Description

A 42-year-old Japanese woman with a body mass index of 42, presented with a long history of bilateral swelling of buttocks and lower extremities. The upper trunk, upper extremities and feet were spared of excessive fat deposition without a complete loss of adipose tissues (figure 1), lowering the likelihood of partial lipodystrophy. Physical examination revealed that the edema was dry, hard and non-pitting. Stemmer’s sign was negative, and five out of seven criteria for the diagnosis of lipoedema1 were met. A CT scan showed massive circumferential enlargement of subcutaneous tissues with the same CT value as fat, further suggesting the diagnosis of lipoedema (figure 1). Other conditions causing lower-extremity swelling or fat excess were excluded. We performed skin punch biopsy of the right hip (figure 2). Chief pathological findings were as follows: (1) the size of adipocytes was generally large (with a diameter up to 100 μm); (2) the contour of adipocytes was maintained, but with membrane breakage; and (3) infiltration of plasma cells or lymphocytes typically observed in lymphoedema was scarce.

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Figure 1

General appearance and CT scan of the lower extremities.

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Figure 2

Histology of adipocytes with H&E.

While the diagnostic pathology of lipoedema has not been established, hypertrophic and hyperplastic adipocytes are common pathological features.2 We presume that hypertrophic and ruptured adipocytes in our specimen highly suggest a rare case of lipoedema in Japanese woman.