J Breast Cancer.  2014 Dec;17(4):397-400. 10.4048/jbc.2014.17.4.397.

Multiple Symmetric Lipomatosis (Madelung's Disease) Presenting as Bilateral Huge Gynecomastia

• Jang JH
• Lee A
• Han SA
• Ryu JK
• Song JY

• KMID: 2176133
• DOI: http://doi.org/10.4048/jbc.2014.17.4.397

Abstract

Multiple symmetric lipomatosis (MSL), or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and upper body. MSL presenting as bilateral huge gynecomastia is an extremely rare phenomenon. The present report describes a case of MSL in a 66-year-old man. The patients presented with bilateral breast bulging. He had a history of cigarette and alcohol use. His condition was treated with a bilateral nipple-sparing mastectomy. MSL can present as a form of gynecomastia, for its accurate diagnosis and proper treatment of MSL, increasing awareness of the clinical characteristics of the disease is required, especially amongst breast surgeons. Herein, we review the literature and discuss the clinical characteristics, pathology, and surgical treatment of MSL.

Keyword

Breast; Gynecomastia; Lipomatosis; Male; Multiple symmetrical lipomatosis

MeSH Terms

Adipose Tissue
Aged
Breast
Diagnosis
Gynecomastia*
Humans
Lipomatosis
Lipomatosis, Multiple Symmetrical*
Male
Mastectomy
Pathology
Rare Diseases
Tobacco Products

Figure

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  Figure 1 Physical findings and imaging studies of the patient. (A) Breast masses had elastic consistency and could be moved without causing any pain. Mammography (B) and ultrasonography (C) shows bilateral excessive fatty breast without definite glandular tissue (pseudogynecomastia).

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  Figure 2 Computed tomography (CT) and magnetic resonance imaging (MRI) findings of the patient. (A) Marked bulging contours of both breasts with fat depositions are observed on CT scan. (B) MRI shows fat deposition in occipital lesion (white arrow). (C) CT scan shows bilateral fat deposition in shoulder (white arrow). (D) Excessive focal fat deposition as another focus of lipoma is also observed in superficial soft tissue layer of upper central abdomen on CT scan (white arrow).

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  Figure 3 Postoperative physical finding and breast specimen. (A) The patient underwent both nipple-sparing mastectomy with nipple interposition. (B) Breast specimen shows multiple lipomas, which were measured 30×17×5 cm (right) and 27×16×5 cm (left), respectively.

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  Figure 4 Microscopic pictures of specimen. Diffuse proliferation of normal adipose tissue is observed in microscopic pictures of specimen (H&E stain, ×100).

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