Shedding Light on Multiple Symmetric Lipomatosis: An Overlooked Syndrome in the Evaluation of Obesity

BACKGROUND Multiple symmetric lipomatosis (MSL), also known as Launois-Bensaude syndrome, is a rare syndrome that is frequently misinterpreted as simple obesity. It has seldom been reported. Both conditions can coexist; however, unlike common obesity, in which total body fat is well distributed, patients affected by MSL present with symmetrical, painless fat masses that predominantly appear in the face, neck, occipital region and supraclavicular fossa. Launois-Bensaude syndrome's etiology is still poorly understood but an association with alcohol use has been documented. CASE REPORT A 49-year-old woman was referred to our department due to class II obesity (body mass index of 39.8 kg/m²). She had a history of arterial hypertension and daily wine consumption (2 glasses on average). She complained of weight gain after menopause and she reported having tried multiple times to lose weight by herself without success. On physical examination, the patient had an unusual pattern of fat distribution: exuberant symmetrical fat masses that were localized in her arms and thighs and spared her face, neck, forearms, and lower legs. She claimed that these masses had a rapid onset and then stabilized. The clinical history and the patient's phenotype were compatible with a non-classic type of Launois-Bensaude syndrome. CONCLUSIONS We concluded that our patient's condition encompasses more than just simple obesity; it involved a distinct form of adiposopathy that led to a completely different clinical approach. A detailed physical examination seems to be key for clinical suspicion of this rare syndrome, which can be a true pitfall in obesity evaluation.

Multiple symmetrical lipomatosis: A literature review and case report of a patient with Madelung's disease

<b><br>Introduction:</b> Madelung's disease is a rare condition characterised by the symmetric growth of fatty tumours (lipomas) around the neck, shoulders, upper arms and trunk.</br> <b><br>Case report:</b> We present a description of a male patient with extensive adipose tissue overgrowth around the neck. Once the possibility of malignancy was excluded, the patient's history and clinical and radiological findings led to the diagnosis of Madelung's disease. A two-stage surgery was planned and the patient underwent lipectomy of the lipomas around the neck.</br> <b><br>Conclusions:</b> This article analyses the clinical data with Madelung's disease; discusses its aetiology, clinical manifestations, diagnosis and treatment methods; and provides help with clinical diagnosis and treatment.</br>.

[A case of Madelung's disease combined with laryngeal cancer]

Madelung's disease is a lipodystrophy of unknown etiology. This article reports a case of Madelung's disease complicated with laryngeal cancer. The clinical manifestations of the patient were progressive hoarseness and dyspnea, dysphagia, and diffuse symmetrical swelling of the neck, submental, and submandibular. Dynamic laryngoscopy revealed a giant cauliflower-like neoplasm in the throat, with the left vocal cord fixed. Laryngeal CT showed laryngeal carcinoma （transglottic type）, signs of lymph node metastasis in the left jugular chain region, and Madelung syndrome in the neck. Biochemical tests showed albumin 38.7 g/L, globulin 27.5 g/L, prealbumin 160 g/L, aspartate aminotransferase 14 IU/L, γ-transpeptidase 80 IU/L, alanine aminotransferase 7 IU/L, Creatinine 43 μmol/L. Preoperative pathology suggested squamous cell carcinoma. Admission diagnosis included laryngeal cancer （transglottic T4N1M0）, Ⅲ degree laryngeal obstruction, Madelung's disease and fatty liver. The patient recovered well after surgery.

Proptosis of the eye: a potential form of Madelung's disease

Madelung's disease is a rare disorder characterised by excessive and symmetrical deposits of adipose tissue, typically in the cervicofacial region. Alcohol is a known cause of the condition, however, there are reports that this condition is genetically inherited. Lipomatosis of the orbit has been described in the alcoholic Madelung's disease, however, in our case report, we believe this is the first reported instance of proptosis caused by the genetic form of the condition. We present a 69-year-old woman, with a medical history of genetic Madelung's disease, who presented with bilateral proptosis worse in her right eye. Her ocular examination was normal apart from exophthalmometry, showing bilateral proptosis. This was confirmed by an MRI, which further showed intraorbital fat deposition bilaterally. Due to the stability of her condition, no treatment was deemed necessary. We highlight the importance of monitoring for progressive optic nerve compromise and liposarcomatous malignant transformation.

