Limb-Predominant Familial Multiple Lipomatosis: The Role of En Bloc Excision and Systematic Pedigree in Modern Surgical Practice - A Case Report.

Introduction: Familial multiple lipomatosis (FML) is a rare hereditary disorder characterized by multiple encapsulated subcutaneous lipomas, typically sparing the head and neck. Although benign, these lesions often necessitate intervention due to cosmetic deformity, discomfort, or functional impairment. Case Presentation: A 36-year-old male presented with a 6-month history of multiple, gradually enlarging, mildly painful subcutaneous masses in both arms and thighs. Physical examination revealed 16 soft, mobile nodules; the largest measured 6 × 7 cm in the left thigh. Preoperative ultrasonography of an arm lesion suggested a heterogeneous fluid collection without a discrete solid mass. Management and Outcomes: All lesions were excised en bloc under general anesthesia using tumescent infiltration and incisions along Langer's lines. Histopathology confirmed mature adipocytes with thin fibrous septa and branching capillaries, without atypia, consistent with lipomas. Recovery was uneventful. Subsequent pedigree analysis identified affected maternal relatives, confirming FML. Conclusion: This case underscores the necessity of systematic family history and oncologically safe excision for symptomatic FML.