0697-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum's disease (DD) may be misdiagnosed as obesity. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Although lifestyle changes and bariatric surgery work effectively for the obesity component of RADs, these treatments do not routinely reduce the abnormal subcutaneous adipose tissue (SAT) of RADs. RAD SAT likely results from the growth of a brown stem cell population with secondary lymphatic dysfunction in MSL, or by primary vascular and lymphatic dysfunction in lipedema and DD. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone. In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may be confused. Treatment recommendations focus on evidence-based data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. Associated RAD conditions including depression, anxiety and pain will improve as healthcare providers learn to identify and adopt alternative treatment regimens for the abnormal SAT component of RADs. Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations.
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Müller CSL, Niclou M, Vogt T, Pföhler C. Lipedematous diseases of the scalp are not separate entities but part of a spectrum of lipomatous lesions. J Dtsch Dermatol Ges 2012; 10:501-7. [PMID: 22222012 DOI: 10.1111/j.1610-0387.2011.07830.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lipedematous lesions of the scalp share a wide range of morphologic criteria with classical lipomatosis. In the past decade, lipedematous scalp and lipedematous alopecia have been described as pathomorphologically related diseases of the scalp, but many clinicians and dermatopathologists disagree with this assessment. Morphologic and pathogenetic concepts remain unclear and raise the concern that a plethora of terms are being used to describe and distinguish phenotypical variations of an identical theme. PATIENT AND METHODS Here, we report a 15-year-old male Turkish child with what we could consider, according to the currently accepted classifications, lipedematous scalp without associated alopecia. RESULTS The principal aim of this manuscript is to critically reappraise the current literature on lipomatous lesions and focus on morphologic features in order to reestablish five crucial diagnostic criteria. CONCLUSIONS Due to the possibility of excluding therapeutic elements by separating the lipomatous lesions into various entities, we propose using the term "localized lipomatosis of the scalp with or without associated alopecia" in order to arrive at a straightforward diagnosis, thereby avoiding numerous partially synonymous terms; moreover, we do not intend to expand the spectrum of distinct lipomatous entities, but propose classification of these diseases within the group of conventional lipomatosis.
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Affiliation(s)
- Cornelia S L Müller
- Saarland University Hospital, Department of Dermatology, Homburg/Saar, Germany.
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Fonseca VR, Freitas C, Palmeira M, Ferreira C, Victorino R. Cardiac Noradrenergic Denervation in a Patient with Multiple Symmetric Lipomatosis. Cardiology 2012; 121:160-3. [DOI: 10.1159/000336951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 01/23/2012] [Indexed: 12/12/2022]
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Gomes da Silva R, Detoffol Bragança R, Ribeiro Costa C, Torres de Melo L, Weiss Telles R, Costa Silva L. Multiple symmetric lipomatosis. J Cutan Med Surg 2011; 15:230-5. [PMID: 21781630 DOI: 10.2310/7750.2011.10026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Multiple symmetric lipomatosis (MSL) is a relatively uncommon entity of unknown etiology characterized by symmetrically subcutaneous accumulation of nonencapsulated adipose tissue. Approximately 200 to 300 cases have been published. OBJECTIVES The aims of this article are to report the case of a 58-year-old Brazilian patient with MSL and provide a comprehensive overview of the current concepts concerning this disease. METHODS Our search yielded 28 articles on MSL, including case reports and reviews of the literature. RESULTS MSL predominantly affects Mediterranean males with a history of chronic alcohol abuse. It is usually asymptomatic and may be associated with diabetes mellitus, hyperlipidemia, hyperuricemia, macrocytic anemia, and oral cancer. Surgical resection is the best treatment option. CONCLUSION The case reported is a classic presentation of MSL; however, it is particularly uncommon owing to the association with immune thrombocytopenic purpura. This association has been described only once in the medical literature.
