Multiple subcutaneous angiolipomas associated with new‐onset diabetes mellitus

Abstract

A 44‐year‐old Hispanic man, with a past medical history of diabetes mellitus type 2 and cerebrovascular accident, presented to the Mount Sinai Department of Dermatology with sudden, fast‐growing nodules over both of his shins. Approximately 2 months before the appearance of the nodules, the patient was diagnosed with diabetes mellitus type 2 with hemoglobin A1c (HbA1c) of 8.5%. The patient was taking metformin orally, 500 mg three times daily, at the time of presentation. Six nodules appeared over a period of days. They caused a burning, throbbing pain upon ambulation. Over a period of 6 months, the lumps decreased in size, and two totally disappeared. The resolution of the nodules coincided with the control of the patient's diabetes, as demonstrated by HbA1c of 5.5%. The patient denied trauma to the sites of the nodules. The patient denied any associated purpura or ecchymoses over the nodules. The past medical history was significant for a stroke with residual right hemiparesis at 42 years of age. The family history was negative for similar lesions, but an aunt did have diabetes mellitus type 2. The patient denied alcohol use, smoking, or intravenous drug use. Physical examination was positive for six soft, tender, freely mobile, symmetrical, well‐demarcated, round masses, 1–2 cm in diameter and skin colored, over the anterior aspects of both legs. The patient was obese (body mass index, 38.5). Laboratory tests (barring the initially elevated HbA1c) were normal. One lesion was excised. Histopathology revealed features typical of an angiolipoma (see Fig. 1a,b). A karyotype of the angiolipoma was not performed. 1 (a) Prominent vessels filled with fibrin thrombi at the periphery of mature fat lobules. (b) At higher magnification Because excision of one angiolipoma produced scarring with a poor cosmetic result, intralesional triamcinolone, 5 mg/mL, was tried without success.

Solitary noninfiltrating angiolipoma on the finger, an unusual localization.

“…The lesions may be solitary or multiple. Multiple angiolipomas may be familial or associated with diabetes mellitus and antiretroviral therapy [7,9]. In our case the lesion was localized and solitary on the extensor surface of the index finger.…”

Pfeifer-Weber-Christian Disease and Benign Multiple Subcutaneous Noninfiltrative Angiolipomas: A Puzzling Case and Review of a Rare Entitety

“…A variable length of period from initiation of steroid use till appearance of lipomatosis or angiolipomas and presence of androgen receptors expression in angiolipomas suggest anabolic effects of steroids, rather than immunosuppression, as a mechanism of fat cell proliferation. Angiolipomas are widely associated with diabetes mellitus [29] or are known as a complication of antiretroviral therapy [7]. In our case, the patient was neither a diabetic nor immunocompromised with HIV.…”

Multiple angiolipoma of the hand, back, and abdomen; a case report

“…Hence, histopathological examination is often required to provide definite diagnosis [15] . These tumors are usually reported as a soft, lobulated, and encapsulated mass [16] . Histopathology of angiolipoma often reveals encapsulated nodules containing mature adipocytes and vascular proliferation with hyalin fibrin thrombi [4] .…”