Journal of General Practice

A Typical Presentation of Madelung Disease

Abstract

Maisel Lotan Adi, Retchkiman Meir and Gronovich Yoav

We present a unique case of a sixty two year old woman with symmetric lipomatosis of the lower back, similar to cup C female breast. Lipoma is the most common type of soft tissue mesenchymal tumor, commonly found in the upper back, neck, shoulders and abdomen, and rarely in the face, hands or feet. When lipomatosis is symmetrical it is often termed Multiple Symmetrical Lipomatosis (MSL), also known as Madelung disease, a rare syndrome of unknown etiology. Our patient was referred with large symmetrical subcutaneous masses in her lower back similar to cup C female breast. Prior to her surgery, the patient was referred to ultrasonography of the lower back which demonstrated two large subcutaneous lesions with an average size of 12.5 × 3 × 14 cm. Lesions were excised under general anesthesia, with the left lipoma weighing 535 gr’, and the right 425 gr’, and sent for pathological examination. Surgical drains were removed two days after the procedure, and the patient was discharged. Pathology confirmed our clinical diagnosis, and 18 months after the procedure-the surgical wounds healed to the patient’s satisfaction. We believe that although this disease remains rare, the deferential diagnosis between simple lipoma, MSL and obesity may contribute to current underdiagnoses of MSL. It is important to accurately diagnose MSL as it may be related to systemic comorbidities. Plastic surgeons should bear in mind that clinical presentation may vary, as for our patient, and must be familiar with this disease and its management.