Madelung's disease in a non-alcoholic Ethiopian male patient mistaken for obesity: a case report

BACKGROUND

Madelung's disease (MD) is a rare disorder of fat storage characterized by the presence of diffuse, symmetrical deposition of subcutaneous fat around the neck, shoulder, arm, trunk and thigh. Although its cause is not fully understood, this benign condition is commonly presented among adult males with Mediterranean origin and history of alcohol abuse. Patients often presents with compression of vital structures, cosmetic disfigurement and associated psychosocial problems and systemic comorbidities. It is often under-recognized by physicians, possibly due to obliviousness of the condition and often misdiagnosed as obesity.

CASE PRESENTATION

We present a 65-year-old non-alcoholic black Ethiopian man, presented with a slowly growing body fat in his trunk and proximal limbs associated by multiple joint and back pain which got worse recently. He denied any history of chronic alcohol use. On examination, huge, bilateral, non-tender, soft, globular masses in his torso, shoulder, arm and thigh with bilateral breast enlargement. On investigation his biochemical profile was normal except hyperuricemia (10.6 mg/dl). Imaging of the cervical and lumbar vertebrae showed excess subcutaneous fat depositions with degenerative disc disease. Biopsy from the mass revealed non-encapsulated lipoma and he was diagnosed with type II MD. We treated his pain with supportive therapy and discharged in stable condition. The patient deferred surgical treatment.

CONCLUSIONS

Madelung's disease is often reported among white adult males with chronic alcoholism. However, our case reported a black man without the typical risk factor which was misdiagnosed as obesity. Hence, clinicians should be aware of MD and need to consider it in their differential diagnosis when encountered with a patient having progressive centripetal fat deposition with or without a history of alcoholism and systemic comorbidities. As early detection of this disorder helps to avoid diagnostic delays and prevent complications through timely interventions which will in turn improves patient quality of life.

Madelung Disease Epidemiology and Clinical Characteristics: a Systemic Review

BACKGROUND

Madelung disease is a rare lipid metabolic disorder, and most cases are sporadically reported. There are currently no systematic reviews summarizing the epidemiological and clinical characteristics of this disease. The purpose of the current article is to extract and analyze the existing evidence concerning Madelung disease derived from case series in order to provide adequate treatments for patients based on a more comprehensive understanding of the disease.

METHODS

PubMed, Embase, and Web of Science databases were queried for relevant articles using the search terms "Madelung disease," "multiple symmetric lipomatosis," "Launois-Bensaude syndrome" and synonyms until Aug 31,2020. Data statistics of Madelung disease epidemiology and clinical characteristics are summarized in different tables or charts with Microsoft Office software.

RESULTS

Patients exhibiting Madelung disease were mostly located in Europe, although some records existed in Asia as well. Average patient age was between 45 and 65 years old. Type I was the most common form of the disease, and the neck was the most common location for tumors. Madelung disease is associated with various metabolic disorders, and hematoma and seroma were the most common complications. Overall recurrence rate was 18.3%, with similar recurrence rates after lipectomy and liposuction. Fewer complications occurred after liposuction compared with lipectomy, but relapse was more common after liposuction.

CONCLUSION

Madelung disease consists of specific epidemiological and clinical characteristics, knowledge of which can be helpful for diagnosis and cognition. Lipectomy and liposuction are considered to be the most effective treatment methods for Madelung disease; however, choice of surgery should be based on comprehensive consideration of the disease, such as severity, mass location, and patient expectations.

LEVEL OF EVIDENCE IV

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Multiple symmetric lipomatosis with secondary laryngeal obstruction: A case report

INTRODUCTION

Multiple symmetric lipomatosis (MSL) is an uncommon medical condition characterized by symmetric fat accumulation mainly in the neck and other upper body regions. The involvement of the larynx is rare according to the literature, and we present a case of MSL with larynx involvement treated with a surgical approach.

PATIENT CONCERNS

A 55-year-old male was admitted to our hospital due to progressively aggravated breathing difficulty, and tracheotomy was performed before transfer. When he tried to block the cannula, the breathing difficulty returned. The patient's neck had been thickening for the past 2 years.

DIAGNOSIS

Pathological examination confirmed the diagnosis of MSL.

INTERVENTIONS

The patient underwent lumpectomy and neck exploration.

