Adipose tissue remodeling in lipedema: adipocyte death and concurrent regeneration

TLDR

Lipedema is an idiopathic disease characterized by bilateral, symmetric enlargement of the lower extremities due to subcutaneous adipose deposition, distinct from systemic obesity. The study aims to describe the histopathological features of lipedema tissue and adjacent nonaffected adipose tissue from a typical patient with severe lipedema. Tissue samples were collected from a typical patient with severe lipedema for histopathological analysis. Immunohistochemistry revealed degenerative crown‑like structures of necrotizing adipocytes with infiltrating CD68+ macrophages and proliferating Ki67+CD34+ adipose‑derived stem/progenitor cells, indicating increased adipogenesis that may cause hypoxia, adipocyte necrosis, and macrophage recruitment similar to obesity.

Abstract

Lipedema is a disease with unknown etiology presenting as bilateral and symmetric enlargement of the lower extremities due to subcutaneous deposition of the adipose tissue. Here we describe the histopathological features of the lipedema tissue and nonaffected adipose tissue obtained from a typical patient with severe lipedema. Immunohistochemical analyses indicated degenerative and regenerative changes of the lipedema tissue, characterized by crown‐like structures (necrotizing adipocytes surrounded by infiltrating CD68+ macrophages; a feature commonly seen in obese adipose tissue) and proliferation of adipose‐derived stem/progenitor/stromal cells (Ki67+CD34+ cells), respectively. These findings suggested increased adipogenesis in the lipedema tissue, which may further lead to hypoxia similar to that seen in obesity, resulting in adipocyte necrosis and macrophage recruitment. The confinement to the lower extremities and the difference from systemic obesity warrants further elucidation in future studies.