CASE 918: MADELUNG DISEASE in a Young Asian Woman, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER and Dr NGUYỄN PHAN TÚ DUNG, VIETNAM.

A 24 year-old nurse with height 160cm, weight 90kg and 136cm of her circumference of the waits.

She would like to reduce her waits by cosmetic management.

Ultrasound notes hypertrophy of fatty tissues without  capsule of her waist, no tumor inside.

MSCT confirmed symmetric fatty tissue of the waits and nothing abnormal detected in the abdomen and bone and vessels.

Surgery with ultrasound knife removed the fatty tissue # 2.5kg each side.

Specimen were benign lipoma. 

Madelung disease, also known as Madelung-Launois-Bensaude syndrome or neck lipomatosis or multiple symmetric lipomatosis. That is a rare benign entity clinically characterized by the presence of multiple and symmetric, non-encapsulated masses of fatty tissue, usually involving the neck and the upper region of the trunk, mainly in the posterior aspect. Limb involvement is usually proximal and around the shoulder and hip girdles.

Madelung’s disease causes fatty tissue to grow on neck, upper back and shoulders. It can cause symptoms like difficulty swallowing, talking or moving the head.

Madelung’s disease is a rare condition where extra fatty tissue builds up in places it normally wouldn’t, like around the neck and shoulders. It causes painless, fatty masses that grow over time. If the lumps get too big, they can affect nearby body functions. 

Less commonly, fatty deposits appear on Abdomen, Chest, Hips, Thighs.

This fatty tissue is different than a fatty lump (lipoma) or typical body fat. It spreads and mixes under the skin — looking like jelly spread on a piece of bread. It also grows evenly. For example, it will be on both the left and right sides of the shoulders.

Risk factors

Alcohol use disorder is one of the biggest risk factors. Between 60% and 90% of people with this disease also have cirrhosis of the liver from heavy alcohol use.

Other risk factors include:

Being male and between the ages of 30 and 70

Having a biological family history of the disease

Having a metabolic disorder, like diabetes or hyperlipidemia

May classify the type of Madelung’s disease based on where the fat has built up:

Type 1 (classic type): This type is most common in men. Fat builds up in only the neck, shoulders and upper body. It can sometimes give someone athletic-looking appearance. It’s strongly associated with alcohol use disorder.

Type 2: This type is more common in women, but rarer overall. Fat builds up in the upper body, like Type 1. It also builds up in the abdomen, thighs and hips. It doesn’t have a strong connection to alcohol use disorder.

From  Việt Đức Hospital, a 45 yo woman with a lipoma at her posterior neck and two fatty masses at her back.

So our case may classified in type 2 of Madelung disease: no alcohol intake,  symmetric lipomatosis  at the waist.