Lipoedema in patients after bariatric surgery: report of two cases and review of literature

Pouwels, Sjaak; Huisman, Sander A.; Smelt, Hendrika J.M.; Said, M.; Smulders, J. F.

doi:10.1111/cob.12239

Cited by 30 publications

(26 citation statements)

References 9 publications

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“…This excess fluid in the interstitial tissue may induce growth of lipedema fat [36] as well as hypoxia resulting in adipocyte cell death and the recruitment of macrophages. Fibrosis follows inflammation resulting in fat that is difficult to lose by extreme measures (overexercise, caloric-restricting or ketosis-generating diets, fasting, and bariatric surgeries) [37, 38]. These microvessel changes are especially intriguing considering that hypermobile joints have been found in a high percentage of women with lipedema, suggesting a connective tissue disorder [20].…”

Section: Discussionmentioning

confidence: 99%

Dilated Blood and Lymphatic Microvessels, Angiogenesis, Increased Macrophages, and Adipocyte Hypertrophy in Lipedema Thigh Skin and Fat Tissue

et al. 2019

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Background and Aim. Lipedema is a common painful SAT disorder characterized by enlargement of fat primarily in the legs of women. Case reports of lipedema tissue samples demonstrate fluid and fibrosis in the interstitial matrix, increased macrophages, and adipocyte hypertrophy. The aims of this project are to investigate blood vasculature, immune cells, and structure of lipedema tissue in a cohort of women. Methods. Forty-nine participants, 19 controls and 30 with lipedema, were divided into groups based on body mass index (BMI): Non-Obese (BMI 20 to <30 kg/m2) and Obese (BMI 30 to <40 kg/m2). Histological sections from thigh skin and fat were stained with H&E. Adipocyte area and blood vessel size and number were quantified using ImageJ software. Markers for macrophages (CD68), mast cells (CD117), T cells (CD3), endothelial cells (CD31), blood (SMA), and lymphatic (D2-40 and Lyve-1) vessels were investigated by IHC and IF. Results. Non-Obese Lipedema adipocyte area was larger than Non-Obese Controls (p=0.005) and similar to Obese Lipedema and Obese Controls. Macrophage numbers were significantly increased in Non-Obese (p<0.005) and Obese (p<0.05) Lipedema skin and fat compared to Control groups. No differences in T lymphocytes or mast cells were observed when comparing Lipedema to Control in both groups. SMA staining revealed increased dermal vessels in Non-Obese Lipedema patients (p<0.001) compared to Non-Obese Controls. Lyve-1 and D2-40 staining showed a significant increase in lymphatic vessel area but not in number or perimeter in Obese Lipedema participants (p<0.05) compared to Controls (Obese and Non-Obese). Areas of angiogenesis were found in the fat in 30% of lipedema participants but not controls. Conclusion. Hypertrophic adipocytes, increased numbers of macrophages and blood vessels, and dilation of capillaries in thigh tissue of non-obese women with lipedema suggest inflammation, and angiogenesis occurs independent of obesity and demonstrates a role of altered vasculature in the manifestation of the disease.

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Section: Discussionmentioning

confidence: 99%

Dilated Blood and Lymphatic Microvessels, Angiogenesis, Increased Macrophages, and Adipocyte Hypertrophy in Lipedema Thigh Skin and Fat Tissue

et al. 2019

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“…Lipedema is often misdiagnosed as obesity (1,2), a clinical challenge that is receiving increased attention (3,4). Adipose tissue deposition in affected areas is resistant to common diet and exercise treatments (2) and even bariatric surgery (5). Many women remain undiagnosed or receive a diagnosis only after adipose accumulation becomes advanced (6).…”

Section: Introductionmentioning

confidence: 99%

Upper and Lower Extremity Measurement of Tissue Sodium and Fat Content in Patients with Lipedema

