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Lipedema is a chronic adipose tissue disorder characterized by the disproportional subcutaneous deposition of fat and is commonly misdiagnosed as lymphedema or obesity. The molecular determinants of the lipedema remain largely unknown and only speculations exist regarding the lymphatic system involvement. The aim of the present study is to characterize the lymphatic vascular involvement in established lipedema. The histological and molecular characterization was conducted on anatomically-matched skin and fat biopsies as well as serum samples from eleven lipedema and ten BMI-matched healthy patients. Increased systemic levels of vascular endothelial growth factor (VEGF)-C (P = 0.02) were identified in the serum of lipedema patients. Surprisingly, despite the increased VEGF-C levels no morphological changes of the lymphatic vessels were observed. Importantly, expression analysis of lymphatic and blood vessel-related genes revealed a marked downregulation of Tie2 (P < 0.0001) and FLT4 (VEGFR-3) (P = 0.02) consistent with an increased macrophage infiltration (P = 0.009), without changes in the expression of other lymphatic markers. Interestingly, a distinct local cytokine milieu, with decreased VEGF-A (P = 0.04) and VEGF-D (P = 0.02) expression was identified. No apparent lymphatic anomaly underlies lipedema, providing evidence for the different disease nature in comparison to lymphedema. The changes in the lymphatic-related cytokine milieu might be related to a modified vascular permeability developed secondarily to lipedema progression. Lipedema is a distinct adipose tissue disorder, affecting primarily women 1. Epidemiological data of large studies are still not available but the prevalence of lipedema is estimated between 7 and 9.7%. Interestingly the prevalence of lipedema in patients referred to lymphatic clinics is increased, estimated as 10-15% 2,3. The mechanisms involved in lipedema development are largely unknown and despite the distinct clinical features the disease is commonly misdiagnosed as obesity or lymphedema. Clinically, lipedema is characterized by the bilateral and symmetrical adipose tissue deposition, mostly of the lower extremities, sparing the feet. The Stemmer sign is negative and the edematous appearance is resistant to diet restrictions, elevation of the extremities or lymphatic drainage 4 .

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We investigated the role of conventional radiographs and computed tomography scans for the routine followup of total hip arthroplasty patients. Among 92 total hip arthroplasties with a mean followup of 8.5 years, 94 acetabular lesions were detected among 63 hips using computed tomography and 42 of these hips had osteolysis diagnosed on radiograph. Using computed tomography as a gold standard, the sensitivity of anteroposterior pelvic radiographs for the detection of acetabular osteolysis was 67% and the specificity was 72%. Although smaller lesions were more frequently missed, osteolysis was diagnosed on radiograph in 20 of 22 total hip arthroplasties with lesion volumes of at least 10 mL. Because larger osteolytic lesions were generally detected on radiograph, two-dimensional and three-dimensional lesion sizes correlated. However, the limits of agreement for the volume estimates based on the radiograph area were -14.6 to 18.7 mL. Although radiographs can be useful to screen for clinically important pelvic osteolysis, computed tomography images are necessary to accurately measure lesion volumes.