Plate 13

Plate 13

Lipomatosis perimuscularis circumscripta.

One of our ( first described, Curschmann)* particularly instructive cases of this idiosyncratic condition.

The image shows a medium built 50 year old man whose tremendous promontory trunk and upper arm stand in striking disproportions to the relatively thin arms, legs, and gluteal quarters.

While the face appears unchanged, the neck turns out considerably thickened, separated by a deep furrow from the roundly swollen upper back area. The deltoid region appears puissantly enlarged, a deep fold defecting it and the scapular region from a significant bulge on the hind side of the arm marking the musc. triceps brachii. Furthermore, the region of the pector. major. is skewed by a huge round mass on which the nipples sit high. From there downwards one is certain to recognize three broader swellings, in which a hypertrophy of the muscul. rect. abdominis with its inscript tendin. The lower back region is skewed by several seemingly limp, drooping bulges.

The closer examination of the condition results in that everything described, of the trunk and the upper arms, imparts such a wierd look approximating tumescence of hyperplastic subdermal adipose tissue. But the fat is not, as one observes of the more common lipomatosis, simply accumulating tumorous irregularities in the various surface locations of the body, but rather , as also shown by the figure, circumcrescent over and around the individual muscles and muscle groups, and to a certain extent true to their physiological form and circumference.

The impression of a muscular hypertrophy can emerge through cursory inspection, as the illustration also teaches. But irrespective of the results of the evidence, learned by only a glance at the illustration, the contours of the apparently herculean developed muscles are undefined, pulpier, as with models, for example, shaped out of a soft material.

As with all such affected patients, whom I have observed up to now (in total seven, three by the time of the first publication), the perimuscular lipomatosis shows itself only in the trunk and upper arms, restricted to the upper parts of the thigh at the most, always in a perfectly symmetrical development.

The fat tumescent muscles of the patient are shown to be noticeably wimpy. There was also the start of debilitating hyperplastic skeins of fat over the individual muscle parts not yet lame, e.g. the frontal parts of the left deltoideus. The muscles here may be palpated for their slack, thin cords. No fibrillar convulsions. Electrical excitation reduced-- if not debilitated-- to no degenerative reaction time.

         (microscopic diag: comp. Schmidts Jahrbucher 1.c.)

*Meeting of the Leipziger Med. Society, 29 January 1889. Schmidts Jahrb. 1889 v. 222 pp. 110-111.

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