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Affiliation(s)
- Juliana D'Andrea Molina
- Dermatology Service, Hospital Regional de Presidente
Prudente, Universidade do Oeste Paulista, Presidente Prudente (SP), Brazil
| | - Gisele Alborghetti Nai
- Dermatology Service, Hospital Regional de Presidente
Prudente, Universidade do Oeste Paulista, Presidente Prudente (SP), Brazil
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Affiliation(s)
- Devis Benfaremo
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Michele Maria Luchetti
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy.
| | - Armando Gabrielli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
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Schaffer PR, Hale CS, Meehan SA, Shupack JL, Ramachandran S. Adiposis dolorosa. Dermatol Online J 2014; 20:13030/qt1st6x3dm. [PMID: 25526345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 06/04/2023] Open
Abstract
We report a 46-year-old woman with a nine-year history of obesity; chronic diffuse pain in the adipose tissue of her medial upper arms, lower trunk, and thighs; multiple biopsy-proven lipomas and angiolipomas; and a lipomatous pseudomass of the breast. Her systemic symptoms included generalized weakness, fatigue, memory impairment, and arthralgias. Although some of the lesions were tender, most were only appreciated with palpation. Her clinical history and histopathologic data suggested adiposis dolorosa (Dercum's disease). Owing to the chronic pain, an interdisciplinary approach with the use of analgesics and doxycycline has been initiated.
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Rasmussen JC, Herbst KL, Aldrich MB, Darne CD, Tan IC, Zhu B, Guilliod R, Fife CA, Maus EA, Sevick-Muraca EM. An abnormal lymphatic phenotype is associated with subcutaneous adipose tissue deposits in Dercum's disease. Obesity (Silver Spring) 2014; 22:2186-92. [PMID: 25044620 PMCID: PMC4180796 DOI: 10.1002/oby.20836] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 06/22/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Investigational, near-infrared fluorescence (NIRF) lymphatic imaging was used to assess lymphatic architecture and contractile function in participants diagnosed with Dercum's disease, a rare, poorly understood disorder characterized by painful lipomas in subcutaneous adipose tissues. METHODS After informed consent and as part of an FDA-approved feasibility study to evaluate lymphatics in diseases in which their contribution has been implicated, three women diagnosed with Dercum's disease and four control subjects were imaged. Each participant received multiple intradermal and subcutaneous injections of indocyanine green (ICG, total dose ≤400 µg) in arms, legs, and/or trunk. Immediately after injection, ICG was taken up by the lymphatics and NIRF imaging was conducted. RESULTS The lymphatics in the participants with Dercum's disease were intact and dilated, yet sluggishly propelled lymph when compared to control lymphatics. Palpation of regions containing fluorescent lymphatic pathways revealed tender, fibrotic, tubular structures within the subcutaneous adipose tissue that were associated with painful nodules, and, in some cases, masses of fluorescent tissue indicating that some lipomas may represent tertiary lymphoid tissues. CONCLUSIONS These data support the hypothesis that Dercum's disease may be a lymphovascular disorder and suggest a possible association between abnormal adipose tissue deposition and abnormal lymphatic structure and function.
