Liposuction Normalizes – in Contrast to Other Therapies – Lymphedema-Induced Adipose Tissue Hypertrophy

Brorson, Håkan

doi:10.1055/s-0032-1323749

Cited by 12 publications

(19 citation statements)

References 31 publications

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“…Several studies (37)(38)(39) have suggested that lymphedema leads to adipose tissue accumulation and fibrosis. Moreover, we believe that this process is amplified in NF1 and in EN due to a primary lymphatic disorder, which is at the base of the clinical manifestation induced by the plexiform neurofibroma growth.…”

Section: Discussionmentioning

confidence: 99%

Giant elephantiasis neuromatosa in the setting of neurofibromatosis type 1: A case report

et al. 2016

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Abstract. Elephantiasis neuromatosa (EN) can arise from a plexiform neurofibroma of the superficial and deep nerves developing from a hyperproliferation of the perineural connective tissue infiltrating adjacent fat and muscles. To date, the clinical association between EN and neurofibromatosis type 1 (NF1) has been poorly defined, particularly with regard to the role of lymphatic alterations and the consequent lymphedema. The present study reports the clinical and biomolecular features of EN in a NF1 patient with the clear clinical diagnostic criteria of multiple cafè-au-lait macules, neurofibromas, EN, a positive family history and a novel NF1 germline c.1541_1542del mutation. Lymphoscintigraphy (LS) highlighted marked dermal backflow in the affected limb, hypertrophy of the ipsilateral inguinal and external iliac lymph nodes, and a bilateral lower limb lymph flow delay. These data support the hypothesis that an extensive hyperproliferative process involving perineural connective, limb soft tissues, bones and the lymphatic system can be responsible for EN in NF1 patients, on the basis of adipocyte metaplasia triggered by lymphostasis and lymphedema, and bone overgrowth and gigantism caused by chronic hyperemia. LS and magnetic resonance imaging can be efficacious tools in the diagnosis and clinical characterization of the early onset of the disease. IntroductionNeurofibromatosis type 1 (NF1) (MIM no. 162200), also known as von Recklinghausen disease, is clinically characterized by the presence of simple, diffuse and plexiform neurofibromas. Plexiform neurofibromas are unencapsulated, poorly-circumscribed tumors infiltrating the nerves and adjacent fat and muscles (1). The connective overgrowth can be limited to a single nerve or a plexus; in the latter case, when the plexus spreads to the epidermal and dermal tissues, it is termed molluscum fibrosum. This can occur multiple times, covering all body sites (including the forehead, temple, eyes, nape and upper lip) with the exception of the palms and soles (2). The plexiform neurofibroma variant, mixoglioma gelatiniforme, is usually soft and is located in the lower third of the leg, and when associated with lymphangiomatosis, it can give rise to elephantiasis neuromatosa (EN). EN is characterized by abnormal soft-tissue hypertrophy and bone dysplasia together with early and excessive bone growth of the affected leg compared with the contralateral leg (3,4). Pachidermocele or dermatholysis may be associated with NF1, showing an overlap of skin layers in the thorax, buttocks and roots of the limbs.The etiology of EN is not yet fully understood, but the association of primary lymphatic dysplasia with a lymphatic proliferative process has been proposed (5-7).The current study presents a case of NF1-associated EN with typical clinical manifestations. Written informed consent was obtained from the patient.

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Section: Discussionmentioning

confidence: 99%

Giant elephantiasis neuromatosa in the setting of neurofibromatosis type 1: A case report

et al. 2016

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“…33–35 Our water displacement technique has previously been validated and showed a coefficient of variation of 0.609%. 35 …”

Section: Methodsmentioning

confidence: 99%

SF-36 Shows Increased Quality of Life Following Complete Reduction of Postmastectomy Lymphedema with Liposuction

Hoffner

Bagheri

Hansson

et al. 2017

Lymphatic Research and Biology

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AbstractsBackground: Arm lymphedema after breast cancer surgery affects women both from physical and psychological points of view. Lymphedema leads to adipose tissue deposition. Liposuction and controlled compression therapy (CCT) reduces the lymphedema completely.Methods and Results: Sixty female patients with arm lymphedema were followed for a 1-year period after surgery. The 36-item short-form health survey (SF-36) was used to assess health-related quality of life (HRQoL). Patients completed the SF-36 questionnaire before liposuction, and after 1, 3, 6, and 12 months. Preoperative excess arm volume was 1365 ± 73 mL. Complete reduction was achieved after 3 months and was sustained during follow-up. The adipose tissue volume removed at surgery was 1373 ± 56 mL. One month after liposuction, better scores were found in mental health. After 3 months, an increase in physical functioning, bodily pain, and vitality was detected. After 1 year, an increase was also seen for social functioning. The physical component score was higher at 3 months and thereafter, while the mental component score was improved at 3 and 12 months. Compared with SF-36 norm data for the Swedish population, only physical functioning showed lower values than the norm at baseline. After liposuction, general health, bodily pain, vitality, mental health, and social functioning showed higher values at various time points.Conclusions: Liposuction of arm lymphedema in combination with CCT improves patients HRQoL as measured with SF-36. The treatment seems to target and improve both the physical and mental health domains.

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“…The next studies indicate the effect of lymphatic fluid on fat accumulation. According to Brorson et al, liposuction can be an effective treatment for patients with fat accumulation due to lymphedema [62]. Nougues and colleagues studying rabbit adipocytes observed enhanced differentiation and lipid accumulation caused by mesenteric lymph and chylomicrons in the culture medium [63].…”

Section: Lymphangiopathymentioning

confidence: 99%

Pathophysiological dilemmas of lipedema

et al. 2014

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Liposuction Normalizes – in Contrast to Other Therapies – Lymphedema-Induced Adipose Tissue Hypertrophy

Cited by 12 publications

References 31 publications

Giant elephantiasis neuromatosa in the setting of neurofibromatosis type 1: A case report

Giant elephantiasis neuromatosa in the setting of neurofibromatosis type 1: A case report

SF-36 Shows Increased Quality of Life Following Complete Reduction of Postmastectomy Lymphedema with Liposuction

Pathophysiological dilemmas of lipedema

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