Baciu et al. published this study about the lumbar sclerolipoma (back mice) or the Copeman-Ackerman Syndrome in 1968 in Romania. It is written in Romanian.

They studied 60 cases and presented the hypothesis that the entity has a HORMONAL ORIGIN (pituitary or ovarium) with a DISTURBANCE OF THE WATER DISTRIBUTION and presents as painful lipomas in the lumbo-sacral region. Surgical removal is the best solution, closing the possible fascial gap (they present as fatty hernias). There is a relapse rate of 25%.

Despite they say that they studied 60 cases, the article is very short and just mentions briefly the main topics related to back mice. It shows a macroscopic and a microscopic photo. IT SAYS THAT the fatty tissue presents PERIVASCULAR and VASCULAR FINDINGS (that is also described by other authors).

Baciu et al. refer to others works, especially Copeman and Ackerman. But I did not find any detailed reference list.

Notes on the article:

Painful lumbar sclerolipoma (syndrome Copeman-Ackermann)

By C. Baciu, CH. Filipescu and A. Brazda

Department of Orthopedics. Bucharest. Romania.

They start the article by stating that the pathology underlying certain extraarticular rheumatism with diffuse painful conditions is unclear.

But some patients with extra-articular rheumatism present painful lipomatous nodes under the skin that can present segmental or radicular pain associated.

They studied 60 patients with these painful fatty nodes that were first described by Copeman and Ackerman in 1944. Later, their work was confirmed by Paviota, Lageze, Lewise and others.

There is not a clear etiopathogenic explanation and many names have been used to describe these painful nodes. But all the authors agree that the nodes present a fatty nature and some times can be related to a fat herniation.

Some terms like fibrositis, cellulitis (French) and panniculitis (German) have been related to it.

The nodules appear especially at the sacro-iliac region (Lewis called them epi-sacro-iliac lipoma).

Joly and Payolle suggested that these nodes appear more often in women with tendency to obesity and menopause and that often present arthritic spine-osetophyte disorder and discopathy, degenerative disease of the knee or hip.

These patients usually present a characteristic physical examination. Around the sacroiliac region one, or two or three ROUND, OVATE, DEEP AND RIGID, where moving nodes can be palpated. The palpation causes pain to the patient. It sometimes causes sciatic pain.

 

The figure shows a lumbar node of 9 cm long.

 There are 3 published syndromes that may be related:

-The ILIOSACRAL BLOCK (according to Anglo-Saxon authors)

-The pyramidalis syndrome (according to Freiberg and Wincke, due to fibrositis or myyositis)

-The iliolumbar syndrome

 Copeman explained the presence of the nodes as a “reduced” form of the NODULAR PANNICULITIS by Weber-Christian, where the fatty tissue presents edema probably by an endocrine dysfunction. Paviot and Lageze consider that there is a sero-fibrositic exudate related to a dysfunction.

Treatment includes infiltration or surgery. Sometimes there are gaps in the fascias that need to be repaired, especially to avoid recurrences.

The microscopic studies showed PERIVASCULAR reaction. They presented altered walls and endothelial thickening. Areas with hyalinazation were also observed. They also observed nerve fibers with dystrophic changes.

 Recurrences are common (25%).

 Published in November 2018 by  Marta Cañis Parera    

 Reference

Baciu C, Filipescu C, Brazda A. [Painful lumbar sclerolipoma (Copeman-Ackermann’s syndrome)]. Acta Chir Orthop Traumatol Cech. 1968 Oct;35(5):429-32. Czech. PubMed PMID: 4236582.