1
|
Li S, Xiao Y, Wang Y, Bai M, Du F, Zhang H. Exploration of Influencing Factors for Postoperative Recurrence in Patients with Madelung's Disease on the Basis of Multivariate Stepwise Cox Regression Analysis. Clin Cosmet Investig Dermatol 2023; 16:103-110. [PMID: 36686607 PMCID: PMC9851055 DOI: 10.2147/ccid.s368273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/16/2022] [Indexed: 01/16/2023]
Abstract
Purpose Madelung's disease (MD) is a rare condition of massive deposits of fat accumulations between superficial and deep fascia at typical locations. There is an absence of systematic studies related to MD in the Chinese cohort. Thus, the objective of the study was to investigate the clinical features of the MD cases in our institution and to explore the clinical variables associated with postoperative recurrence. Materials and Methods We retrospectively analyzed the clinical information of 21 individuals with MD from 2013 to 2021 enrolled in our institution. The paired t-test and χ 2 test were, respectively, used to determine the difference between continuous and classified variables. The univariate Kaplan-Meier analysis by log-rank and multivariate stepwise Cox regression analysis were used to explore variables possibly associated with postoperative recurrence in MD individuals. Results In the current study, 90.48% of the studied patients were male with a mean age of 48.76 years old. About 61.90% exhibited type I MD. MD patients who experienced postoperative recurrence had a higher age, BMI, incidence of chronic complications, and prevalence of alcoholism than the other MD patients without recurrence (P < 0.05). The univariate Kaplan-Meier analysis by log-rank identified that age, BMI, alcoholism, and comorbidities were influencing factors related with postoperative recurrence (P < 0.05). Conclusion Demographic characteristics of the 21 studied Chinese cases with MD were generally in accordance with previously published data of other foreign populations. The factors possibly influencing the postoperative recurrence for patients with MD were age, BMI, alcoholism, and a combination of comorbidities. This is the first time that a summarization of clinical characteristics and postoperative recurrence variables of Chinese patients with MD has been reported.
Collapse
Affiliation(s)
- Shuo Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yiding Xiao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ming Bai
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fengzhou Du
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hailin Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| |
Collapse
|
2
|
Yan YJ, Zhou SQ, Li CQ, Ruan Y. Diagnostic and surgical challenges of progressive neck and upper back painless masses in Madelung’s disease: A case report and review of literature. World J Clin Cases 2022; 10:361-370. [PMID: 35071540 PMCID: PMC8727246 DOI: 10.12998/wjcc.v10.i1.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/14/2021] [Accepted: 12/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Madelung’s disease (MD) is a chronic alcoholism-associated metabolic syndrome characterized by symmetrical subcutaneous deposition of adipose tissue in the head, neck, shoulders, back, trunk, and nerve roots of the upper and lower limbs. It is relatively rare in Asian individuals and is prone to misdiagnosis. Herein, we report a case of a patient with MD who had undergone surgical management at our hospital, and we discuss the pathogenesis, diagnosis, and treatment of MD.
CASE SUMMARY We report a case of MD in a 65-year-old man of Han descent. The patient had multiple, painless progressive masses for more than five years in the neck and more than 30 years in the upper back. Because of neck mobility limitations and progressive cosmetic deformities caused by the masses, he was admitted to our hospital. He drank approximately 500 mL of liquor per day and smoked heavily for more than 30 years. Contrast-enhanced computed tomography of the neck and chest documented abundant unencapsulated, subcutaneous fatty deposits. We prepared a staged operation plan. The patient was diagnosed with MD; he was advised to abstain from alcohol and was followed up regularly. After a 3-month follow-up, no recurrence of fat accumulation was found in the surgical areas.
CONCLUSION This report presents a case of surgical treatment for MD to improve clinicians' understanding of the disease.