OUTCOMES

The lipoma was removed, the patient was free of any dyspnea symptoms and recovered well, and the tracheal cannula was removed at a local hospital.

CONCLUSION

MSL can infiltrate the larynx and grow into the preepiglottic space and paraglottic spaces, resulting in breathing difficulties. Lipomas present in the spaces described above must be removed at the same time; otherwise, symptoms of dyspnea cannot be alleviated.

Benign symmetric lipomatosis in the tongue: an uncommon case

Symmetric lipomatosis of the tongue (SLT) is rare and characterized by diffuse growth and unencapsulated lipomas. An 87-year-old man was referred for evaluation of tongue lesions. Intraoral findings showed soft yellowish nodules with a smooth shiny surface diffusely on the lateral border of the tongue, bilaterally. Our clinical diagnosis was multiple tongue lipomas and an incisional biopsy was done. Histopathological examination revealed unencapsulated lobules of mature adipocytes with slight variation in the size and shape, confirming the diagnosis of lipoma. The final diagnosis was SLT. On follow-up at 6 months, the tongue findings were unchanged and no new lesions were observed.

Absence of 18 F-fluorodeoxyglucose uptake using Positron Emission Tomography/Computed Tomography in Madelung's disease: A case report

Madelung's disease is characterized by the manifestation of multiple ectopic lipomas, usually found in the cervical-thoracic region, however, clinical manifestation may vary among patients. It has been postulated that lipomas associated with Madelung's disease are linked to brown adipose tissue (BAT) due to the presence of uncoupling protein 1 (UCP1). Therefore, we here investigated whether BAT activity is present in a patient with Madelung's disease. ¹⁸ F-fluorodeoxyglucose (¹⁸ F-FDG) uptake using PET/CT after a cooling procedure was measured together with body temperature and energy expenditure. Finally, adipose tissue biopsies were taken from the lipomas for gene expression analysis and histology. ¹⁸ F-FDG uptake was not detected after the cooling procedure in the lipomas. Furthermore, adipose tissue biopsies derived from the lipomas did not express UCP1. We thus conclude that cold-stimulated BAT activity was not detected in lipomas associated with Madelung's disease. Additional research in other patients is needed to unravel the role of dysfunctional BAT in Madelung's disease.

Madelung's Disease: Is Insobriety the Chief Cause?

BACKGROUND

Madelung's disease (MD) is a rare disease of unknown etiology that is characterized by massive fatty deposits distributed in a symmetrical pattern mainly in the head, neck, and upper trunk. Here, we sought to explore the pathogeny and treatment of MD.

METHODS

We enrolled ten patients who underwent surgical operations and one patient who refused an operation at our hospital between January 2009 and December 2016. We collected their medical histories and the preoperative and postoperative serological indices. The serum chemistry clinical outcomes were compared between the preoperative and postoperative states.

RESULTS

The mean alcohol intake of the eleven patients exceeded 450 g daily. Ten patients underwent open excisions, and the other patient refused an operation. No significant differences were observed between the preoperative and postoperative serum chemistry results. No recurrence has yet been observed in any of the ten operated patients.

CONCLUSIONS

All of the patients in our study had associated alcoholism. Thus, insobriety might be one of the causes of MD. We believe that open operations may be an effective treatment based on the outcomes of the surgeries.

LEVEL OF EVIDENCE IV

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Spinal cord compression syndrome caused by intraspinal epidural fibrous cord: Three case reports

RATIONALE

The spinal cord compression caused by intraspinal epidural fibrous cord.

PATIENT CONCERNS

All patients in this study had spinal cord compression syndrome caused by an intraspinal epidural fibrous cord, manifested as abnormally increased epidural adipose tissue by imaging.

DIAGNOSE

These abnormal fibrous connective tissue strips were not identical to the known pathological tissue such as "meningovertebral ligament." Instead, it might be a novel pathogenic cause for the spinal cord compression.

INTERVENTIONS

The intraspinal exploratory operation.

OUTCOMES

the first case has expected effect, the remaining two need further test.

LESSONS SUBSECTIONS

The disease could be easily misdiagnosed as spinal epidural lipoma or lipomatosis before the operation. However, the overt intraoperative finding was the indefinite starting and ending points of the epidural adipose mass in addition to the increased amount of adipose tissue. The obvious compression on the spinal cord could be found as the extraordinarily large and broad hypertrophic fibrous connective tissue strips.Further studies are needed to elucidate whether it is different from, or associated with, lipoma and epidural lipomatosis, which is a serious issue to be considered by both clinicians and radiologists. Therefore, early discovery,diagnosis, and treatment should be the prerequisites to achieve a satisfactory effect.

