Macrodystrophia lipomatosa

Macrodystrophia lipomatosa (ML) is a rare congenital disorder characterized by localised overgrowth of a part of an extremity or less commonly a whole extremity. The involvement of more than one extremity is even more uncommon. There is a slight predilection for the lower limb affection namely the foot. The overgrown region consists predominantly of adipose tissue. Yet, other tissue components that represent the mesenchyme may be involved.[1][2]

Clinical presentation

Macrodystrophia lipomatosa can manifest in functional incapacitation and esthetic problems. It is usually noticed by parents at birth or shortly after. It may be subject to an increase in size especially around puberty. The diagnosis is largely built upon establishing a comprehensive correlation between history and clinical examination on the one hand and characteristic imaging features on the other hand namely plain radiographs, ultrasound and magnetic resonance imaging examination.[2]

Imaging findings

Plain radiographs may show bone overgrowth and deformity together with osteoarthritis changes in advanced cases. Magnetic resonance imaging (MRI) has been shown to delineate the extent of abnormal fatty tissue in various sequences.[2] It may also be used as a tool for the differential diagnosis of ML.[2]

Differential diagnosis

The differential diagnosis of macrodystrophia lipomatosa includes a wide array of disorders which result in various degrees and patterns of limb overgrowth especially those occurring in childhood and adolescence.

Management

No medical therapy exists for such a disorder. Treatment depends upon the patient's symptomatology. Gait and functional problems may be addressed by foot wear adjustments. Esthetic complaints may be addressed through plastic surgery procedures such as debulking surgery. If a significant deformity is present a corrective osteotomy can be performed in conjugation. Digital amputation is reserved for severe deformities with or without pain.

References
  1. Prasetyono TO, Hanafi E, Astriana W (2015). "A Review of Macrodystrophia Lipomatosa: Revisitation". Archives of Plastic Surgery. 42: 391–406. doi:10.5999/aps.2015.42.4.391.CS1 maint: multiple names: authors list (link)
  2. Abdulhady, H; El-Sobky, TA; Elsayed, NS; Sakr, HM (11 June 2018). "Clinical and imaging features of pedal macrodystrophia lipomatosa in two children with differential diagnosis review". Journal of Musculoskeletal Surgery and Research. 2 (3): 130. doi:10.4103/jmsr.jmsr_8_18.
  3. EL-Sobky TA, Elsayed SM, EL Mikkawy DME (2015). "Orthopaedic manifestations of Proteus syndrome in a child with literature update". Bone Rep. 3: 104–108. doi:10.1016/j.bonr.2015.09.004. PMC 5365241. PMID 28377973.CS1 maint: multiple names: authors list (link)
  4. Friedman, JM (11 January 2018). "Neurofibromatosis 1". GeneReviews. University of Washington, Seattle. Retrieved 30 April 2018.
  5. Sung, HM; Chung, HY; Lee, SJ; et, al (2015). "Clinical experience of the Klippel-Trenaunay syndrome". Arch Plast Surg. 42 (5): 552–8. doi:10.5999/aps.2015.42.5.552. PMC 4579165. PMID 26430625.
  6. Nguyen, TA; Krakowski, AC; Naheedy, JH; Kruk, PG; Friedlander, SF (2015). "Imaging Pediatric Vascular Lesions". Clin Aesthet Dermatol. 8 (12): 27–41. PMC 4689509. PMID 26705446.
  • Bailey EJ, Thompson FM, Bohne W, Dyal C (Feb 1997). "Macrodystrophia lipomatosa of the foot: a report of three cases and literature review". Foot Ankle Int. 18 (2): 89–93. doi:10.1177/107110079701800209. PMID 9043881.CS1 maint: multiple names: authors list (link)
  • Goldman AB, Kaye JJ (1977). "Macrodystrophia Lipomatosa: Radiographic Diagnosis". Am. J. Roentgenology. 128: 101–105. doi:10.2214/ajr.128.1.101.
  • Blacksin M., Barnes FJ, Lyons MM (1992). "MR Diagnosis of Macrodystrophia Lipomatosa". Am. J. Roentgenology. 158: 1295–1297. doi:10.2214/ajr.158.6.1590127.CS1 maint: multiple names: authors list (link)
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