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Affiliation(s)
- John C. Rasmussen
- The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - Karen L. Herbst
- Department of Medicine, University of California – San Diego, San Diego, CA
- Veteran’s Affairs San Diego Healthcare System
| | - Melissa B. Aldrich
- The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - Chinmay D. Darne
- The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - I-Chih Tan
- The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - Banghe Zhu
- The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - Renie Guilliod
- Medical School, The University of Texas Health Science Center at Houston, Houston, TX
- Memorial Hermann Hospital, Houston, TX
| | - Caroline A. Fife
- Medical School, The University of Texas Health Science Center at Houston, Houston, TX
- Memorial Hermann Hospital, Houston, TX
| | - Erik A. Maus
- Medical School, The University of Texas Health Science Center at Houston, Houston, TX
- Memorial Hermann Hospital, Houston, TX
| | - Eva M. Sevick-Muraca
- The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX
- , 1825 Pressler St, Houston, TX 77030; Phone: 713-500-3561; Fax: 713-500-0319
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Petersen RB, Berg JO. [Picture of the month: dercum disease]. Ugeskr Laeger 2011; 173:1887. [PMID: 21712013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Rikke Børthy Petersen
- Klinik for Plastikkirurgi og Brandsårsbehandling, Afsnit 2102, HovedOrtoCentret, Rigshospitalet, 2100 København Ø, Denmark
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Kawale J, Mahore A, Dange N, Bhoyar K. Adiposis dolorosa of scalp presenting with severe headache: an unusual case. J Headache Pain 2010; 11:539-41. [PMID: 20811764 PMCID: PMC3476222 DOI: 10.1007/s10194-010-0253-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 08/16/2010] [Indexed: 11/25/2022] Open
Abstract
A 46-year-old female, known case of adiposis dolorosa since adolescence, noticed painful thickening of scalp in bilateral parieto-occipital areas and vertex 1 year back. Six weeks prior to the presentation to our service, she developed severe occipital headache refractory to drug treatment. She improved after bilateral greater occipital nerve blocks. She was subjected to bilateral greater occipital chemical neurolysis which has given her complete pain relief.
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Affiliation(s)
- Juhi Kawale
- Department of Medicine, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, India
| | - Amit Mahore
- Department of Neurosurgery, King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, 400012 India
| | - Nitin Dange
- Department of Neurosurgery, King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, 400012 India
| | - Kalpesh Bhoyar
- Department of Neuro-anaesthesia, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, India
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Haddad D, Athmani B, Costa A, Cartier S. [Dercum's disease: a severe complication in a rare disease. A case report]. ANN CHIR PLAST ESTH 2005; 50:247-50. [PMID: 15963847 DOI: 10.1016/j.anplas.2004.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Accepted: 12/13/2004] [Indexed: 11/18/2022]
Abstract
Dercum's disease or adiposis dolorasa is unusual and unknown. Four symptoms are typical. It is characterized by painful subcutaneous fatty tumors in postmenopausal woman. We present this disease through the study of an uncommon clinical case: a sceptic choc following the "steato-cutaneous-necrosis" of a fatty tumor. The disease remains rare. The etiology is to this day unknown and different hypothesis (endocrinous, metabolic, genetics) are put forward. Multiple complications can occur but severe septicemia is rare. The treatment can be medical (loss of weight, corticoids, intravenous lidocaine) or surgical (surgical excision or liposuction).
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Affiliation(s)
- D Haddad
- Service de chirurgie plastique et maxillofaciale, centre hospitalier de Gonesse, 25, rue Pierre-de-Theilley, 95503 Gonesse, France.
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Abstract
Adiposis dolorosa is a rare condition characterized by multiple painful lipomas. We describe two typically affected siblings who were found to have at least 5 affected first-degree relatives in two generations. Manifestations were remarkably variable, ranging from complete disability to solitary asymptomatic tumors. Review of histopathologic findings did not reveal any features that might distinguish the tumors from common sporadic lipomas. Mutational analysis excluded the 8344 A to G mitochondrial mutation seen in other patients with multiple lipomas. Adiposis dolorosa may be an extreme manifestation of the more common condition of familial multiple lipomas. Further work is needed to define the genetic basis of these conditions.
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Affiliation(s)
- R Campen
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
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Abstract
Adiposis dolorosa is a disease characterized by painful, subcutaneous fatty tumors. This disorder usually occurs in obese, postmenopausal women and is associated with weakness and mental disturbances such as depression, confusion, lethargy, and dementia. The cause is unknown, and there is no specific treatment. Pain may be relieved by steroids, intravenous lidocaine, or analgesics. Surgical treatment consists of excision or liposuction of the painful masses. We present two cases of adiposis dolorosa in men, with a follow-up of more than 10 years.
