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Abstract
Multiple symmetric lipomatosis (MSL) is a rare disease associated with metabolic disorders and alcoholism. In this report, we describe the clinical outcome and surgical protocol for eight men with Madelung collar who underwent treatment in a craniofacial and plastic surgery facility in Hanoi, Vietnam, between May 2018 and December 2020. We discuss the patients' clinical symptoms, subclinical signs, epidemiology, magnetic resonance imaging, computerized tomography, surgical protocol, complications, and postoperative indicators that we collected and evaluated. Each patient underwent surgery in two stages (i.e., in supine and prone positions). We injected a tumescent solution 10 min before the incision. Two surgeons performed each operation simultaneously. After surgery, we followed the patients for 6-27 months. All of the patients had a history of long-time alcohol abuse and had associated comorbidities that included liver disease, blood disorders, restricted neck movement, and orthopnea. We did not have to open the trachea or transfuse blood during any of the surgical procedures. Postoperatively, all patients were satisfied with their functional results and aesthetic appearance. One patient experienced a recurrence of his MSL. We believe our surgical protocol provides optimal results for patients with MSL and Madelung collar.
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Affiliation(s)
- Nguyen Quang Duc
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Vu Ngoc Lam
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Le Thi Thu Hai
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Nguyen Trong Nghia
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
| | - Le Diep Linh
- Nguyen Quang Duc, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Vu Ngoc Lam, PhD, MD, is Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Thi Thu Hai, PhD, is Plastic Surgeon, 108 Institute of Clinical Medical and Pharmaceutical Sciences, The 108 Military Central Hospital, Hanoi, Vietnam
- Nguyen Trong Nghia, PhD, MD, is Plastic Surgeon, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
- Le Diep Linh, PhD, MD, is Deputy Director, The Center for Craniofacial and Plastic Surgery, The 108 Military Central Hospital, Hanoi, Vietnam
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Chen K, Wan X, Zhao L, Zhao S, Peng L, Yang W, Yuan J, Zhu L, Mo Z. Cbl Proto-Oncogene B (CBLB) c.197A>T Mutation Induces Mild Metabolic Dysfunction in Partial Type I Multiple Symmetric Lipomatosis (MSL). Diabetes Metab Syndr Obes 2020; 13:3535-3549. [PMID: 33116705 PMCID: PMC7547790 DOI: 10.2147/dmso.s273780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Multiple symmetric lipomatosis (MSL) is a rare disease showing chronic progression of multiple, symmetrical, and non-encapsulated subcutaneous lipoma. The cause of the disease remains unknown. PATIENTS AND METHODS This study reported and summarized 13 sporadic cases of Type I MSL patients in terms of histopathology and cellular and molecular biology and assessed the CBLB c.197A>T mutation in the IRS1-PI3K-Akt pathway. RESULTS The clinical data showed that these 13 Type I patients were all male with a mean age of 57.0 ± 6.6 years old and consumed alcohol heavily. The laboratory tests revealed that most of the patients had hyperuricemia, diabetes, hyperinsulinemia, or insulin resistance; however, their blood lipid levels were close to a normal range. The imaging data exhibited lipomas that only occurred subcutaneously but not viscerally, ie, Types Ia (15.4%), Ib (30.8%), and Ic (53.8%). The molecular analyses of adipocytes of isoprenaline stimulated human adipose tissue-derived mesenchymal stromal cells (hADSCs) isolated from the adipose tissue lipoma-like masses (ATLLM) demonstrated that these adipocytes did not express UCP-1. The Cbl proto-oncogene B (CBLB), an E3 ubiquitin-protein ligase, was associated with insulin resistance and obesity and was mutated (ie, CBLB c.197A>T) in four MSL patients after the whole genome and Sanger sequencing of the blood samples. Furthermore, the CBLB c.197A>T mutation induced hADSC resistance to insulin by inactivation of the IRS-1-PI3K-AKT pathway. CONCLUSION This study analyzed clinical, histopathological, and cellular and molecular biological characterizations of 13 Type I MSL patients and identified the CBLB c.197A>T heterozygous mutation that could be responsible for MSL metabolic dysfunction or even MSL development.
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Affiliation(s)
- Ke Chen
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Xinxing Wan
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Liling Zhao
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Shaoli Zhao
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Lin Peng
- Department of Nephrology, The First Hospital of Changsha, Changsha, Hunan410005, People’s Republic of China
| | - Wenjun Yang
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Jingjing Yuan
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Liyong Zhu
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Zhaohui Mo
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
- Correspondence: Zhaohui Mo Tel/Fax +86 731 88618006 Email
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