A case of symmetrical lipomatosis of the tongue presenting as macroglossia

Lipomas are the most common benign soft tissue mesenchymal tumours composed of mature adipose tissue. They are uncommon in the oral and maxillofacial regions, with 15-20 % of cases involving the head and neck region and less than 5% of all benign oral lesions. Multiple symmetric lipomatosis is rare and characterized by diffuse growth and nonencapsulated lipomas. It is usually found in the posterior neck and upper trunk and they are relatively infrequent on the oral and maxillofacial regions like Madelung disease. In the report, we describe a rare case of symmetrical lipomatosis of tongue with OSAS and Dysartria. This lesions were resected under general anesthesia. Intraoperative findings revealed only adipose tissues with replacement of lingual muscles and no capsulation. The lesion was finally diagnosed as symmetric lipomatosis of the tongue based on clinical radiological and histologic examination. SLT (Symmetrical lipomatosis of the tongue) is an extremely rare case that appears like a macroglossia. Partial glossectomy is the treatment of choice because of the improvement of symptoms and the low rate of recurrence.

KEY WORDS

Macroglossia, Oral lipoma, Tongue lipomatosis.

[Benign symmetric lipomatosis (Madelung's disease): four cases report]

Benign symmetrical lipomatosis (BSL), or Madelung's disease, is a rare disease characterized by he progressive growth of diffuse, painless, non-enveloped symmetric lipomas at typical sites in the body. The etiology of this disease remains 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. Surgical lipectomy in several sessions can relieve pressure and provide satisfactory patient functional recovery as well as cosmetic disfiguration.

Syndromic lipomatosis of the head and neck: a review of the literature

INTRODUCTION

Patients with syndromic causes of lipomatosis of the head and neck, although rare, often present late in the course of the disease in a myriad of ways, including concomitant airway obstruction, severe functional limitations, and/or significant cosmetic defects. The goal of this report was to review the literature and present a concise overview of the major syndromes causing lipomatosis of the head and neck.

METHODS

A literature search was performed to gather information on syndromic lipomatosis of the head and neck region. PubMed was searched for the following conditions: Familial multiple lipomatosis (FML), multiple symmetrical lipomatosis (MSL), congenital infiltrating lipomatosis of the face (CIL-F), and Nasopalpebral lipoma-coloboma syndrome (NLCS). Data gathered included results of surgical cases of the head and neck region.

RESULTS

A total of 48 reports comprising 172 cases of syndromic lipomatosis of the head and neck region were deemed eligible for review. Eighty-five percent of patients were male with an average age of 35 years. Seventy-four percent of cases appeared in the neck region, whereas 23 % presented in the face and scalp. 89 % of cases were treated with surgical excision, with 11 % of cases treated with liposuction. The most common complications were hematoma and seroma in MSL, recurrence in FML, neuropraxia in CIL-F, and mild telecanthus in NLCS.

CONCLUSIONS

Syndromic causes of lipomatosis are generally benign in nature but difficult to control long term. Because these conditions include frequent recurrence and subsequent difficulty in clearing the disease, the authors advocate early and aggressive surgical excision of syndromic lipomatosis.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Madelung disease : report of a case and review of the literature

Madelung disease is a rare disorder characterized by the presence of multiple, symmetric, nonencapsulated fatty accumulations diffusely involving the cheeks, the neck, the upper trunk, the shoulder girdle area, and the upper extremities. The cause of this syndrome is unknown, but it has been associated with alcoholism in 60% to 90% of -patients. The long-term lipomatous deposits are often large and cosmetically deforming, and the upper aerodigestive tract and great veins may be compressed. We report the case of a man with MD, involving the cervical and upper dorsal -regions, who underwent surgical treatment at our Department.

