REPORT OF A CASE
A 60-year-old man presented with a 4-year history of gradually enlarging, sagging masses of the cervicofacial region. His medical history included hospital admission 2 years previously for ascites and alcoholic hepatitis. The patient denied alcohol intake since that admission. There was no family history of similar deformity.On examination, the patient was 185 cm in height and weighed 93 kg. His general appearance was remarkable for soft, bilateral, symmetrical, confluent masses of the cervical and mandibulofacial areas that extended suboccipitally (Fig 1). The masses were nontender, and the overlying skin was normal in color and texture.Laboratory investigations revealed normal complete blood cell count, urinalysis, and serum electrolyte levels. Renal function was normal, but liver function testing showed elevated aspartate aminotransferase, lactate dehydrogenase, and bilirubin levels.Owing to the extent of deformity, the patient underwent staged excision on three occasions. A representative section from the skin