Oedema in obesity; role of structural lymphatic abnormalities

Am, Vasileiou; Bull, R.H.; Kitou, D; Αλεξιάδου, Κλεοπάτρα; Nj, Garvie; Sw, Coppack

doi:10.1038/ijo.2010.273

Cited by 27 publications

(22 citation statements)

References 15 publications

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“…Coppack et al 26 compared lymphoscintigraphy results from 22 obese patients (body mass index 49.4 ± 10.4) with bilateral lymphedema, 9 patients with recognized causes of edema (pelvic surgery, deep vein thrombosis, joint replacement), and 18 patients with cyclic edema. The patients with cardiorespiratory disease and lipoedema were excluded.…”

Section: Discussionmentioning

confidence: 99%

Massive localized lymphedema: a clinicopathologic study of 46 patients with an enrichment for multiplicity

et al. 2016

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Massive localized lymphedema is a monstrous tumefactive pseudosarcoma seen in middle-aged morbidly obese adults. Since its initial description in 1998, the etiology remains unknown, although associations with trauma, surgeries, and hypothyroidism have been reported. Herein, we report the largest study of massive localized lymphedema and expand upon its clinicopathologic features. Fifty-four cases from 46 patients were retrospectively identified from the institutional archives of The Ohio State University Wexner Medical Center between 2002 and 2015. Forty-six patients (21 males and 25 females, mean age 50 years) presented with large masses developing over a 5-60-month period. The majority of patients were Caucasian (n = 39). All patients were obese with a mean weight of 384.7 lb and a mean body mass index of 59.6 kg/m 2 . Thirty-six patients had a history of atherosclerotic cardiovascular disease and diabetes mellitus type 2 was present in 22 patients. Eight patients had multifocal massive localized lymphedema. The sites included thigh (n = 33), abdomen (n = 17), suprapubic region (n = 1), mons pubis (n = 6), scrotum (n = 2), perianal region (n = 1), and right flank (n = 1). Mostly, the clinical impression was benign processes, including pannus or lymphedema pseudotumor. Grossly, the mean weight was 8237 g and the mean size was 53.2 cm. Histologically, eight cases showed a unique pattern of dystrophic calcifications mimicking hyperchromatic, atypical nuclei that might lead to misdiagnosis of liposarcoma, four cases showed focal metaplastic ossification, and three cases showed multinucleated cells in addition to prototypic features of massive localized lymphedema. We report that this is the largest series of massive localized lymphedema. This is a lesion mostly seen in morbidly obese patients and the thigh is the most common site of involvement. We note a marked racial predilection for Caucasians and a tendency towards multiplicity. We suggest that obesity itself and the related metabolic syndrome have an important role in its pathogenesis.

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Section: Discussionmentioning

confidence: 99%

Massive localized lymphedema: a clinicopathologic study of 46 patients with an enrichment for multiplicity

et al. 2016

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“…In mice, it was recently found that obesity diminishes lymphatic fluid transport to draining lymph nodes [10]. However, in humans the data are more controversial –while one study found impairment of lymphatic function in morbidly obese patients [11], another recent report found similar lymph flow between normal weight and obese individuals [12].…”

Section: Introductionmentioning

confidence: 99%

Chronic High-Fat Diet Impairs Collecting Lymphatic Vessel Function in Mice

et al. 2014

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Lymphatic vessels play an essential role in intestinal lipid uptake, and impairment of lymphatic vessel function leads to enhanced adipose tissue accumulation in patients with lymphedema and in genetic mouse models of lymphatic dysfunction. However, the effects of obesity on lymphatic function have been poorly studied. We investigated if and how adipose tissue accumulation influences lymphatic function. Using a lymphatic specific tracer, we performed in vivo near-infrared (NIR) imaging to assess the function of collecting lymphatic vessels in mice fed normal chow or high-fat diet (HFD). Histological and whole mount analyses were performed to investigate the morphological changes in initial and the collecting lymphatic vessels. HFD was associated with impaired collecting lymphatic vessel function, as evidenced by reduced frequency of contractions and diminished response to mechanostimulation. Moreover, we found a significant negative correlation between collecting lymphatic vessel function and body weight. Whole mount analyses showed an enlargement of contractile collecting lymphatic vessels of the hind limb. In K14-VEGF-C mice, HFD resulted in a reduced spreading of the tracer within dermal lymphatic vessels. These findings indicate that adipose tissue expansion due to HFD leads to a functional impairment of the lymphatic vasculature, predominantly in collecting lymphatic vessels.

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“…Increased volumes of SAT in MSL, like obesity, may therefore be sufficient to externally compress vasculature and lymphatics inducing further growth of SAT as seen in other localized fat collections [84] . Impedance of lymph flow into lymph collectors is a local effect and does not affect flow in larger lymph trunks, therefore the role of lymphoscintigraphy in MSL is questionable [85] .…”

Section: Physiology Of Msl Satmentioning

confidence: 99%

Rare adipose disorders (RADs) masquerading as obesity

2012

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Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum's disease (DD) may be misdiagnosed as obesity. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Although lifestyle changes and bariatric surgery work effectively for the obesity component of RADs, these treatments do not routinely reduce the abnormal subcutaneous adipose tissue (SAT) of RADs. RAD SAT likely results from the growth of a brown stem cell population with secondary lymphatic dysfunction in MSL, or by primary vascular and lymphatic dysfunction in lipedema and DD. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone. In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may be confused. Treatment recommendations focus on evidencebased data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. Associated RAD conditions including depression, anxiety and pain will improve as healthcare providers learn to identify and adopt alternative treatment regimens for the abnormal SAT component of RADs. Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations.

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Oedema in obesity; role of structural lymphatic abnormalities

Cited by 27 publications

References 15 publications

Massive localized lymphedema: a clinicopathologic study of 46 patients with an enrichment for multiplicity

Massive localized lymphedema: a clinicopathologic study of 46 patients with an enrichment for multiplicity

Chronic High-Fat Diet Impairs Collecting Lymphatic Vessel Function in Mice

Rare adipose disorders (RADs) masquerading as obesity

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