A middle-aged man with increasing body fat

A 51-year-old man was referred for evaluation of gradual increase in body fat over bilateral arms, chest and abdomen for 6 months. He was a non-smoker and he drank at least four bottles of beer daily since the age of 18. There was no significant past medical history or any family history of obesity or endocrine diseases. Physical examination showed localized large bulk of fat over the neck, both arms and mammary regions, abdomen, and back (Figs  and ). The lower limbs and buttock were relatively spared. There was telangiectasia over the face and chest wall, but no palmar erythema nor finger clubbing. The liver span was normal, and the spleen tip was palpated 2 cm below the costal margin. Examination of the cardiovascular, respiratory and neurological system was normal. [Figure: see text] [Figure: see text] Blood tests showed thrombocytopenia (platelet 140 × 10(9)  L(-1) [normal: 170-380 × 10(9)  L(-1) ]) and liver function derangement (bilirubin 27 μmol L(-1) , ALP 298 U L(-1) , ALT 127 U L(-1) , AST 165 U L(-1) , GGT 1353 U L(-1) , albumin 33 g L(-1) and globulin 42 g L(-1) ). His clotting profile and renal functions were normal. His hepatitis B surface antigen was positive, but his HBV DNA was <60 copies per mL. Fasting glucose was 5.0 mmol L(-1) . HbA1c was 5.6%. His lipid profile was satisfactory with total cholesterol of 2.9 mmol L(-1) , triglycerides 1.0 mmol L(-1) , HDL-C 1.37 mmol L(-1) and LDL-C 1.1 mmol L(-1) . Ultrasound of the abdomen showed normal-sized liver with coarsened liver parenchymal echogenicity. The spleen was enlarged to 14 cm. This middle-aged man suffered from multiple symmetric lipomatosis and alcoholic liver disease. Dual-energy X-ray showed 1746 gm (40.1%), 1498 gm (32.8%) and 8322 gm (26.8%) fat over the left arm, right arm and trunk, respectively. The legs were unaffected with 1703 gm (19.4%) and 1627 gm (17.7%) fat over the left and right sides, respectively. The patient was advised to stop drinking and he declined surgical treatment.

Bilateral large palpable cervical masses: not always a malignant or infectious process

Madelung's disease is an extremely rare disorder of unknown etiology characterized by multiple, non-encapsulated, infiltrative lipomas located symmetrically on the trunk, neck, and proximal parts of the limbs. Approximately 200 patients have been reported in the medical literature. In this case report we present an extremely unusual case of multiple symmetric lipomatosis compatible with Madelung's disease.

Multiple benign symmetric lipomatosis -- a differential diagnosis of obesity

Benign symmetrical lipomatosis (BSL), or Madelung's disease, is a rare disease characterized by the progressive growth of diffuse, painless, non-enveloped symmetric lipomas. The etiology of this disease remains unknown, although it was associated in the medical literature with alcohol and nicotine abuse, metabolic disorders and a number of malignancies. It is assumed that there is a genetic predisposition for this affliction. The management in such cases is surgical removal of the lipomas, most times in several sessions, but this is often followed by relapse. However, surgical removal of the lipomas can provide satisfactory patient functionality and cosmetic results. The differential diagnosis is made with morbid obesity, Cushing syndrome, angiolipomatosis, encapsulated lipomas, neurofibromatosis, myxoid liposarcoma, lymphoma, salivary gland disease, Frolich and lipomatosis syndrome in patients infected with HIV. The current paper reports the case of a 55 year-old man, who presented with several large lipomatous masses, arranged symmetrically on the front and back of the trunk, and several smaller lipomas in the upper and lower limbs. Treatment consisted of resection of these lipomas in several sessions, without recurrence at one year after the last operation.

Madelung's disease: comorbidities, fatty mass distribution, and response to treatment of 22 patients

BACKGROUND

Madelung's disease (MD) is an uncommon pathology characterized by the presence of multiple masses of unencapsulated adipose tissue that is symmetrically distributed. The aim of this study was to investigate clinical and epidemiological features of patients diagnosed with MD in our department. Associated diseases and evolution after treatment were also investigated.

METHODS

We reviewed the clinical histories of 22 patients diagnosed with MD from 1990 to 2010 and obtained their epidemiological and clinical characteristics.

RESULTS

We found 21 patients with MD type 1 and one patient with MD type 2 according to Enzi's classification. All patients were male, 95.5% with high alcohol intake, and 59.1% with some hepatic disease. No family antecedents were significant; 40.9% had dyslipidemia, 22.7% arterial hypertension, 22.7% chronic obstructive pulmonary disease (COPD), 13.6% hyperuricemia, 9.1% hypothyroidism, 4.5% diabetes mellitus type 2, and 4.5% carbohydrate intolerance; 40.9% had a body mass index>30, and 27.3% presented gynecomastia/lipomastia. The region most frequently affected by fatty deposits was the neck.