Collapse
Affiliation(s)
- Ya-Jie Yan
- Department of Otorhinolaryngology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Shi-Qing Zhou
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510075, Guangdong Province, China
- Department of Otorhinolaryngology head and neck, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Chun-Qiao Li
- Department of Otorhinolaryngology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Yan Ruan
- Department of Otorhinolaryngology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| |
Collapse
|
3
|
Duc NQ, Lam VN, Thu Hai LT, Nghia NT, Linh LD. Multiple Symmetric Lipomatosis: Lipectomy for Madelung Collar. PLASTIC AND AESTHETIC NURSING 2022; 42:18-26. [PMID: 36450070 DOI: 10.1097/psn.0000000000000413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Multiple symmetric lipomatosis (MSL) is a rare disease associated with metabolic disorders and alcoholism. In this report, we describe the clinical outcome and surgical protocol for eight men with Madelung collar who underwent treatment in a craniofacial and plastic surgery facility in Hanoi, Vietnam, between May 2018 and December 2020. We discuss the patients' clinical symptoms, subclinical signs, epidemiology, magnetic resonance imaging, computerized tomography, surgical protocol, complications, and postoperative indicators that we collected and evaluated. Each patient underwent surgery in two stages (i.e., in supine and prone positions). We injected a tumescent solution 10 min before the incision. Two surgeons performed each operation simultaneously. After surgery, we followed the patients for 6-27 months. All of the patients had a history of long-time alcohol abuse and had associated comorbidities that included liver disease, blood disorders, restricted neck movement, and orthopnea. We did not have to open the trachea or transfuse blood during any of the surgical procedures. Postoperatively, all patients were satisfied with their functional results and aesthetic appearance. One patient experienced a recurrence of his MSL. We believe our surgical protocol provides optimal results for patients with MSL and Madelung collar.
Collapse
Affiliation(s)
- Nguyen Quang Duc
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Vu Ngoc Lam
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Le Thi Thu Hai
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Nguyen Trong Nghia
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Le Diep Linh
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| |
Collapse
|
4
|
Seskute G, Dapkute A, Kausaite D, Strainiene S, Talijunas A, Butrimiene I. Multidisciplinary diagnostic dilemma in differentiating Madelung’s disease — the value of superb microvascular imaging technique: A case report. World J Clin Cases 2021; 9:6145-6154. [PMID: 34368337 PMCID: PMC8316957 DOI: 10.12998/wjcc.v9.i21.6145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/13/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Madelung’s disease, also known as multiple symmetrical lipomatosis, is a rare, underrecognized disorder of fat metabolism that results in unusual accumulation of subcutaneous fat deposits around the neck, shoulders, upper arms, trunk, hips, and upper thighs. Our case demonstrates the importance of differential diagnosis and the value of a superb microvascular imaging technique for suspecting and confirming Madelung’s disease. Timely diagnosis and alcohol abstinence could prevent the progression of growing fatty masses and prevent surgery.
CASE SUMMARY A 62-year-old male was admitted to the Rheumatology center complaining of symmetric subcutaneous tumors in the area of the parotid and submandibular salivary glands, small soft masses in the occiput and upper third of the forearm, rashes on calves. A high titer of rheumatoid factor and low concentrations of serum complements were detected. The high-end ultrasound and magnetic resonance imaging examinations of all affected areas of the soft tissues showed predominantly adipose tissue (lipomas) without suspicion of liposarcoma. The biopsy from the small salivary gland revealed no pathology. After evaluating the patient’s clinical presentation (symmetrical lipomatosis, cirrhosis, gynecomastia, anemia, hyperuricemia), Madelung’s disease, type I, along with the psoriatic rash and psoriatic arthritis and secondary liver cirrhosis were established.
CONCLUSION Madelung’s disease consists of many co-occurring disorders imitating and overlapping with other conditions. Ultrasonography is the first choice for suspecting and confirming symmetrical lipomatosis.
Collapse
Affiliation(s)
- Goda Seskute
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Austeja Dapkute
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | | | - Sandra Strainiene
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Andrius Talijunas
- Institute of Dentistry, Faculty of Medicine, Vilnius University, Vilnius 01512, Lithuania
| | - Irena Butrimiene
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| |
Collapse
|
5
|
Li B, Rang ZX, Weng JC, Xiong GZ, Dai XP. Benign symmetric lipomatosis (Madelung’s disease) with concomitant incarcerated femoral hernia: A case report. World J Clin Cases 2020; 8:5474-5479. [PMID: 33269286 PMCID: PMC7674738 DOI: 10.12998/wjcc.v8.i21.5474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Benign symmetric lipomatosis (BSL) was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888. At present, about 400 cases have been reported worldwide. Across these cases, surgical resection remains the recommended treatment. Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region, which concealed the signs of a right incarcerated femoral hernia.
CASE SUMMARY A 69-year-old male patient was admitted to our hospital with “abdominal pain, abdominal distension, nausea-vomiting and difficult defecation for half a month”. Moreover, he had a mass in the right inguinal region for more than 10 years. An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later. In addition, the patient had a history of heavy alcohol consumption for more than 40 years. With the aid of computerized tomography scan, the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia. Under general anesthesia, right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed. However, this patient did not receive BSL resection. After a 1-year follow-up, no recurrence of the right inguinal femoral hernia was found. Moreover, no increase in fat accumulation was found in the neck or other areas.
CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect, but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.
Collapse
Affiliation(s)
- Bo Li
- Department of Vascular and Hernia Surgery, The Second Affiliated Hospital of Nanhua University, Hengyang 421001, Hunan Province, China
| | - Zheng-Xing Rang
- Department of Vascular and Hernia Surgery, The Second Affiliated Hospital of Nanhua University, Hengyang 421001, Hunan Province, China
| | - Jia-Cong Weng
- Department of Vascular and Hernia Surgery, The Second Affiliated Hospital of Nanhua University, Hengyang 421001, Hunan Province, China
| | - Guo-Zuo Xiong
- Department of Vascular and Hernia Surgery, The Second Affiliated Hospital of Nanhua University, Hengyang 421001, Hunan Province, China
| | - Xian-Peng Dai
- Department of Vascular and Hernia Surgery, The Second Affiliated Hospital of Nanhua University, Hengyang 421001, Hunan Province, China
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Hamza F, Elbanoby T, Dahshan H, Elbatawy A. Infantile Asymmetrical Diffuse Infiltrative Lipomatosis of the Abdomen and Upper Thighs: A Case Report with Long-Term Follow-up. Aesthet Surg J Open Forum 2020; 2:ojaa026. [PMID: 33791649 PMCID: PMC7671237 DOI: 10.1093/asjof/ojaa026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2020] [Indexed: 11/14/2022] Open
Abstract
The authors present the case of an 11-year-old male patient with a diffuse infiltrative lipomatosis involving the abdomen, flanks, and upper thighs by applying body contouring principles at this early age. Abdominoplasty can be used in children for various purposes, including harvesting a full-thickness skin graft in burns or to treat congenital anomalies involving the pelviabdominal area. Level of Evidence: 5 ![]()
Collapse
Affiliation(s)
- Fawzy Hamza
- Plastic and Reconstructive Surgery Department, Al Azhar University, Cairo, Egypt
| | - Tarek Elbanoby
- Plastic and Reconstructive Surgery Department, Al Azhar University, Cairo, Egypt
| | - Hazem Dahshan
- Plastic and Reconstructive Surgery Department, Al Azhar University, Cairo, Egypt
| | - Amr Elbatawy
- Plastic and Reconstructive Surgery Department, Al Azhar University, Cairo, Egypt
| |
Collapse
|
8
|
Madelung’s disease: case series and literature review. ACTA MEDICA MARTINIANA 2018. [DOI: 10.2478/acm-2018-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Madelung’s disease also called benign symmetric lipomatosis is a rare disorder of unknown etiology. The disease affects almost exclusively middle-aged men with a history of multi-year alcohol abuse. The major symptom is presence of non-encapsulated benign fat masses, especially in the area of the head and neck. Limited head and neck movement, dysphagia, and dyspnea may appear as well.
The diagnosis is clinical and is supported by imaging methods, often elevated hepatic enzymes in blood serum, and histological examination with finding of mature adipose tissue without signs of proliferation. Therapeutic methods involve liposuction or excision which is a method of choice nowadays.
In this article the authors review current knowledge, research state, and present five cases of the Madelung’s disease occurring within the last 10 years at the Clinic of Otorhinolaryngology and Head and Neck Surgery in Martin, Slovakia.
Collapse
|
9
|
Maximiano LF, Gaspar MT, Nakahira ES. Madelung disease (multiple symmetric lipomatosis). AUTOPSY AND CASE REPORTS 2018; 8:e2018030. [PMID: 30101135 PMCID: PMC6066263 DOI: 10.4322/acr.2018.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022] Open
Abstract
Madelung disease or multiple symmetric lipomatosis (MSL) is a rare entity among the overgrowth syndromes. It is characterized by painless non-encapsulated and symmetric fatty deposits in the neck, torso, mammary, and abdominal areas, and in the upper and lower limbs. The etiology of the disease is still unknown. Chronic alcohol consumption may play a role in adipocyte hyperplasia in genetically susceptible individuals. Besides the overgrowth of adipose tissue, patients with MSL present features of metabolic syndrome. Patients seek medical attention usually for esthetic reasons. We present the case of a middle-aged man who sought the outpatient clinic complaining of bulging masses in the posterior upper part of the thorax, the occipital area, and the neck. The masses grew over a period of 2 years. The physical examination and imaging study revealed the presence of symmetric lipomatosis. A two-step surgical treatment was undertaken for the excision of the lipomatous tissue. The postoperative outcome was uneventful with satisfactory esthetic results.
