[Multiple symmetrical lipomatosis: report of two different clinical types and review of the literature]

Multiple symmetrical lipomatosis or Lauwnois-Bensaude disease is a rare entity characterized by the development of subcutaneous fat masses around the neck shoulders and upper extremities. Peripheral neuropathy is a common finding as well as the association with alcholism, hepatopathy and glucose intolerance. Pathogenesis is unknown. We describe three cases with two different clinical types and review the data reported in medical literature.

Multiple symmetric lipomatosis: clinical aspects and outcome in a long-term longitudinal study

BACKGROUND

Multiple symmetric lipomatosis (MSL) is a rare disease characterized by the growth of uncapsulated masses of adipose tissue. MSL is associated with high ethanol intake and complicated by somatic and autonomic neuropathy and by the infiltration of the adipose tissue at the mediastinal level. To date, the disease is considered as slowly progressive, but long-term longitudinal data are still lacking. In this study, a long-term follow-up of a large series of MSL patients is presented.

METHODS

We studied 31 patients with MSL (30 males and one female) first evaluated at our institution from 1973 to 1992. All patients were followed until 1998-1999 or until death, with a mean follow-up of 14.5+/-5.0 y (range 4-26 y). Both at baseline and during follow-up, the location and the size of the subcutaneous lipomatous fat depots, the presence and the extension of deeply localized lipomatous tissue, and the presence and the severity of both somatic and autonomic neuropathy were evaluated.

RESULTS

Eight MSL patients died during follow-up (25.8% of patients). A sudden death was proved to be the cause of death in three patients. All these three patients had severe autonomic neuropathy and none had coronary disease, acute myocardial infarction or other cardiac abnormalities. No signs or symptoms of coronary heart disease were present in the whole series. In addition to this high fatality rate, a substantial morbidity related to the occupation of the mediastinal space by the lipomatus tissue and to somatic neuropathy was also observed.

CONCLUSIONS

MSL is associated with a significant morbidity and mortality. Therefore, the definition of 'benign symmetric lipomatosis', still adopted by several authors, cannot be justified.

Long-term results following surgical treatment of benign symmetric lipomatosis (BSL)

Benign symmetric lipomatosis is a rare disease. Its main characteristic is the symmetric deposition of fat, in an unencapsulated form, at typical sites in the body, but primarily in the head and neck region. Its aetiopathogenesis is unknown. A disturbance of lipid metabolism is involved, and there is a proven connection with chronic alcoholism. Problems with the differential diagnosis of the characteristic clinical picture arise from the fact that this disease is not widely recognized. Over a period of 30 years, the authors treated 31 patients with benign symmetric lipomatosis. They review the pertinent literature and report retrospectively on the fates of the 11 surviving patients.

Mitochondrial toxicity induced by nucleoside-analogue reverse-transcriptase inhibitors is a key factor in the pathogenesis of antiretroviral-therapy-related lipodystrophy

Highly active antiretroviral therapy (HAART) can induce a characteristic lipodystrophy syndrome of peripheral fat wasting and central adiposity. HIV-1 protease inhibitors are generally believed to be the causal agents, although the syndrome has also been observed with protease-inhibitor-sparing regimens. Here, we postulate that the mitochondrial toxicity of the nucleoside-analogue reverse-transcriptase inhibitors plays an essential part in the development of this lipodystrophy, similar to the role of mitochondrial defects in the development of multiple symmetrical lipomatosis.

[Lipoma, multiple lipomas and lipomatosis]

Lipomatous tumors are very frequent; simple lipoma is the most common variety. According to Enzinger, lipomatous tumors are classified into five different groups: simple lipomas, variant lipomas forms, heterotopic lipomas, infiltrating lipomas and lipomatosis, and finally hibernomas. Usually, lipomatous tumors are characterized by a slow, unpainful, growth. Classical treatment includes surgical resection. The clinical diagnosis is confirmed by histology. Liposucion can be a therapeutic option in certain cases.

[Launois Bensaude disease. Focus apropos of 16 cases]

After a review of the clinical, pathological and aetiological features, the authors describe the various surgical techniques used (conventional surgery or liposuction) to restore a normal social life to these patients, deformed by their disease. They confirm the predominant role of conventional surgery and define the limited indications in which liposuction can be used. Based on a review of 16 cases, the surgeon must make sure that the patient has ceased his or her alcohol abuse before performing this difficult treatment associated with a number of complications.

[Classification and terminological designation of Madelung's lipomatosis]

From experience in the treatment of 18 patients with Madelung's lipomatosis the authors suggest a system of designation of the spread of the disease embracing the possible localizations of the tumor. The system of recording the spread and marked character of the adipose tumors makes it possible to appraise the developmental stage of the disease. It is suggested that 4 stages of the disease are distinguished. According to the type of growth, two forms of tumors are distinguished: nodular and diffuse. Systemic designation and the form of the tumor give a more complete idea of the disease and thus allow the optimal tactics of surgery to be chosen. Among the numerous terms suggested for the disease, the most appropriate, reflecting the essence of the disease is "Madelung's lipomatosis". The authors suggest it for unification of the designations of the disease and easier literature search and generalization of information on this rare disease.

[Benign symmetric Launois-Bensaude type III lipomatosis and Bureau-Barrière syndrome]

We report on a patient with an unusual distribution of benign symmetric Launois-Bensaude lipomatosis. In addition, the patient presented with Bureau-Barrière syndrome. With regard to our own observations and those reported in the literature, we propose a new classification of the disease referred to the distribution of the fatty tissue.