Symmetric multiple lipomatosis: Classification and surgical treatment [Lipomatosi multipla simmetrica: inquadramento diagnostico e trattamento chirurgico]

The authors describe the outcome of the surgical treatment of 12 patients with Symmetric Multiple Lipomatosis. After a review of the literature on this subject, they feel the necessity for a new classification of the disease, especially considering the new findings. In fact, Berkovic and his coworkers suspect the biochemic basis of the disease to be represented by mytochondrial anomalies, in accordance with similar findings in the radiate red striped muscle fibres. In familial cases, such anomaly would be transmitted as X-linked (mytochondrial) whilst in alcohol-abusers it would be alcohol-induced. The authors have performed a muscle biopsy of the deltoid in seven patients, in order to detect possible mytochondrial anomalies. They have noticed the presence of radiate red fibres and cytochrome-C-oxidase negative fibres, considered the expression of anomalies of the mytochondria; such anomalies have been confirmed by biochemical studies on muscle fibres, which have shown a marked reduction in the cytochrome-C-oxidase activity of the mytochondria. The authors suggest therefore that the problems of SML should be viewed in terms of general rather than surgical treatment. The treatment should be patient-taylored and not necessarily aggressive, with the aim of improving function and, whenever possible, cosmetic problems.