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Caron-Debarle M, Lagathu C, Boccara F, Vigouroux C, Capeau J. HIV-associated lipodystrophy: from fat injury to premature aging. Trends Mol Med 2010; 16:218-29. [DOI: 10.1016/j.molmed.2010.03.002] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/09/2010] [Accepted: 03/12/2010] [Indexed: 01/11/2023]
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Villarroya F, Domingo P, Giralt M. Drug-induced lipotoxicity: Lipodystrophy associated with HIV-1 infection and antiretroviral treatment. Biochim Biophys Acta Mol Cell Biol Lipids 2010; 1801:392-9. [DOI: 10.1016/j.bbalip.2009.09.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 09/09/2009] [Accepted: 09/17/2009] [Indexed: 12/24/2022]
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Rorke S, Lee M, Niumsawatt V, Hunter-Smith D, Kostos P, Findlay M. Benign symmetric lipomatosis. Pathology 2009; 41:600-2. [DOI: 10.1080/00313020903071546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shen CY, Ou CH, Tsao TF, Wu MC, Tyan YS. Multiple symmetric lipomatosis in two chinese patients, one typical and one unusual. Neuroradiol J 2009; 21:801-4. [PMID: 24257048 DOI: 10.1177/197140090802100608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 11/02/2008] [Indexed: 11/16/2022] Open
Abstract
Multiple symmetric lipomatosis (MSL; Madelung disease) is an uncommon disorder with diffuse multiple symmetrical unencapsulated accumulations of fat located in the neck and the upper trunk. MSL usually occurs in middle aged Caucasian men of Mediterranean ancestry with a history of alcoholism. In the past decade, an increasing number of cases in the Chinese population have been reported which appear to be limited to the head and neck regions. We describe two Chinese patients with MSL who have a history of alcoholism. The MR and CT findings disclosed that one patient had the typical accumulation of unencapsulated fat in the neck and upper back, while the other patient had more than the typical neck involvement and an unusual distribution of fat in the scrotum.
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Affiliation(s)
- C-Y Shen
- Department of Radiology, Chung Shan Medical University Hospital; Taichung, Taiwan -
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Zeitler H, Ulrich-Merzenich G, Richter DF, Vetter H, Walger P. Multiple Benign Symmetric Lipomatosis—A Differential Diagnosis of Obesity. Is There a Rationale for Fibrate Treatment? Obes Surg 2008; 18:1354-6. [DOI: 10.1007/s11695-008-9491-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 06/30/2007] [Indexed: 12/25/2022]
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Zhang XY, Li NY, Xiao WL. Madelung disease: manifestations of CT and MR imaging. ACTA ACUST UNITED AC 2008; 105:e57-64. [PMID: 18329916 DOI: 10.1016/j.tripleo.2008.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 11/14/2007] [Accepted: 01/01/2008] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of the present study was to assess the head and neck imaging features of Madelung disease on computerized tomography (CT) and magnetic resonance imaging (MRI), delineate the effects of the fatty deposits on underlying structures, and tabulate the anatomic sites where the neck fat was deposited. STUDY DESIGN Sixteen Chinese patients with Madelung disease in our hospital were reviewed. The CT manifestations of the 16 cases and the MRI manifestations of 1 case were analyzed retrospectively. The imaging features of the fatty distribution in the head and neck area were studied. RESULTS Cross-sectional CT showed that the excess fat was symmetric and unencapsulated, mainly deposited at the anterior or posterior subcutaneous tissue of the neck, was deep under the sternocleidomastoid and trapezius muscles, was situated in the posterior cervical triangle, and was around the salivary glands. It was also found to be situated in supraclavicular fossa, around the paraspinal muscles and larynx, and so on. The accumulated fat at superficial sites was situated at the napex and/or at the anterior neck, forming small or large fatty masses to protrude backwards locally or sometimes at submentum; the markedly thickened neck might appear tubby or oval in anteroposterior diameter. The accumulated fat at deep sites compressed adjacent muscles, salivary glands, and great vessels and caused them to shift and deform. The distinctive appearance was that marked thickening of fat caused sternocleidomastoid muscles and submaxillary glands to shift forward obviously, like a bird spreading its wings. The density of the abnormally proliferated fat was equal to that of normal fat. In MRI, the distribution of the excess fat was equal to that seen with CT. The signal intensity of the excess fat was equal to that of normal fat. Besides the accumulation of the neck fat tissue, CT and MRI did not show other abnormal soft tissue masses. CONCLUSIONS The use of CT and MRI can accurately show the excess fat based on density of CT and signal intensity of MRI. The density and signal intensity of the excess fat are equal to those of normal fat. The excess fat, mainly deposited at the anterior or posterior subcutaneous tissue of the neck, was deep under the sternocleidomastoid and trapezius muscles, was situated in the posterior cervical triangle, and was around the salivary gland, and so on. CT and MRI can also show compression, shift, and deformation of surrounding salivary glands, great vessels, and muscles caused by the excess fat. The CT and MRI can accurately diagnose the disease and exclude other soft tissue tumors.
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Affiliation(s)
- Xin-yu Zhang
- Department of Radiology, The Medical School Hospital of Qingdao University, Qingdao, China.
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Multiple Benign Symmetric Lipomatosis—A DifferentialDiagnosis of Obesity. Obes Surg 2008; 18:240-2. [DOI: 10.1007/s11695-007-9247-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 06/30/2007] [Indexed: 12/27/2022]
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Meningaud JP, Pitak-Arnnop P, Bertrand JC. Multiple symmetric lipomatosis: case report and review of the literature. J Oral Maxillofac Surg 2007; 65:1365-9. [PMID: 17577504 DOI: 10.1016/j.joms.2005.10.045] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 10/10/2005] [Accepted: 10/17/2005] [Indexed: 12/25/2022]
Affiliation(s)
- Jean-Paul Meningaud
- Department of Maxillofacial Surgery, Pitié-Salpêtrière Hospital, Paris, France.