CONCLUSIONS

Madelung's disease affects mainly alcoholic males in their fourth decade of life. Hepatic diseases appear in most patients. Also associated with MD are high lipid blood levels, arterial hypertension, COPD, hyperuricemia, and obesity. MD type 1 is the most frequent phenotype and the neck the most common location for fatty masses. Recurrence after surgery, in the same location or different locations, is a frequent event, even in patients who later abstain from alcohol intake.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .

[A man with a pseudo-athletic posture]

We describe a 50-year-old man with slowly progressive symmetric nonencapsulated fatty deposits on the shoulders, upper extremities en abdomen. These clinical findings are compatible with Madelungs disease and are associated with alcohol abuses and polyneuropathy.

Cytophagic histiocytic panniculitis with haemophagocytosis in a patient with familial multiple lipomatosis and review of the literature

We report a patient with the extremely rare familial multiple lipomatosis syndrome, who developed the uncommon autoimmune disease cytophagic histiocytic panniculitis, manifested as inflammation of preexisting lipomas. Despite his initial critical condition and unsuccessful treatment with steroids, he responded to cyclosporin and remains well 15 years after diagnosis. In contrast with most previous reports, our patient stays dependent on cyclosporin; repeated attempts of discontinuing or substituting treatment were quickly followed by relapse. Haemophagocytic panniculitis is considered as a T-cell disorder, but its exact pathophysiological mechanism has not been clarified. Differential diagnosis of cytophagic histiocytic panniculitis mainly includes malignant histiocytosis, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and lupus erythematosus panniculitis (lupus profundus). We discuss the main clinical features, diagnostic challenges and treatment issues of this usually benign, but at times life-threatening autoimmune condition.

[Recent progress on diagnosis and treatment of benign symmetric lipomatosis]

OBJECTIVE

To introduce recent progress on diagnosis and treatment of benign symmetric lipomatosis (BSL).

METHOD

Detailed clinical data of 6 patients with BSL were reviewed and analyzed. We present a summary of the clinical symptoms, physical sign, diagnosis and therapeutic methods of BSL. And related literatures were discussed together.

RESULT

All of 6 patients have excessive subcutaneous fat deposit predominantly around neck. One patients had upper extremity localizations. Six patients had the complication of left ventricular diastolic function changes, glucose intolerance or diabetes mellitus, chronic hepatopathy, hyperuricemia and sleep apnea syndrome in one or more. One patients with several symptoms occur simultaneously, another one female patient was accompanied by all symptoms but chronic hepatopathy. Five male patient were alcohol abusers. Total neck lipectomy and abstinence from alcohol were performed on 5 patients. One patient refused treatment. During a follow-up of 3 months to 4 years, one patients was relapsed again, and no recurrence was seen in another 4 patients. All patho logical results were nonencapsulated fat.

CONCLUSION

BSL is a lipodystrophy caused by diffuse fatty tissue, symmetry deposition in the neck and shoulder subcutaneous fascia space or deep fascial space. The highest incidence favors to middle-aged man who is alcoholic. Chronic alcohol addiction and typical clinical symptoms help to diagnosis BSL. Lipectomy represents a successful procedure in treating BSL.

The endocrine and metabolic evaluation of benign symmetrical lipomatosis: a case report and literature review

OBJECTIVE

Benign symmetrical lipomatosis (BSL) is a rare disease characterized by the presence of multiple, symmetric and nonencapsulated fat masses. Alcoholism is observed in nearly 90% patients. However the etiology of this disease is still unclarified. BSL is very rare in Chinese people. Herein we described the endocrine and metabolic status of a patient with typical BSL. We also discussed the clinical manifestation, etiology, diagnosis and treatment for BSL.

RESULTS

Hyperuricemia and abnormal liver enzyme levels were observed in this case. However insulin sensitivity and function of the thyroid, adrenal glands and pituitary were all normal. The insulin sensitivity was assessed by the hyperinsulinemic euglycemic clam.

CONCLUSIONS

Although an association had been found between BSL and some endocrinological or metabolic disorders including abnormal glucose tolerance, excessive secretion of insulin, hyperuricemia, and so on, they were not specific for BSL. It is necessary to develop into the pathogenesis of BSL further.

