Familial multiple lipomatosis

Last updated
The arm of a patient with familial multiple lipomatosis. The arm of a patient with familial multiple lipomatosis.jpg
The arm of a patient with familial multiple lipomatosis.

Familial multiple lipomatosis is a hereditary adipose tissue disorder that is characterized by the formation of multiple lipomas that occur in a particular distribution. [1] The lipomas are well-encapsulated, slow-growing, benign fatty tumors. The distribution is defined as being focused in the trunk of the body and extremities. [2] Familial Multiple Lipomatosis can be identified when multiple lipomas occur in multiple family members that span different generations. [2] Some people may have hundreds of lipomas present. [2]

Contents

Symptoms and signs

The source of this disease is from family history, and symptoms most often arise in middle age. [2] [3] Newly formed lipomas frequently present themselves as a bead-like lump under the skin, and become rubbery and movable. [3] They may be seen throughout the body and in some areas more than others, however, it does not make an appearance on the head or shoulders of the individual. [2] The size of those bumps may vary and could possibly get in the way of an individual living their life peacefully. [2] There are usually no feelings of discomfort or pain unless a lipoma has been aggravated or is directly on a nerve. [4] Lipomas that sit over bony areas such as the ribs and lower back can cause discomfort when lying down or receiving any kind of pressure. The age at which familial multiple lipomatosis begins to make an appearance on the individual's body varies; for some it may be as early as 5 years of age. [4]

Causes

The exact cause of FML is not yet known, but there are several theories of different causes: [5]

Diagnosis

Lipoma ultrasound 110322120428 1206550 Lipoma ultrasound 110322120428 1206550.jpg
Lipoma ultrasound 110322120428 1206550

Familial multiple lipomatosis is usually diagnosed through a physical exam via palpation, medical history and imaging studies such as ultrasound, CT scan, or magnetic resonance imaging (MRI). A CT scan is an imaging method that uses x-rays to create images of cross sections of the body, while an MRI uses powerful magnets and radio waves to create images of lipomas and surrounding tissues. [3] Both tests are useful to establish the diagnosis of multiple symmetric lipomatosis, although magnetic resonance imaging provides more details and may be used when lipomas are large, deep, or have infiltrated muscle fibers or nerves. In some cases, a biopsy of the lipomas may be necessary to confirm the diagnosis. [3]

Differential diagnoses

The DDx is as follows:[ citation needed ]

Treatment

Lipomas removed from the arm of a patient with familial multiple lipomatosis. Lipomas removed from the arm of a patient with familial multiple lipomatosis.jpg
Lipomas removed from the arm of a patient with familial multiple lipomatosis.

The only effective treatments for lipomas caused by familial multiple lipomatosis are liposuction or surgical removal. [6] Steroid injections may also be used to shrink the tumors by causing local fat atrophy. [7] Patients with the condition often seek removal when the lipomas are large, disfiguring, or cause pain. [2] This may be done by a dermatologist or other surgeon. In the majority of cases where one to a few subcutaneous lipomas are being excised, the procedure is done under local anaesthetic and the patient can resume most normal activities immediately afterward. [6] Over-the-counter pain medications are generally sufficient in the following days and long-term scarring is minimal. [6] Regrowth is rare because lipomas are usually well-encapsulated and are therefore removed entirely although more new lipomas may start to grow in the same area. [7]

Therapeutic treatments that are recommended for adipose tissue disorders include improving lymphatic flow through exercise and massage, following an anti-inflammatory diet, and reducing non-disordered fat tissue when necessary. [6] Weight loss has not been shown to eliminate lipomas but may help reduce overall inflammation and influence hormone levels. [6] While there is no total cure for FML to stop the growth of new lipomas, most of the growths can remain untreated and rarely cause medical complications. [1] [7]

Society and culture

Related Research Articles

<span class="mw-page-title-main">Lipoma</span> Benign tumor made of fat tissue

A lipoma is a benign tumor made of fat tissue. They are generally soft to the touch, movable, and painless. They usually occur just under the skin, but occasionally may be deeper. Most are less than 5 cm (2.0 in) in size. Common locations include upper back, shoulders, and abdomen. It is possible to have several lipomas.

<span class="mw-page-title-main">Chylomicron</span> One of the five major groups of lipoprotein

Chylomicrons, also known as ultra low-density lipoproteins (ULDL), are lipoprotein particles that consist of triglycerides (85–92%), phospholipids (6–12%), cholesterol (1–3%), and proteins (1–2%). They transport dietary lipids, such as fats and cholesterol, from the intestines to other locations in the body, within the water-based solution of the bloodstream. ULDLs are one of the five major groups lipoproteins are divided into based on their density. A protein specific to chylomicrons is ApoB48.

<span class="mw-page-title-main">Gardner's syndrome</span> Medical condition

Gardner's syndrome is a subtype of familial adenomatous polyposis (FAP). Gardner syndrome is an autosomal dominant form of polyposis characterized by the presence of multiple polyps in the colon together with tumors outside the colon. The extracolonic tumors may include osteomas of the skull, thyroid cancer, epidermoid cysts, fibromas, as well as the occurrence of desmoid tumors in approximately 15% of affected individuals.

