Obesity‐associated lymphoedematous mucinosis

Abstract

Pretibial mucinosis is a histological feature associated with morbid obesity and lymphoedematous features of the legs that should be distinguished from true pretibial myxoedema. The term of 'obesity-associated lymphoedematous mucinosis' seems to be appropriate for this condition.

Obesity-Associated Lymphedematous Mucinosis: Two Further Cases and Review of the Literature

“…The pathogenesis of this rare condition has not been fully elucidated and, to the best of our knowledge, 22 cases have been reported in the English literature and are summarized in Table 1[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. Lymphatic stasis, stimulated by the obesity, seems to determine a local hypoxia leading to the accumulation of mucin [4].…”

“…This appears to be induced by the deposition in the interstice of plasmatic proteins due to a defect of the lymphatic drainage and the ischemia favored by a frequently associated venous insufficiency. A distinct histopathological picture for OALM, different from classic pretibial myxedema and from venous insufficiency-associated dermal mucinosis, has been defined whose histopathological clues are (1) epidermal atrophy, (2) moderate amount of dermal mucin in the superficial dermis, (3) angioplasia made by vertically running vessels in the superficial and mid dermis, (4) increased stellate or linear fibroblasts; subepidermal blister can be occasionally seen [2]. On the contrary, pretibial myxedema shows an acanthotic epidermis with ortohyperkeratosis and diffuse striking mucin deposition throughout all the reticular dermis without evident angioplasia.…”

“…Obesity-associated lymphedematous mucinosis (OALM) is a rare and newly recognized disorder that can clinically mimic pretibial myxedema [1, 2]. The absence of thyroid disease and histological findings can differentiate the two conditions [1].…”

Elephantiatic dermopathy

“…Morbid obesity has been associated with pretibial lymphedematous mucinosis mimicking that seen in Graves' dermopathy; however, our patient's BMI was 24 and mucin was absent on histopathology. 3 …”

Radiation therapy as part of the therapeutic regimen for extensive multilocular myxedema in a patient with exophthalmos, myxedema and osteoarthropathy syndrome: A case report

“…Pathophysiologically, myxedema is characterized by the accumulation of glycosaminoglycans in the dermis and panniculus adiposus that compresses the dermal lymphatics, resulting in dermal edema and the clinical features of lymphedema (2,9).…”