title: Adipose tissue remodeling in  lipedema: adipocyte death and  concurrent regeneration.
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.
authors.affiliation: Department of Plastic Surgery, University of Tokyo Graduate School of Medicine, Bunkyo-Ku, Tokyo, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Suga
authors.forename: Jun
authors.initials: J
authors.lastname: Araki
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Aoi
authors.forename: Harunosuke
authors.initials: H
authors.lastname: Kato
authors.forename: Takuya
authors.initials: T
authors.lastname: Higashino
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yoshimura
mesh_terms: D017667:Adipocytes / Q000378:metabolism / Q000473:pathology*; D000273:Adipose Tissue / Q000378:metabolism / Q000473:pathology*; D000368:Aged; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000378:metabolism / Q000473:pathology*; D007150:Immunohistochemistry