Multiple symmetric lipomatosis with vulvar involvement: a rare case report associated with walking difficulty and urination disorder

Abstract

Multiple symmetric lipomatosis (MSL)-a rare metabolic condition characterized by diffuse, nonencapsulated, painless fat deposits-remains a challenging condition to treat. In addition, the clinical manifestation of MSL in women has not been fully understood due to the male-dominated prevalence of the disease. Here, we report a rare case of MSL with vulvar involvement and provide a review of the literature to increase the understanding of both the diagnosis and treatment of the disease. A 46-year-old Japanese woman, who had a history of chronic alcohol consumption for over 20 years, presented with bilateral giant enlargement of the labia major and complained of difficulty in walking and urination. Magnetic resonance imaging revealed nonencapsulated fat deposits involving the vulvar region and extending around the rectum. The patient underwent pubic lipectomy followed by episioperineoplasty, which resulted in a good esthetic outcome with sufficient patient satisfaction. The morphological presentation of MSL in women is different from that in men, and clinical expression of MSL in the vulvar region is rare but cannot be overlooked owing to the potential of serious sequelae such as walking difficulty, urination disorder, and sexual dysfunction. In such cases, lipectomy followed by episioperineoplasty is indicated for the treatment of the condition and its sequelae, while ensuring less chance of relapse and better esthetic outcome compared with other treatment strategies.

En bloc resection of a large bilateral vulvar lipoma through a caesarean scar: A case report

“…The differences between Madelung's disease and bilateral lipomas are not clear, but some sex-related morphologic features have been described, including a “buffalo hump” or “horse collar” in men and a “football player appearance” in women. [ 13 ]…”

The Growth Factors of Subcutaneous Benign Lipoma: Consideration from Anatomical Position of Occurrence

“…Multiple symmetrical lipomatosis is thought to be associated with abnormal lipid metabolism due to heavy alcohol consumption. 28 The adipose tissue is symmetrically localized on the anterior neck and bilateral shoulder/trunk, presenting the typical appearance of a “horse collar” or “buffalo hump.” The fat tissue could often accumulate in the superficial subcutaneous layer, 29 that is diffuse, nonencapsulated adipose tissue proliferation in the subcutaneous bed, the boundary of which remains unclear. 30 Because of the multiple and symmetric nature, this lipomatosis differs from the subcutaneous lipomas investigated in this study.…”