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Affiliation(s)
- S Brodovsky
- Department of Plastic Surgery, Assaf HaRofeh Medical Center, Tzrifin, Israel
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Abstract
Radiation-induced changes to the parotid gland may complicate later surgery for new or recurrent tumors of the area. Radiation commonly causes the replacement of parotid parenchyma by adipose cells as well as fibrosis and glandular atrophy. If the Mohs micrographic surgeon is not prepared for the gross and microscopic changes which may be present in the parotid gland, neighboring structures such as the facial nerve may be inadvertently encountered and tumor depth and extent may be poorly estimated. By discussing and illustrating this situation, we hope to make other surgeons aware of the difficulties which may be present after radiation to the parotid gland.
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Affiliation(s)
- A C Harrington
- Department of Dermatology, New England Medical Center, Boston, MA
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Fagher B, Monti M, Nilsson-Ehle P, Akesson B. Fat-cell heat production, adipose tissue fatty acids, lipoprotein lipase activity and plasma lipoproteins in adiposis dolorosa. Clin Sci (Lond) 1991; 81:793-8. [PMID: 1662586 DOI: 10.1042/cs0810793] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
1. Gluteal adipose tissue was examined in 13 patients with generalized adiposis dolorosa, a clinical condition characterized by painful adiposity with a chronic intractable course. The total metabolic activity of fat cells, isolated by collagenase and suspended in Krebs-Ringer bicarbonate buffer with glucose and insulin, was assessed by the measurement of heat production at 37 degrees C using microcalorimetry. 2. Fat cells were markedly enlarged; their metabolic activity expressed in terms of microW/g, but not in pW/cell, was significantly decreased when compared with both lean and weight-matched non-painful subjects. Both mean values were, however, significantly higher than in grossly obese subjects with similar mean cell size. Heat production as expressed per g of tissue, but not per cell, was inversely correlated with body mass index. One additional patient had unilateral disease, and fat cells from the painful side had a lower heat production than cells from the unaffected side. 3. The fatty acid composition of adipose tissue, as determined by g.c., revealed a significantly increased proportion of monounsaturated (18:1 and 16:1) at the expense of saturated (14:0 and 18:0) fatty acids compared with healthy control subjects. The activity of adipose tissue lipoprotein lipase was slightly, but not significantly, decreased. 4. It is concluded that a metabolic pathogenetic factor cannot be ruled out in adiposis dolorosa. As the results do not explain the nature of the diffuse pain, further studies need to be performed.
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Affiliation(s)
- B Fagher
- Department of Internal Medicine, University Hospital of Lund, Sweden
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Abstract
Two patients are presented who had symptomatic relief of juxta-articular adiposis dolorosa of the knees after liposuction. Liposuction is recommended for the treatment of this condition.
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Affiliation(s)
- M De Silva
- Department of Rheumatology, Prince Charles Hospital, Merthyr Tydfil
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DeFranzo AJ, Hall JH, Herring SM. Adiposis dolorosa (Dercum's disease): liposuction as an effective form of treatment. Plast Reconstr Surg 1990; 85:289-92. [PMID: 2300638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The clinical picture of adiposis dolorosa makes a lasting impression on the examining physician. The patient is typically an obese, asthenic woman who appears to have a low pain threshold. She has an unusual distribution of fatty tumors, and her complaint of pain in these tumors seems out of proportion to the physical findings. Alcoholism, emotional instability, and depression are common, and narcotic pain medicine is frequently requested. The patient is easily dismissed as a malingerer after a brief examination. However, liposuctioning of the painful fatty tumors appears to be both practical and effective. While adiposis dolorosa is an unusual disease, it is one that plastic surgeons can recognize and treat.
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Affiliation(s)
- A J DeFranzo
- Department of Surgery, Bowman Gray School of Medicine
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Kapkaev RA, Akovbian VA, Rumi TK. [Dercum's disease]. Vestn Dermatol Venerol 1984:41-2. [PMID: 6720070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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