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[A case of pelvic lipomatosis].

This is a report of the fifth case of pelvic lipomatosis in Japan. A 52-year-old man presented himself in our hospital with a complaint of left lower abdominal pain on August 28, 1988. At that time, physical examination was unremarkable with the exception of mild obesity. The excretory urogram and retrograde pyelogram revealed left hydroureteronephrosis with tapering of the left lower ureter. Urethrocystogram showed an elongated posterior urethra with anterior displacement and elevation of the bladder. Computed tomography revealed excess of diffuse fatty tissue in the pelvic space with bladder deformity and rectal compression. Pelvic arteriogram demonstrated no neovascularity. A diagnosis of pelvic lipomatosis was established. He lost 6 kg by diet therapy. Left lower abdominal pain disappeared, but excretory urogram after eight months showed no changes.

Humans↗

Derangement of adipose tissue: a case report of multicentric retroperitoneal liposarcomas, retroperitoneal lipomatosis and multiple subcutaneous lipomas.

No aetiological factors are at present known in the pathogenesis of liposarcomas. Benign lipomatous disorders, such as lipomas and lipomatosis, generally do not predispose to the development of liposarcomas. A case is presented of a patient with multicentric retroperitoneal liposarcomas, associated with retroperitoneal lipomatosis and preceded by a long history of multiple subcutaneous lipomas. In the literature this combination has not been described. This rare combination of lipomatous disorders seems to indicate a common derangement of adipose tissue.

Humans↗

Epidural lipomatosis as a cause of spinal cord compression in polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is a common rheumatologic disorder in older individuals that usually requires chronic, low dose corticosteroid therapy for adequate control of symptoms. Epidural lipomatosis is a rare complication of chronic corticosteroid use in which neurologic deficits occur due to extradural fat compression of the spinal cord. The author describes the first reported case of epidural lipomatosis occurring as a complication of corticosteroid therapy in a patient with PMR.

Adrenal Cortex Hormones↗

Pelvic lipomatosis with cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder: first reported case.

Pelvic lipomatosis is a rare disease which may cause obstructive uropathy. It has been reported with cystitis cystica and cystitis glandularis. Cystitis cystica and cystitis glandularis have been reported previously as progressing to adenocarcinoma of the bladder. The first reported case of pelvic lipomatosis, cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder is presented and the literature reviewed.

Adenocarcinoma↗

Isolated, segmental lipomatosis of the jejunum. Case report.

A case of segmental lipomatosis of the jejunum producing intermittent intussusception is reported. Preoperative barium studies suggested the diagnosis. Segmental resection of the affected bowel gave complete relief from symptoms. Of the 19 previously reported cases of small-bowel lipomatosis, only one had isolated involvement of the jejunum.

Adult↗

Computed tomography in renal replacement lipomatosis.

Replacement lipomatosis of the kidney is the result of severe atrophy or destruction of the renal parenchyma often caused by calculous disease with secondary marked proliferation of renal sinus, renal hilus, and perirenal fatty tissue. The diagnosis is difficult to establish with conventional radiographic methods. Though ultrasonography may show highly suggestive findings, computed tomography seems to be the most accurate method in demonstrating the distinctive features of replacement lipomatosis, i.e. a rim of the destroyed renal parenchyma adjacent to a lipomatous mass with attenuation values similar to those of normal fat and calculi. This entity should readily be differentiated from fat-containing tumors in the kidney or its vicinity by computed tomography. When surgery is contemplated CT may also be of value to determine the extension of the fibrous fatty tissue relative to adjacent organs and possible abscess formation.

Aged↗

Diffuse lipomatosis and tuberous sclerosis.

Diffuse lipomatosis, a classic example of an infiltrating fatty tumor, is a rare entity characterized by infiltration of adult-type adipose tissue into skin, subcutaneous tissue, and muscle. It usually involves a large portion of an extremity or the trunk. Some cases are associated with distant lipomas or angiomas, or hypertrophy of subjacent bone. The association of diffuse lipomatosis with tuberous sclerosis is reported.

Adolescent↗

[Fatty infiltration of the heart and Uhl's disease. Apropos of a case of cardiac lipomatosis].

