MEDICAL IMAGES

A 37-lb Tumor

Livia T. Hegerova, MD, and Anupam Chandra, MD, PhD

From the Department ofInternal Medicine (L.T.H.)and Division of PrimaryCare Internal Medicine(A.C.), Mayo Clinic,Rochester, MN.

A 67-year-old woman presented with a15-year history of a slowly growing fattymass in the upper back (Figure 1).

Recently, the patient began to have difficultywith balance and ambulation because ofthe weight of the tumor. Physical examination

FIGURE 1. A 37-lb (16.8 kg) fatty tumorinvolving the upper back in a patient with benignsymmetric lipomatosis, or Madelung disease.

FIGURE 2. Preoperative appearance of a 37-lb(16.8 kg) tumor in a patient with benign sym-metric lipomatosis, or Madelung disease.

Mayo Clin Proc. n November 2013;88(11):e135 n http://dx.doi.org/www.mayoclinicproceedings.org n ª 2013 Mayo Foundation for M

revealed a diffuse, symmetric, painless soft massin the upper back. Surgical debulking was per-formed. The specimen removed weighed 37 lb(16.8 kg) (Figures 2 and 3). Histological exami-nation revealed mature adipose tissue. A clinicaldiagnosis of benign symmetric lipomatosis, orMadelung disease, was made. It is a rare disordercharacterized by benign, nonencapsulated fattymasses of the neck, upper trunk, and back.The disease predominantly affects middle-agedmen with chronic alcohol abuse. The etiologyremains largely unknown, and recurrence iscommon. The patient was satisfied with theappearance and her ability to walk shortly afterthe operation.

FIGURE 3. Staged wound closure after removalof a 37-lb (16.8 kg) tumor in a patient with benignsymmetric lipomatosis, or Madelung disease.

10.1016/j.mayocp.2013.04.031edical Education and Research

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