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Lungu M, Oprea VD, Stoleriu G, Ionescu AM, Zaharia AL, Croitoru A, Stan B, Niculet E. Madelung's Disease Evolving to Liposarcoma: An Uncommon Encounter. Life (Basel) 2024; 14:521. [PMID: 38672791 PMCID: PMC11051324 DOI: 10.3390/life14040521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Madelung's disease-known also as Benign Symmetric Adenolipomatosis (BSA) or Multiple Symmetric Lipomatosis (MSL), is a rare subcutaneous tissue disease characterized by the proliferation of non-encapsulated fat tissue with mature adipocytes. Patients develop symmetrical fatty deposits of varying sizes, (located particularly around the neck, shoulders, upper and middle back, arms, abdomen, and thighs), having clinical, esthetic, and psychiatric repercussions. (2) Methods: We report a case diagnosed with BSA upon admission to the Neurological and Internal Medicine Departments of the Emergency Clinical Hospital of Galati. (3) Results: This patient developed compressive phenomena and liposarcoma with liver metastasis, followed by death shortly after hospital presentation. The histopathology examination confirmed right latero-cervical liposarcoma and round cell hepatic metastasis. The specific metabolic ethiopathogenic mechanism has not been elucidated, but the adipocytes of BSA are different from normal cells in proliferation, hormonal regulation, and mitochondrial activity; a rare mitochondrial gene mutation, together with other interacting genetic or non-genetic factors, have been considered in recent studies. A thorough literature search identified only three cases reporting malignant tumors in BSA patients. (4) Conclusions: The goal of our paper is to present this rare case in the oncogenic synergism of two tumors. In the management of this BSA disorder, possible malignant transformation should be considered, although only scarce evidence was found supporting this.
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Affiliation(s)
- Mihaiela Lungu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Violeta Diana Oprea
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Gabriela Stoleriu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Spiridon” Clinical Emergency County Hospital Iasi, 700111 Iasi, Romania
| | - Ana-Maria Ionescu
- Faculty of Medicine and Pharmacy, Ovidius University of Constanța, 900470 Constanța, Romania;
| | - Andrei Lucian Zaharia
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Ana Croitoru
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Bianca Stan
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Elena Niculet
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
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Rajakumar P, Mahadevan S, Asirvatham AR, Ranjan A. Drug-Induced Atypical Lipodystrophy. JCEM CASE REPORTS 2024; 2:luae067. [PMID: 38638337 PMCID: PMC11025636 DOI: 10.1210/jcemcr/luae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 04/20/2024]
Abstract
We describe a case of an Asian-Indian female patient who presented to us with abnormal fat accumulations in the torso and upper arms following indiscriminate use of corticosteroid and anabolic steroids for about 7 years. Despite prolonged steroid use, the patient did not display cushingoid phenotype or metabolic decompensation. Bone density, echocardiography, and ultrasonogram of the liver were also normal with no evidence of excess pericardial fat, hepatic steatosis, or peliosis hepatis. Concurrent use of anabolic androgen is thought to be protective against the ill effects of steroids, especially on the muscle and bone. This phenomenon has been observed in children and adolescents with Cushing syndrome where the adrenal androgen excess and increased physical activity have shown to reasonably reduce protein catabolism and help in preserving muscle and bone mass. The patient was withdrawn from the drugs and was put on replacement hydrocortisone that was gradually tapered over the next few weeks and planned for surgical correction. This case highlights the fact that medical providers should be aware that a combination of anabolic steroids and glucocorticoids are still used for weight-building purposes, and these patients may present with atypical signs/symptoms as a result of this combination of drugs.
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Affiliation(s)
- Priyadarshini Rajakumar
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai 600116, Tamilnadu, India
| | - Shriraam Mahadevan
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai 600116, Tamilnadu, India
| | - Adlyne Reena Asirvatham
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai 600116, Tamilnadu, India
| | - Asha Ranjan
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai 600116, Tamilnadu, India
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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.
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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
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Li R, Wang C, Bu Q, Pu W, Zhou B, Che L, Zhang H, Xu Y, Luan H. Madelung's Disease: Analysis of Clinical Characteristics, Fatty Mass Distribution, Comorbidities and Treatment of 54 Patients in China. Diabetes Metab Syndr Obes 2022; 15:2365-2375. [PMID: 35966829 PMCID: PMC9364939 DOI: 10.2147/dmso.s363836] [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: 03/03/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Madelung's disease (MD) is a rare disease characterized by the deposition of unencapsulated fat masses on the face, neck, chest, back and other areas of patients. The aim of the study was to analyze the clinical characteristics, comorbidities and treatment of MD in Chinese populations. PATIENTS AND METHODS We retrospectively reviewed the medical records of 54 patients who were diagnosed with MD at the Affiliated Hospital of Qingdao University and Qingdao Municipal Hospital from January 2005 to February 2021 and collected the subjects' demographic information, clinical indicators, location of fat deposits, treatment, complications and prognostic data. RESULTS Among 54 MD patients in the study, only 1 (1.85%) was female, and the subjects had an average age of 56.65 ± 7.93 years. More than 70% of patients had a history of long-term smoking or/and alcohol abuse. In our study, type I accounted for approximately 61.11% of cases according to Donhauser's classification, and almost all patients had neck fat deposition. MD patients often have multiple comorbidities across several systems, such as the endocrine, digestive, circulatory, urinary, and neurological systems. Among these, endocrine system diseases were the most common comorbidities in our study, accounting for 81.48%. Notably, up to 20.37% of cases were complicated with cancer, especially digestive system tumors. More than 70% of the patients received surgical treatment, and nearly 40% experienced postoperative recurrence. CONCLUSION Considering that MD patients often have comorbidities of multiple systems and that a small number of cases are even complicated by cancer, we recommend that clinicians comprehensively assess a patient's condition and complications, advocate that patients quit consuming alcohol and smoking as soon as possible, establish healthy dietary and living habits, and formulate individualized and comprehensive diagnosis and treatment plans.
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Affiliation(s)
- Runze Li
- Department of Medicine, Qingdao University, Qingdao, People’s Republic of China
- Department of Endocrine, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Chuanxiao Wang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, People’s Republic of China
| | - Quandong Bu
- Department of Nephrology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Wenshen Pu
- Department of Nephrology, Baoshan People’s Hospital, Baoshan, People’s Republic of China
| | - Bin Zhou
- Department of Nephrology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Lin Che
- Department of Nephrology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Hui Zhang
- Department of Nephrology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Yan Xu
- Department of Nephrology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Hong Luan
- Department of Nephrology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
- Correspondence: Hong Luan, Department of Nephrology, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, People’s Republic of China, Tel +86 18661803208, Fax +86 532-82911601, Email
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