A case is reported of gross lipomatosis of the heart which caused death by gross circulatory failure. The clinical, haemodynamic and angiographic diagnosis was Uhl's disease, and it was the post mortem examination which revealed the massive fatty infiltration of the heart; this involved mainly the right ventricle, but also affected the left ventricle to a major degree. Although fatty deposits in the heart have been recognised for some time, it is surprising to find that there have been extremely few publications on this subject during the last ten years; It is possible that a certain number of case reports of Uhl's disease in adults are really cases of lipomatosis of the heart which have not been recognised as such.

Diagnosis, Differential↗

Pelvic lipomatosis.

Although usually in the domain of the urologist, pelvic lipomatosis sometimes first may present to the general surgeon. Often called perivesical lipomatosis, this process of unknown etiology has been defined as a nonmalignant overgrowth of normal fatty tissue limited primarily to the perirectal and perivesical spaces in the pelvis. Typically it occurs in middle-aged, nonobese, men presenting with dysuria and sometimes with suprapubic fullness. High position of the prostate may be noted on rectal examination. Urinary tract roentgenograms show a high, gourd-shaped bladder with the surrounding radiolucency of fatty tissues. Elongation of the urethra usually makes cystoscopy difficult. Sigmoidoscopy and barium enema may reveal extrinsic pressure on the rectum. Pelvic venography rarely shows external venous compression; arteriography does not suggest neoplastic vessels. Fat metabolism studies are of little value. The absence of adequate cleavage planes renders direct surgical management difficult. The frequently progressive lower ureteral obstruction eventually may require urinary diversion. Four biopsy-proved cases from the Eastern Virginia Medical School Hospitals are reported, and the 57 previous cases from the literature are reviewed.

Adult↗

[A case of localized lipomatosis in the pancreatic head presenting a lipoma-like appearance].

A 63-year-old woman with localized lipomatosis in the pancreatic head is reported. She was diagnosed to have a lipoma by clinical data including CT scanning. Histopathological examination of the extirpated mass revealed that the lesion was mostly composed of mature fatty tissue without any lobulation or encapsulation by connective tissue, there was a small amount of scattered pancreatic parenchyma at the peripheral and deeper parts of the mass. No Langerhans' islets were detected. Based on these findings, the lesion was diagnosed as localized lipomatosis in the pancreatic head.

Female↗

Pelvic lipomatosis.

Pelvic lipomatosis is a recently reported, rare entity of uncertain clinical significance. Although it is usually an incidental finding from a gastrointestinal or genitourinary evaluation, various symptoms, usually urologic, have been ascribed to its presence. The authors recently encountered three patients with this condition, however, all of whom had complaints that caused them to seek general surgical consultation. the first patient presented with abdominal pain associated with a pelvic mass; the second developed lower extremity thrombophlebitis; and the third had bowel obstruction from colonic cancer obscured by the pelvic lipomatosis. As it becomes increasingly apparent that this process may be associated with conditions of importance to the general surgeon, an awareness of its presentation, resultant complications, and the possibility of associated disease processes is required. Thorough, systemic evluation of all these patients is necessary, and exploratory laparotomy may be indicated to establish complete diagnosis.

Abdomen↗

Idiopathic spinal epidural lipomatosis. Case report and review of literature.

Idiopathic spinal epidural lipomatosis rarely is found (8 reported cases) in the absence of steroid treatment or obvious endocrinopathy. One additional symptomatic case with gait difficulty is described here. The only common etiologic factor for all cases is their obesity. Magnetic resonance imaging is the most helpful diagnostic means and should be used initially. In a patient with radicular pain or progressive paralysis who is obese, spinal epidural lipomatosis may be the etiologic factor involved.

Adolescent↗

[Diffuse symptomatic polypoid lipomatosis of the colon with hyperplasia of epiploic appendices: a case report].