Crescenzi

Donahue

Petersen

et al. 2020

Obesity

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Objective: The aim of this study is to compare tissue sodium and fat content in the upper and lower extremities of participants with lipedema versus controls using magnetic resonance imaging (MRI). Methods: MRI was performed at 3.0 T in females with lipedema (n = 15, age = 43.2 ± 10.0 years, BMI = 30.3 ± 4.4 kg/m 2 ) and controls without lipedema (n = 14, age = 42.8 ± 13.2 years, BMI = 28.8 ± 4.4 kg/m 2 ). Participants were assessed for pain and disease stage. Sodium MRI was performed in the forearm and calf to quantify regional tissue sodium content (TSC, mmol/L). Chemical-shift-encoded water-fat MRI was performed in identical regions for measurement of fat/water (ratio). Results: In the calf, skin TSC (16.3 ± 2.6 vs. 14.4 ± 2.2 mmol/L, P = 0.04), muscle TSC (20.3 ± 3.0 vs. 18.3 ± 1.7 mmol/L, P = 0.03), and fat/water (1.03 ± 0.37 vs. 0.56 ± 0.21 ratio, P < 0.001) were significantly higher in participants with lipedema versus control participants. In the forearm, skin TSC (13.4 ± 3.3 vs. 12.0 ± 2.3 mmol/L, P = 0.2, Cohen's d = 0.50) and fat/water (0.65 ± 0.24 vs. 0.48 ± 0.24 ratio, P = 0.07, Cohen's d = 0.68) demonstrated moderate effect sizes in participants with lipedema versus control participants. Calf skin TSC was significantly correlated with pain (Spearman's rho = 0.55, P = 0.03) and disease stage (Spearman's rho = 0.82, P < 0.001) among participants with lipedema. Conclusions: MRI-measured tissue sodium and fat content are significantly higher in the lower extremities, but not upper extremities, of patients with lipedema compared with BMI-matched controls.Obesity (2020) 28, 907-915.

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“…As mentioned earlier, and as also the case in our patient, lipoedema is a progressive and chronic disease that has a significant negative impact on self-esteem, mobility, and quality of life. In advanced stages of the disease, there is mainly bulging localized often on the inner sides of the thighs and knees and rarely around the ankles [1-7]. Rubbing and friction cause micro tissue trauma and occlusion effects in the skin folds, which can cause maceration and eventually will result in infections [1-4].…”

Section: Discussionmentioning

confidence: 99%

“…It is very important that in case of clinical suspicion, a dermatologist is consulted in an early stage and preferably prior to bariatric surgery. This is because even after bariatric surgery, lipoedema is progressive, results in gradual enlargement of fatty deposition, and causes impaired mobility and further comorbidities like osteoarthritis and lymphatic insufficiency [3-4,7] The earlier mentioned disproportion becomes more pronounced when obesity and lipoedema coexist and patients lose a significant amount of weight after bariatric surgery [7]. This cannot be treated with dieting or physical exercise and often results in considerable frustration and psychological issues [2,7].…”

Section: Introductionmentioning

confidence: 99%

Mobility Problems and Weight Regain by Misdiagnosed Lipoedema After Bariatric Surgery: Illustrating the Medical and Legal Aspects

Pouwels

Smelt

Said

et al. 2019

Cureus

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Lipoedema is a progressive disorder that is characterized by an abnormal distribution of subcutaneous adipose tissue, which results in a disproportion between the extremities and the trunk. This vascular/dermatological disease might have a detrimental impact on psychosocial wellbeing and quality of life. In this article, we report on a patient with morbid obesity that had a Roux en-Y Gastric bypass with sufficient weight loss. However, due to this weight loss, an abnormal disproportion came to light. A dermatologist diagnosed lipoedema five years after the surgery. Eventually, she had a dermolipectomy of the upper arms, of which reimbursement was initially rejected by her insurance.

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Lipoedema in patients after bariatric surgery: report of two cases and review of literature

Cited by 30 publications

References 9 publications

Dilated Blood and Lymphatic Microvessels, Angiogenesis, Increased Macrophages, and Adipocyte Hypertrophy in Lipedema Thigh Skin and Fat Tissue

Dilated Blood and Lymphatic Microvessels, Angiogenesis, Increased Macrophages, and Adipocyte Hypertrophy in Lipedema Thigh Skin and Fat Tissue

Upper and Lower Extremity Measurement of Tissue Sodium and Fat Content in Patients with Lipedema

Mobility Problems and Weight Regain by Misdiagnosed Lipoedema After Bariatric Surgery: Illustrating the Medical and Legal Aspects

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