Collapse
Affiliation(s)
- Linda Ferreira Maximiano
- Universidade de São Paulo (USP), Hospital Universitário, Surgical Clinics Division. São Paulo, SP, Brazil
| | | | | |
Collapse
|
10
|
Multiple Symmetric Lipomatosis: New Classification System Based on the Largest German Patient Cohort. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1722. [PMID: 29876171 PMCID: PMC5977945 DOI: 10.1097/gox.0000000000001722] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/31/2018] [Indexed: 12/25/2022]
Abstract
Background: Multiple symmetric lipomatosis (MSL) is defined as a disorder of nonencapsulated adipose tissue growth. Its prevalence is indicated as 1:25,000 and affects, as stated in the literature, mainly Mediterranean males (male:female ratio of 15:1). Phenotypes are still classified as defined by Donhauser in 1991. We report clinical and phenotypic data of the largest patient cohort investigated in Germany so far. Methods: Forty-five patients diagnosed with MSL at the University Hospital Regensburg between 2007 and 2017 were photographed, clinically examined, and blood samples were taken. Based on the photographs (n = 33), 11 independent observers assessed patients using the Donhauser classification. Furthermore, the bodies of all patients were subdivided into 12 body areas, and the viewers had to indicate all MSL-affected areas per patient. Prevalence was calculated, comorbidities were assessed, and blood samples were analyzed. Results: According to the established Donhauser classification, less than 50% of the patients could be classified. Therefore, based on the constellations of MSL-affected body areas, a new classification that divides phenotypes of MSL into 5 types (Ia, Ib, Ic, II, and III) was set up and was able to cover 100% of our patients. The male to female ratio was found to be 1:2.5 (male:female). Prevalence of MSL in the catchment area was found to be 1:25,000. Hypercholesterinemia and hypothyroidism were frequent comorbidities, and blood analyses were normal besides a hypercholesterinemia. Discussion: The new proposed classification system describes 5 subtypes and allowed to classify all assessed patients. Male to female ratio (1:2.5) contradicted most previous publications.
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Madelung's Disease: Lipectomy or Liposuction? BIOMED RESEARCH INTERNATIONAL 2018; 2018:3975974. [PMID: 29682541 PMCID: PMC5840946 DOI: 10.1155/2018/3975974] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/06/2018] [Accepted: 01/18/2018] [Indexed: 12/27/2022]
Abstract
Background Madelung's disease is a rare lipid metabolic disorder characterized by diffuse, uncapsulated lipomas in the neck, shoulder, and other areas. It mainly affects middle-aged men and is related to alcohol abuse, and the cause is not clear. Surgical treatments include lipectomy and liposuction. Methods This systematic review analyzed the treatment of Madelung's disease described in 52 articles including complete patient details, published between 2000 and 2015, and retrieved from the Web of Science, PubMed, Medline, and Embase. Results Lipectomy was performed in most cases and achieved more complete removal and better control of iatrogenic lesions of nearby structures than liposuction. Liposuction achieved good cosmetic results and is simpler and less invasive than lipectomy, but clinical experience is limited. Conclusions Both lipectomy and liposuction have advantages and drawbacks. Surgeons should base the choice of optimal treatment on patient characteristics. Novel surgical techniques and etiologically targeted treatments hold promise as future therapies.
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Wollina U, Heinig B. Madelung's Disease - Case Series and Treatment by Tumescent Liposuction or Lipectomy. Open Access Maced J Med Sci 2017; 5:427-431. [PMID: 28785324 PMCID: PMC5535649 DOI: 10.3889/oamjms.2017.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 04/22/2017] [Accepted: 04/23/2017] [Indexed: 12/11/2022] Open
Abstract
Madelung disease is a disfiguring disorder belonging to the heterogeneous group of lipomatosis. The aetiology is not well understood, but alcohol consumption has been regarded as of importance. The reported incidence is about 1 in 25,000 inhabitants. We reviewed our files of the last ten years and identified eight adult patients with an equal gender distribution. Their age was between 60 and 85 years of life. Comorbidities are frequent. Clinical presentation may vary. Surgical treatment is reported and discussed. Both cold steel surgery and tumescent liposuction have their place in treatment.
Collapse
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden, Germany
| | - Birgit Heinig
- Center for Physical and Rehabilitative Medicine, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital, Friedrichstrasse 41, 01067, Dresden, Germany
| |
Collapse
|