MERRF syndrome presenting with multiple symmetric lipomatosis in a Japanese patient

Myoclonic epilepsy with ragged red fibers (MERRF), also called Fukuhara's disease, is sometimes accompanied by the rare symptom of multiple symmetric lipomatosis (MSL). MSL associated with MERRF has been reported mainly in Caucasians; such cases have not been reported in Japanese patients. We report the case of a 59-year-old Japanese woman with MERRF syndrome associated with A-->G substitution at nucleotide 8,344 of mtDNA. This case suggests that differences in lifestyle and gene polymorphism among races may be related to the prevalence of MSL due to mitochondrial abnormality, and that mitochondrial abnormalities should be considered as a cause of MSL even in Japanese patients.

[Madelung's disease]

Madelung's disease (Md) is a rare metabolic disorder which presents with multiple symmetrical nonencapsulated fatty masses situated mainly around the head, neck and nape. The main indications for Md treatment are: shortness of breath, head's movement restrictions, swallowing disorders (dysphagia), aesthetic considerations, and the fear of cancer. The standard treatment of Md is the surgical excision of pathological tissues. The disease is progressive, relapses after removal of tissue are often observed. The discussion is based on a three-year observation of Md patient operated by the authors. A good cosmetic result and symptoms subsidence were observed. There were no sings of disease recurrence.

Massive swelling of the cervical region: an uncommon manifestation of B cell chronic lymphocytic leukemia

CASE REPORT

We report about a 61-year-old woman who attended our Department of Oral and Maxillofacial Surgery complaining about an increasing swelling of her neck over a period of several years and asking for possible plastic surgery options. Further examinations lead us to the diagnosis of an uncommon manifestation of chronic B cell lymphoma. We suggest that plastic surgeons may refer to magnetic resonance tomography imaging and blood cell counts prior to liposuction of a massive swelling of the neck.

DISCUSSION

Accurate reduction of adipose tissue in the obese patient is a common field for plastic surgeons. Thus, liposuction has become a standard regimen to treat adipose swelling. But there may be exceptions to the rule. In this case report, we present an uncommon manifestation of a chronic lymphocytic leukemia which showed a massive soft swelling of the whole neck, mimicking Madelung's disease.

From ancient enigmas to novel paradigms: a depiction of multiple symmetric lipomatosis

A rare case of multiple symmetric lipomatosis type 2 in a female patient was presented. New possible iconographic representations of multiple symmetric lipomatosis were considered and some metabolic aspects of this disease were reviewed.

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.

Scrotal involvement in Madelung disease: clinical, ultrasound and MR findings

Multiple symmetrical lipomatosis, also known as Madelung disease, Launois-Bensaude syndrome, and benign symmetrical lipomatosis, is an uncommon disease that is characterized by the presence of multiple and symmetrical deposits of nonencapsulated adipose tissue in the neck, upper trunk, arms, and legs. It affects mainly men, with a higher incidence in the Mediterranean area, and is typically associated with high alcohol consumption and a high prevalence of peripheral neuropathy that usually appears long after the development of lipomatous masses. We report the case of a patient with involvement of the scrotum. We present clinical, ultrasound, and magnetic resonance appearances of these scrotal lipomatous masses for the first time.

[Madelung disease: CT and MRI findings]

OBJECTIVE

To investigate the CT and MRI manifestations of Madelung disease.

METHODS

The CT and MRI manifestations of 12 cases of Madelung disease were analyzed retrospectively.

RESULTS

The CT and MRI manifestations: cross-sectional CT showed that abnormally proliferated fat mainly deposited in anterior or posterior subcutaneous tissues of the neck, deep into the sternomastoid and trapezius muscles, situated in posterior cervical triangle, around the salivary glands, and excess fat was also found to be situated in supraclavicular fossa, around the paraspinal muscles and larynx, and so on. The abnormally proliferated fat can compress surrounding organs and tissues. The density of the abnormally proliferated fat was equal to that of normal fat. The MRI manifestations: the distribution of the thickened fat was equal to that seen with CT. The signal intensity of the thickened fat was equal to that of normal fat.

CONCLUSIONS

CT and MRI can accurately show distribution of the thickened fat, compression of surrounding organs and tissues and exclude soft tissue tumors. MRI seemed to be superior to CT.