<span class="mw-page-title-main">Benign tumor</span> Mass of cells which cannot spread throughout the body

A benign tumor is a mass of cells (tumor) that does not invade neighboring tissue or metastasize. Compared to malignant (cancerous) tumors, benign tumors generally have a slower growth rate. Benign tumors have relatively well differentiated cells. They are often surrounded by an outer surface or stay contained within the epithelium. Common examples of benign tumors include moles and uterine fibroids.

<span class="mw-page-title-main">Lipedema</span> Condition involving excessive deposition of fat in the legs

Lipedema is a medical condition that is almost exclusively found in women and results in enlargement of both legs due to deposits of fat under the skin. Women of any weight may develop lipedema and the fat associated with lipedema is resistant to traditional weight-loss methods. There is no cure and typically it gets worse over time, pain may be present, and patients bruise easily. Over time mobility may be reduced, and due to reduced quality of life, patients often experience depression. In severe cases the trunk and upper body may be involved. Lipedema is commonly misdiagnosed.

<span class="mw-page-title-main">Carnitine palmitoyltransferase I deficiency</span> Medical condition

Carnitine palmitoyltransferase I deficiency is a rare metabolic disorder that prevents the body from converting certain fats called long-chain fatty acids(LCFA) into energy, particularly during periods without food. It is caused by a mutation in CPT1A on chromosome 11.

<span class="mw-page-title-main">Mitochondrial trifunctional protein deficiency</span> Medical condition

Mitochondrial trifunctional protein deficiency is an autosomal recessive fatty acid oxidation disorder that prevents the body from converting certain fats to energy, particularly during periods without food.

<span class="mw-page-title-main">Very long-chain acyl-coenzyme A dehydrogenase deficiency</span> Medical condition

Very long-chain acyl-coenzyme A dehydrogenase deficiency is a fatty-acid metabolism disorder which prevents the body from converting certain fats to energy, particularly during periods without food.

<span class="mw-page-title-main">Metachondromatosis</span> Medical condition

Metachondromatosis is an autosomal dominant, incompletely penetrant genetic disease affecting the growth of bones, leading to exostoses primarily in the hands and feet as well as enchondromas of long bone metaphyses and iliac crests. This syndrome affects mainly tubular bones, though it can also involve the vertebrae, small joints, and flat bones. The disease is thought to affect exon 4 of the PTPN11 gene. Metachondromatosis is believed to be caused by an 11 base pair deletion resulting in a frameshift and nonsense mutation. The disease was discovered and named in 1971 by Pierre Maroteaux, a French physician, when he observed two families with skeletal radiologic features with exostoses and Ollier disease. The observation of one family with five affected people led to the identification of the disease as autosomal dominant. There have been less than 40 cases of the disease reported to date.

<span class="mw-page-title-main">Lipomatosis</span> Medical condition

Lipomatosis is believed to be an autosomal dominant condition in which multiple lipomas are present on the body. Many discrete, encapsulated lipomas form on the trunk and extremities, with relatively few on the head and shoulders. In 1993, a genetic polymorphism within lipomas was localized to chromosome 12q15, where the HMGIC gene encodes the high-mobility-group protein isoform I-C. This is one of the most commonly found mutations in solitary lipomatous tumors but lipomas often have multiple mutations. Reciprocal translocations involving chromosomes 12q13 and 12q14 have also been observed within.

<span class="mw-page-title-main">Short-chain acyl-coenzyme A dehydrogenase deficiency</span> Medical condition

Short-chain acyl-coenzyme A dehydrogenase deficiency (SCADD) is an autosomal recessive fatty acid oxidation disorder which affects enzymes required to break down a certain group of fats called short chain fatty acids.

<span class="mw-page-title-main">Bannayan–Riley–Ruvalcaba syndrome</span> Medical condition

Bannayan–Riley–Ruvalcaba syndrome (BRRS) is a rare overgrowth syndrome and hamartomatous disorder with occurrence of multiple subcutaneous lipomas, macrocephaly and hemangiomas. The disease is inherited in an autosomal dominant manner. The disease belongs to a family of hamartomatous polyposis syndromes, which also includes Peutz–Jeghers syndrome, juvenile polyposis and Cowden syndrome. Mutation of the PTEN gene underlies this syndrome, as well as Cowden syndrome, Proteus syndrome, and Proteus-like syndrome, these four syndromes are referred to as PTEN Hamartoma-Tumor Syndromes.

Dercum's disease is a rare condition characterized by multiple painful fatty tumors, called lipomas, that can grow anywhere in subcutaneous fat from scalp to plantar surface of the foot. Sometimes referred as adiposis dolorosa in medical literature, Dercum’s disease is more of a syndrome than a disease. While the term adiposis dolorosa may be correct, the term Dercum's disease is more often used, along with the acronym DD.