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Poggi G, Moro G, Teragni C, Delmonte A, Saini G, Bernardo G. Scrotal involvement in Madelung disease: clinical, ultrasound and MR findings. ACTA ACUST UNITED AC 2007; 31:503-5. [PMID: 16447078 DOI: 10.1007/s00261-005-0401-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Multiple symmetrical lipomatosis, also known as Madelung disease, Launois-Bensaude syndrome, and benign symmetrical lipomatosis, is an uncommon disease that is characterized by the presence of multiple and symmetrical deposits of nonencapsulated adipose tissue in the neck, upper trunk, arms, and legs. It affects mainly men, with a higher incidence in the Mediterranean area, and is typically associated with high alcohol consumption and a high prevalence of peripheral neuropathy that usually appears long after the development of lipomatous masses. We report the case of a patient with involvement of the scrotum. We present clinical, ultrasound, and magnetic resonance appearances of these scrotal lipomatous masses for the first time.
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Affiliation(s)
- G Poggi
- Divisione di Oncologia II, IRCCS Fondazione S. Maugeri, Istituto Scientifico di Pavia, Pavia, 27100, Italy.
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Abstract
A lipomatose simétrica benigna é síndrome rara, caracterizada pelo acúmulo de massas de tecido adiposo no tronco, pescoço e nos membros que, pela peculiaridade de seus sinais clínicos, recebeu de seus primeiros observadores denominações camparativas que se tornaram clássicas e são até hoje utilizadas de maneira bastante apropriada. Com base no registro de um caso típico dessa condição, são demonstrados alguns desses aspectos, como "colar de cavalo"e a aparência "pseudoatlética".
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Coin A, Sergi G, Enzi G, Busetto L, Pigozzo S, Lupoli L, Sträter D, Peruzza S, Inelmen EM. Total and regional body composition and energy expenditure in multiple symmetric lipomatosis. Clin Nutr 2005; 24:367-74. [PMID: 15896422 DOI: 10.1016/j.clnu.2004.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 11/30/2004] [Indexed: 12/25/2022]
Abstract
AIMS The aim of the present study was to investigate possible alterations in body composition and resting energy expenditure (REE) in type 1 multiple symmetric lipomatosis (MSL). SUBJECTS AND METHODS Thirteen men aged from 40 to 78 years affected by type I MSL were compared with 13 healthy control subjects. Fat mass (FM) and fat-free mass (FFM) were determined by DEXA using both standard analysis and specifically for the lipomatous region. REE was measured by indirect calorimetry. RESULTS FM was higher in MSL subjects at proximal arm level, but significantly lower at distal leg level than in controls (left 1.63+/-0.55 vs. 2.26+/-0.49 kg, P<0.05; right 1.63+/-0.53 vs. 2.40+/-0.54 kg, P<0.01). Arm FFM was similar in the two groups, while distal leg FFM was significantly lower in MSL cases (left: 7.8+/-1.3 vs. 8.7+/-0.8 kg, P<0.05; right: 8.0+/-1.5 vs. 9.2+/-0.9 kg, P<0.05). FFM strongly correlated with REE (r:0.86;P<0.001). REE, expressed as an absolute value and adjusted for FFM (1830+/-215 vs. 1675+/-120 kcal, P<0.05) was higher in MSL patients. CONCLUSION In conclusion, MSL patients had a marked FFM and FM atrophy in the lower segments of the legs and an altered energy expenditure (hypermetabolism).
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Affiliation(s)
- Alessandra Coin
- Department of Medical and Surgical Sciences, Geriatrics Division, University of Padova, Via Giustiniani, 2,35128 Padova, Italy.
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Schoffer K, Grant I. Multiple lipomas, alcoholism, and neuropathy: Madelung's disease or MERRF? Muscle Nerve 2005; 33:142-6. [PMID: 16007676 DOI: 10.1002/mus.20406] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report a 51-year-old alcoholic man with a 10-year history of cervical lipomas and progressive symmetrical sensory neuropathy, initially diagnosed with Madelung's disease, an idiopathic syndrome often attributed to chronic alcoholism. The eventual development of proximal weakness led to pathological and genetic testing which identified a A8344G mutation in the mitochondrial tRNA lysine gene, associated with MERRF (myoclonic epilepsy with ragged-red fibers). This case demonstrates how the varied terminology for this syndrome has resulted in a lack of consistent recognition and assessment for mitochondrial cytopathy.
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Affiliation(s)
- Kerrie Schoffer
- Division of Neurology, Dalhousie University, Halifax, Nova Scotia, Canada.
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