Lipedema is a disorder of adipose tissue that primarily affects females and is often misdiagnosed as obesity or lymphedema.

1. A SEMINAR ON
LIPOEDEMA: CLINICAL MANIFESTATTIONS, DIAGNOSIS AND
TREATMENT.
BY
MLS. ODUMOSON, NEWTON CLESTON (Intern)
TO
THE DEPARTMENT OF HISTOPATHOLOGY, MEDICAL LABORATORY
SERVICE,
FEDERAL MEDICAL CENTRE, YENAGOA.
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
ADMISSION AS AN ASSOCIATE MEMBER, MEDICAL LABORATORY
SCIENCE COUNCIL OF NIGERIA (AMLSCN).
SUPERVISOR: MLS. MIRINN KENNETH
AUGUST,2016.

2. OUTLINE
 INTRODUCTION
 LIPOEDEMA
 GENETIC COMPONENT
 PATHOMECHANISM
 CAUSES OF LIPOEDEMA
 STAGES OF LIPOEDEMA
 TYPES OF LIPOEDEMA
 SIGNS AND SYMPTOMS
 LABORATORY DIAGNOSIS
 TREATMENT
 CONCLUSION
 RECOMMENDATIONS

3. INTRODUCTION
What topic does not receive as much main
stream media coverage as it should?
LIPOEDEMA
Hence, the growing interest by clinicians to
understand the morphology, unique
features and definitive diagnosis and
treatment of lipoedema.

4. LIPOEDEMA
 First described in 1940
 Adipose tissue disorder
 “Painful fat syndrome”
Genetic component
Prevalence in women
(Allen & Hines, 1940).

5. GENETIC COMPONENT
(Child et al., 2010).

6. PATHOMECHANISM
 Aetiology is unknown
 According to hypothesis, lipoedema is an oestrogen-
regulated polygenetic disease, which manifests in parallel
with feminine hormonal changes and leads to vasculo- and
lymphangiopathy. Inflammation of the peripheral nerves
and sympathetic innervation abnormalities of the
subcutaneous adipose tissue also involving oestrogen may be
responsible for neuropathy. Adipocyte hyperproliferation is
likely to be a secondary phenomenon maintaining a vicious
cycle.
(Child et al., 2010).

7. CAUSES OF LIPOEDEMA
 Hormonal
 Genetic factor
Inflammation
Auto-immune
Endocrine issue
Abnormalities of the lymph and vascular system
(Harvey et al., 2005).

8. STAGE 1
 Skin surface smooth (with prominent pores),
thickened fat layer, but uniform
Disproportionate pear shape, with
somewhat increased fat.
 Leg still has shape but may be considered
somewhat larger or thicker than average by
others.
 Some swelling during the day but usually
resolves overnight or with rest and elevation
May have to start wearing significantly different
size pants than tops.
STAGES OF LIPOEDEMA
(Stutz & Krahl, 2009)

9. STAGE 2
 Skin texture change more uneven with
indentations ("orange peel" or
"mattress" skin).
 Fatty deposits grow around knees and
thighs, and some develop larger arms.
 Legs begin to thicken more, decrease of
calf and ankle contour.
 Skin rubbery/spongy begin to feel
nodular in places.
 Oedema can occur but doesn't resolve
as easily as it has in the past.
 Heat and on feet all day or sitting all
day may exacerbate swelling.
(Stutz & Krahl, 2009)
STAGES OF LIPOEDEMA CONTD…

10. Stage 3
 Increased texture "orange peel,”
“mattress,” “cottage cheese” look, Fat
nodules easy to detect.
 Large masses of tissue form folds and
ridges (lobular deformations),
especially above and below knees and
thighs.
 Decreased muscle contour worsens
forms "overshoulder" of the ankle=
ankle cut off sign.
 Swelling more consistent and doesn’t
resolve with rest and elevation.
(Stutz & Krahl, 2009)
STAGES OF LIPOEDEMA CONTD…

11. Stage 4
 Larger masses of skin and fat overhang,
complex folds and ridges with consistent
swelling.
 Large gains in weight occur, mobility
becomes affected.
 Skin becomes harder and/or discoloured.
In severe cases, lymph fluid can leak
from lymphatic vessels
(lymphorrhea).
 Significant increase risk of infection-
cellulitis.
(Stutz & Krahl, 2009)
STAGES OF LIPOEDEMA CONTD…

12. TYPES OF LIPOEDEMA
1. Pelvis, buttock and hips
(saddle bag phenomenon)
2.Buttock to knees,
with formation of folds of fat
around the inner side of the knee
3.Buttocks to ankles
4.Arms
5.Lower leg
(Harvey et al., 2005).

13. SIGNS AND SYMPTOMS
Pain mostly on legs
Easy bruises
Legs and arm swelling
Fatty lumps on legs, abdomen and arms
Heaviness
Fatique
Swelling and fatty deposition worsening after puberty,
pregnancies, contraceptive pills.
(Schmeller et al., 2011)

14. DIAGNOSIS (PHYSICAL EXAMINATION)
 Symmetrical fatty deposition on
legs, abdomen, arms.
 Superficial varicosities may be
present
 Tenderness to palpation most
prominent at pretibial area
 Bruises, varicosities
 Hypermobile joints
 Non pitting oedema, usually feet
are spared
(Rapprich et al., 2011)

15. HISTOLOGICAL DIAGNOSIS
 TISSUE BIOPSY
BIOCHEMICAL DIAGNOSIS
 Low vitamin D = usually ‹15ng/mL
(deficiency)
 Elevated CHO= Presence of chronic
inflammation
LABORATORY DIAGNOSIS
(Harvey et al., 2005).
Lipoedema
Biopsy

16.  Complete Decongestive Therapy (CDT)
Manual lymphatic drainage
 Compression Bandaging
 Garments
 Pneumatic pumps
 Skin care
 Nutrition Anti-inflammatory
 RAD diet
 Psycho-social support
 Exercise Aquatic therapy
 Liposuction
TREATMENT
(Harvey et al., 2005).

17. CONCLUSION
The diagnosis of lipoedema is and may be challenging to
determine among patients who are overweight or obessed.
Therefore, it is important for the clinician to understand the
morphology of lipoedema, as well as its unique features and
definitive diagnosis and treatment

18. RECOMENDATIONS
Create Awareness and recognition of lipoedema
among doctors, therapist , and politicians
Aquatic exercise or hydrotherapy
liposuction