Multiple symmetric lipomatosis: A rare disease and its possible links to brown adipose tissue

• Multiple Symmetric Lipomatosis (MSL) is a rare disease mostly affecting heavy drinking men.
• Clinical features: symmetrical distribution and mediastinal occupation by lipomatous tissue.
• Typical metabolic abnormalities: hyper-α-lipoproteinemia with high lipoprotein-lipase activity.
• MSL could be the result of a disorder of proliferation and differentiation of BAT.

AimAim of this study is an updated review of our case series (72 patients) as well as available literature on the Multiple Symmetric Lipomatosis (MSL), a rare disease primarily involving adipose tissue, characterized by the presence of not encapsulated fat masses, symmetrically disposed at characteristic body sites (neck, trunk, proximal parts of upper and lower limbs).Data synthesisThe disease is more frequent in males, associated to an elevated chronic alcohol consumption, mainly in form of red wine. Familiarity has been reported and MSL is considered an autosomic dominant inherited disease. MSL is associated to severe clinical complications, represented by occupation of the mediastinum by lipomatous tissue with a mediastinal syndrome and by the presence of a somatic and autonomic neuropathies. Hyper-alphalipoproteinemia with an increased adipose tissue lipoprotein-lipase activity, a defect of adrenergic stimulated lipolysis and a reduction of mitochondrial enzymes have been described. The localization of lipomatous masses suggests that MSL lipomas could originate from brown adipose tissue (BAT). Moreover, studies on cultured pre-adipocytes demonstrate that these cells synthetize the mitochondrial inner membrane protein UCP-1, the selective marker of BAT. Surgical removal of lipomatous tissue is to date the only validated therapeutic approach.ConclusionsMSL is supposed to be the result of a disorder of the proliferation and differentiation of human BAT cells.