Multiple Symmetric Lipomatosis--MR appearances

Madelung Disease: Analysis of Clinicopathological Experience in Taipei Veterans General Hospital

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.

Madelung disease: manifestations of CT and MR imaging

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.

Multiple symmetric lipomatosis (MSL) of neck in a child (Madelung's disease): report of a rare presentation

A case of multiple symmetric lipomatosis (MSL) of neck, also known as Madelung's disease or Launois-Bensaude syndrome, is reported in an 8-year-old girl who presented with bilateral swellings in the neck. MSL is characterized by large subcutaneous fat masses distributed around the neck, shoulders and other parts of the trunk, often associated with abnormalities of the nervous system. This is commonly seen in middle-aged men with a history of alcohol abuse. Metabolic disturbances and malignant tumours have also been associated with this disorder. MSL is rare in children and there was only one prior report in the literature describing MSL that affected two children. With an initial clinical suspicion of bilateral cystic hygroma, imaging was sought. CT demonstrated multiple compartmentalized, unencapsulated fat-containing lesions on either side of the neck extending into the mediastinum. This radiographic appearance was strongly suggestive of lipomatous tissue within the neck and eventually confirmed by histopathology. The recognition of this disease is important as, in addition to cosmetic abnormality, it can compress the important neurovascular structures. These fatty deposits were later surgically excised.

From the archives of the AFIP: benign musculoskeletal lipomatous lesions

Benign lipomatous lesions involving soft tissue are common musculoskeletal masses that are classified into nine distinct diagnoses: lipoma, lipomatosis, lipomatosis of nerve, lipoblastoma or lipoblastomatosis, angiolipoma, myolipoma of soft tissue, chondroid lipoma, spindle cell lipoma and pleomorphic lipoma, and hibernoma. Soft-tissue lipoma accounts for almost 50% of all soft-tissue tumors. Radiologic evaluation is diagnostic in up to 71% of cases. These lesions are identical to subcutaneous fat on computed tomographic (CT) and magnetic resonance (MR) images and may contain thin septa. Lipomatosis represents a diffuse overgrowth of mature fat affecting either subcutaneous tissue, muscle or nerve, and imaging is needed to evaluate lesion extent. Lipoblastoma is a tumor of immature fat occurring in young children, and imaging features may reveal a mixture of fat and nonadipose tissue. Angiolipoma, myolipoma, and chondroid lipoma are rare lipomatous lesions that are infrequently imaged. Spindle cell and pleomorphic lipoma appear as a subcutaneous lipomatous mass in the posterior neck or shoulder, with frequent nonadipose components. Hibernoma appears as a lipomatous mass with serpentine vascular elements. Benign lipomatous lesions affecting bone, joint, or tendon sheath include intraosseous lipoma, parosteal lipoma, liposclerosing myxofibrous tumor, discrete lipoma of joint or tendon sheath, and lipoma arborescens. Intraosseous and parosteal lipoma have a pathognomonic CT or MR appearance, with fat in the marrow space or on the bone surface, respectively. Liposclerosing myxofibrous tumor is a rare intermixed histologic lesion commonly located in the medullary canal of the intertrochanteric femur. Benign lipomatous lesions may occur focally in a joint or tendon sheath or with diffuse villonodular proliferation in the synovium (lipoma arborescens) and are diagnosed based on location and identification of fat. Understanding the spectrum of appearances of the various benign musculoskeletal lipomatous lesions improves radiologic assessment and is vital for optimal patient management.

Doença de Madelung (lipomatose cervical benigna simétrica): relato de dois casos

Os autores relatam dois casos da doença de Madelung, que consiste em depósitos simétricos de gordura localizados no pescoço, ombros e mediastino superior, envolvendo nervos e vasos. Recomenda-se o uso da tomografia computadorizada, a qual confirma a natureza lipóide da massa, útil no estadiamento pré-operatório e acompanhamento pós-cirúrgico.