Familial bilateral peritrochanteric lipomatosis

Sir, An unusual abnormal fat distribution of the lower part of the body is characterized by massive and symmetric deposits in the groins, trochanters, buttocks, and hips, which contrast sharply with the normal upper part of the body. The massive lipomatosis of the lower part of the body can be classified into three types: type 1, the familial symmetrical lipomatosis that affects the groins, trochanters, hips, buttocks, and thighs; type 2, the bilateral peritrochanteric familial lipomatosis; and type 3, the unilateral peritrochanteric lipomatosis. This deformity affects only women aged between 18 and 50 in the Mediterranean region [1]. Further, isolated abnormal bilateral peritrochanteric lipomatosis has rarely been reported in literature. We report two patients, a mother and her daughter, with isolated bilateral peritrochanteric lipomatosis, who had normal fat distribution of the upper half of the body which was in contrast with the abnormal lower half. The mother, a 42-year-old patient, presented with bilateral abnormal fat distribution of the lower part of the body. Peritrochanteric fat deposits had appeared at the age of 13 and increased with time. The physical examination revealed bilateral isolated, well-demarcated peritrochanteric lipomatosis and normal fat distribution of the upper half of the body (Fig. 1a). The patient was 167 cm tall and weighed 72 kg (body mass index [BMI]=25.8 kg/m). Laboratory and endocrinologic tests included the serum concentrations of lipoprotein, lipoprotein lipase activity, cholesterol, triglycerides, uric acid, fasting glucose, serum estradiol, and testosterone levels, and thyroid function parameters were within normal limits. Histological study of lipoaspirate showed subcutaneous fatty tissue. The daugther, a 22-year-old patient, also presented with bilateral abnormal fat distribution of the lower part of the body. The patient's signs had appeared at age of 12 also increasing with time. The physical examination revealed bilateral isolated, well-demarcated peritrochanteric lipomatosis although it was more evident on the left side (Fig. 2a). The patient was 169 cm tall and weighed 67 kg (BMI=23.5 kg/m). Laboratory and endocrinological tests were within normal limits. Histological study of lipoaspirate showed subcutaneous fatty tissue. Both patients underwent general anesthesia and all procedures were initiated with infusion of tumescent solution (1 L normal saline solution, 30 mg lidocaine, and 1 mL of 1:1,000 epinephrine) [2]. A suction-assisted liposuction method was employed using 4and 6-mm cannulae. Suction started deep into the superficial fascia and ended with superficial liposuction [3]. Incisionswere closedwith6-0 polyprolene and dressings were applied. A second limited liposuction was planned to treat the irregularities in the first case. Results were satisfactory in both cases (Figs. 1b and 2b). Isolated abnormal bilateral peritrochanteric lipomatosis has rarely been reported in literature. In 2006, Goshtasby et al. presented a case of isolated bilateral peritrochanteric lipomatosis of the soft tissue overlying the trochanters [4]. The unusual distribution of fat in the lower body should be differentiated from the familial multiple nodular symmetrical lipomatosis, where the lipomas are nodular, circumscribed, subcutaneous in location, and more common on the extremities and trunk rather than around the neck, shoulder, or the upper torso [5]. Stavropoulos and his colleagues have suggested that the term symmetric lipomatosis referred to two separate disorders, benign multiple symmetric lipomatosis and female S. Şentürk (*) Department of Plastic and Reconstructive Surgery, Mevlana (Rumi) University Hospital, Konya, Turkey e-mail: drssenturk@hotmail.com