<span class="mw-page-title-main">SCARF syndrome</span> Medical condition

SCARF syndrome is a rare syndrome characterized by skeletal abnormalities, cutis laxa, craniostenosis, ambiguous genitalia, psychomotor retardation, and facial abnormalities. These characteristics are what make up the acronym SCARF. It shares some features with Lenz-Majewski hyperostotic dwarfism. It is a very rare disease with an incidence rate of approximately one in a million newborns. It has been clinically described in two males who were maternal cousins, as well as a 3-month-old female. Babies affected by this syndrome tend to have very loose skin, giving them an elderly facial appearance. Possible complications include dyspnea, abdominal hernia, heart disorders, joint disorders, and dislocations of multiple joints. It is believed that this disease's inheritance is X-linked recessive.

<span class="mw-page-title-main">Naegeli–Franceschetti–Jadassohn syndrome</span> Medical condition

Naegeli–Franceschetti–Jadassohn syndrome (NFJS), also known as chromatophore nevus of Naegeli and Naegeli syndrome, is a rare autosomal dominant form of ectodermal dysplasia, characterized by reticular skin pigmentation, diminished function of the sweat glands, the absence of teeth and hyperkeratosis of the palms and soles. One of the most striking features is the absence of fingerprint lines on the fingers.

<span class="mw-page-title-main">Mitochondrial neurogastrointestinal encephalopathy syndrome</span> Medical condition

Mitochondrial neurogastrointestinal encephalopathy syndrome (MNGIE) is a rare autosomal recessive mitochondrial disease. It has been previously referred to as polyneuropathy, ophthalmoplegia, leukoencephalopathy, and intestinal pseudoobstruction. The disease presents in childhood, but often goes unnoticed for decades. Unlike typical mitochondrial diseases caused by mitochondrial DNA (mtDNA) mutations, MNGIE is caused by mutations in the TYMP gene, which encodes the enzyme thymidine phosphorylase. Mutations in this gene result in impaired mitochondrial function, leading to intestinal symptoms as well as neuro-ophthalmologic abnormalities. A secondary form of MNGIE, called MNGIE without leukoencephalopathy, can be caused by mutations in the POLG gene.

Neural fibrolipoma is an overgrowth of fibro-fatty tissue along a nerve trunk that often leads to nerve compression. These only occur in the extremities, and often affect the median nerve. They are rare, very slow-growing, and their origin is unknown. It is believed that they may begin growth in response to trauma. They are not encapsulated by any sort of covering or sheath around the growth itself, as opposed to other cysts beneath the skin that often are. This means there are loosely defined margins of this lipoma. Despite this, they are known to be benign. Neural fibrolipomas are often more firm and tough to the touch than other lipomas. They are slightly mobile under the skin, and compress with pressure.

Dr Karen Herbst is an American endocrinologist. She is noted for her work in Dercum's Disease, lipedema, multiple symmetric lipomatosis, familial multiple lipomatosis, and angiolipomatosis at both the VA San Diego Healthcare System and University of Arizona College of Medicine in Tucson, Arizona.

Encephalocraniocutaneous lipomatosis (ECCL), is a rare condition primarily affecting the brain, eyes, and skin of the head and face. It is characterized by unilateral subcutaneous and intracranial lipomas, alopecia, unilateral porencephalic cysts, epibulbar choristoma and other ophthalmic abnormalities. This condition is described as sporadic because it occurs in people without a history of the disorder in their family.

PIK3CA-related overgrowth spectrum (PROS) is an umbrella term for rare syndromes characterized by malformations and tissue overgrowth caused by somatic mutations in PIK3CA gene. In PROS diseases individuals malformations are seen in several different tissues such as skin, vasculature, bones, fat and brain tissue depending on the specific disease.

References

  1. 1 2 Leffell, David J.; Braverman, Irwin M. (1986-08-01). "Familial multiple lipomatosis: Report of a case and a review of the literature". Journal of the American Academy of Dermatology. 15 (2): 275–279. doi:10.1016/S0190-9622(86)70166-7. ISSN   0190-9622.
  2. 1 2 3 4 5 6 7 "Familial multiple lipomatosis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2019-11-22.
  3. 1 2 3 4 "Lipomatosis simétrica múltiple | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2019-11-22.
  4. 1 2 "OMIM Entry - % 151900 - LIPOMATOSIS, MULTIPLE". omim.org. Retrieved 2019-11-22.
  5. RESERVED, INSERM US14-- ALL RIGHTS. "Orphanet: Familial multiple lipomatosis". www.orpha.net. Retrieved 2019-11-22.{{cite web}}: CS1 maint: numeric names: authors list (link)
  6. 1 2 3 4 5 "Treatment Summary". Fat Disorders Resource Society. Retrieved 2019-11-22.
  7. 1 2 3 "Lipoma - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2019-11-22.
  8. Harvey-Jenner, Catriona (2018-11-12). "11 celebrities who have proudly showed off their scars". Cosmopolitan. Retrieved 2019-11-22.