Diffuse and symptomatic lipomatosis of the colon, particularly when associated with hyperplasia of the appendices epiploicae, is a rare disease. We report here the case of a lean, 26-year-old woman who had polypoid lipomatosis of the colon with submucosal and subserous expression (involving the mesentery and peritoneum) associated with extreme hyperplasia of the appendices epiploicae. Her disease led to a recurrent subocclusive syndrome which required total colectomy. We discuss the case and review the literature on this subject. The particular characteristics of this case and early onset of disease would suggest that our patient was affected by a congenital lipomatous syndrome linked to mesenchymal dysplasia. Long-term monitoring will enable prompt intervention in the case of reformation of lipomatous tissue.

Adult↗

[Classification and terminological designation of Madelung's lipomatosis].

From experience in the treatment of 18 patients with Madelung's lipomatosis the authors suggest a system of designation of the spread of the disease embracing the possible localizations of the tumor. The system of recording the spread and marked character of the adipose tumors makes it possible to appraise the developmental stage of the disease. It is suggested that 4 stages of the disease are distinguished. According to the type of growth, two forms of tumors are distinguished: nodular and diffuse. Systemic designation and the form of the tumor give a more complete idea of the disease and thus allow the optimal tactics of surgery to be chosen. Among the numerous terms suggested for the disease, the most appropriate, reflecting the essence of the disease is "Madelung's lipomatosis". The authors suggest it for unification of the designations of the disease and easier literature search and generalization of information on this rare disease.

Humans↗

Radiologic manifestations of pelvic lipomatosis.

Ten male patients with pelvic lipomatosis are herein reported and the clinical and radiological features of the disease are reviewed. The main criteria for the preoperative diagnosis of pelvic lipomatosis include: a) radiolucency of the pelvic soft tissues with a normal to slightly increased vascularity on pelvic arteriography; b) deformity and anterior deviation of the urinary bladder together with various degrees of obstructive uropathy; and c) tubular narrowing of the rectum and upward displacement of the sigmoid colon and small intestine. The associated symptoms are usually variable degrees of dysuria, constipation, and frequently hypertension. Surgical excision of the pelvic lipomatous tissue is of limited value in the management of this disease.

Adult↗

Renal sinus lipomatosis and body composition in hypertensive, obese rabbits.

OBJECTIVE: To test whether renal lipomatosis, an accretion of fat in the renal sinus associated with chronic renal infections, abscesses and calculi, can also be caused by rapid weight gain. DESIGN: New Zealand white rabbits were fed either standard rabbit chow (n = 24) or chow fortified with 10% corn oil plus 5% lard (n = 25) for 8-12 weeks. MEASUREMENTS: The rabbits and constituent tissues were weighed initially, after drying and after organic extractions. Renal tissue cholesterol and triglycerides were measured chemically. RESULTS: Rabbits made obese by increased fat intake were 1.8 kg heavier than controls (5.5 +/- 0.3 kg vs 3.7 +/- 0.2; n = 24,25), had 1.54 kg more body fat (1.90 +/- 0.25 vs 0.36 +/- 0.11 kg/rabbit; n = 10,9), and had a mean arterial blood pressure that was 9.2 mm Hg greater than controls (95.1 +/- 8.5 vs 85.9 +/- 5.6 mm Hg; n = 23,24). Individual organs grew in mass (lung, 15%; gastrocnemius, 17%; liver, 27%; kidney, 30%) and their parenchyma gained extractable lipids (lung, 5.5 mg/g tissue; gastrocnemius, 9.6 mg/g tissue; liver, 17.9 mg/g tissue). Total renal triglycerides were increased 2.1 fold, from 103 +/- 36 to 219 +/- 59 mg/kidney (n = 8,8), compared to the 5.3 fold increase in whole body fat. Renal cholesterol was increased 1.7 fold, from 7.5 +/- 1.1 to 12.7 +/- 2.9 mg/kidney, (n = 8,8). Within experimental error, the sum of the total renal triglycerides plus the total renal cholesterol equaled the net fat extracted from the renal sinus alone: 95 +/- 29 mg/kidney in lean rabbits and 253 +/- 71 mg/kidney in obese (n = 17,17). CONCLUSION: Obesity alone can cause renal lipomatosis. This increased volume of anatomically localized fat may be sufficient to externally compress renal veins and lymphatics, thus altering renal hemodynamic behavior.

Animals↗