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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 3  |  Page : 209-211

Lipoleiomyoma of uterus: A case report with review of literature


1 Department of Pathology, D. Y. Patil Medical College, Kolhapur, Maharashtra, India
2 Consultant Pathologist and Microbiologist, Purohit Laboratory, Kolhapur, Maharashtra, India

Date of Web Publication25-Oct-2013

Correspondence Address:
Shilpa Narchal
Department of Pathology, D. Y. Patil Medical College and Research Centre, Kasaba Bavada, Kolhapur - 416 006, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.120595

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  Abstract 

Lipomatous uterine tumors are unusual benign neoplasms. Here, we report a case of lipoleiomyoma in a 45-year-old perimenopausal woman who presented with lower abdominal pain and distension. Ultrasonography revealed a small hyperechoic mass and multiple leiomyomas within the pelvic cavity. Gross examination of the hysterectomy specimen revealed multiple subserosal leiomyomas. On microscopy, presence of mature fat admixed with smooth muscle was noted, which was an incidental finding consistent with a uterine lipoleiomyoma. Hence, it emphasizes the importance of histopathology in the confirmation of the diagnosis. The importance of this case lies in its rarity and its enlistment in the differentials of lipomatous tumors in the pelvic cavity. We seek to discuss such a distinct entity.

Keywords: Leiomyoma, myolipoma, uterine mesenchymal tumors


How to cite this article:
Narchal S, Patil SB, Purohit P V, More S S. Lipoleiomyoma of uterus: A case report with review of literature . Int J Health Allied Sci 2013;2:209-11

How to cite this URL:
Narchal S, Patil SB, Purohit P V, More S S. Lipoleiomyoma of uterus: A case report with review of literature . Int J Health Allied Sci [serial online] 2013 [cited 2019 Sep 20];2:209-11. Available from: http://www.ijhas.in/text.asp?2013/2/3/209/120595


  Introduction Top


Lipoleiomyoma is an uncommon benign mesenchymal neoplasm of uterus, considered to be a variant of uterine myomas. [1],[2] The reported incidence of lipoleiomyoma varies from 0.03 to 0.2%. [1],[2],[3],[4] It consists of variable proportion of mature lipocytes and smooth muscle cells. [1] Lipoleiomyomas generally occur in postmenopausal women and are associated with conventional leiomyomas. The signs and symptoms are similar to those caused by leiomyomas. [2] Lipoleiomyomas can be found anywhere in the uterus or cervix. Uterine lipoleiomyomas are most frequently found in the uterine corpus and are usually intramural. [2],[5] Histologically, these should be differentiated from the spectrum of lipomatous tumors including pure lipomas, lipoleiomyomas, and fibrolipomyomas.


  Case Report Top


A 45-year-old peri-menopausal woman presented with complaints of lower abdominal pain and distension for 4 months. Her past medical and surgical history was unremarkable.

Per abdomen examination revealed a suprapubic well-defined non-tender mass. The lower limit of the mass was not palpable. Per vaginal examination revealed anteverted uterus shifted to the left side. Right fornix was filled with a firm, smooth, and non-tender mass. Left fornix was non-tender and free.

On gynecologic examination, no evident pathological change was detectable. All routine haematological parameters were within normal limits. On ultrasonography, there was a small hyperechoic mass and multiple leiomyomas within the pelvic cavity.

A total abdominal hysterectomy with bilateral salpingo-oopherectomy was performed. Histopathologic evaluation of the uterus with bilateral adnexa was carried out.

On gross examination [Figure 1], the uterus was enlarged and its external surface showed multiple subserosal leiomyomas. The largest one measured 10 cm in diameter and the smallest subserosal leiomyoma measured 2.5 cm in diameter. Cut surface was solid and gray-white with whorled appearance, and tiny foci of yellow areas were noted. Cervix and bilateral adnexa were grossly unremarkable.
Figure 1: Hysterectomy specimen showing yellow foci in subserosal fibroid on gross examination

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Paraffin-embedded sections were prepared from all these tumors and stained with hematoxylin and eosin.

Microscopically [Figure 2], the section from the subserosal leiomyoma revealed a tumor consisting of interlacing bundles of smooth muscle cells with intermingled fat cells. The adipose tissue was entirely mature without any lipoblasts. Several sections studied did not reveal any angiomatous elements. No cytological atypia in smooth muscles and adipocytes was seen. No areas of necrosis and calcification were present.
Figure 2: Photomicrograph showing mature adipose tissue amongst whorling smooth muscle. H and E, ×10

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Sections from other tumors showed features of typical leiomyoma. Section from the endometrium revealed endometrial glands in proliferative phase. Cervix and bilateral adnexa were unremarkable histologically.

Based on the above findings, the tumor was diagnosed as benign lipoleiomyoma - uterus.




  Discussion Top


Lipoleiomyoma is an alteration that was previously called as fatty metamorphosis, lipomatous degeneration, adipose metaplasia, etc. It is now regarded as a distinct true neoplasm. [6]

Finding an admixture of mature adipocytes and smooth muscle cells on microscopy is required to designate a neoplasm as lipoleiomyoma. The adipocytes may be evenly distributed throughout the tumor or may be concentrated in only focal area. Also, adipocyte component in lipoleiomyoma may differ widely and a certain level of adipocytes may not be defined to achieve the diagnosis of lipoleiomyoma. These tumors may contain microscopic foci of adipocytes resembling regular leiomyomas in gross appearance, or high amounts of adipocytes may be detected resulting in yellow and lobulated cut surface. [7] The tumor in our case had an evident yellow foci, though tiny, on the cut surface grossly and reasonable amounts of adipocytes on microscopy to designate it as lipoleiomyoma.

Lipoleiomyomas can occur anywhere in the uterus or the uterine cervix. Intramural being the most common location, in our case, it was encountered in subserosa. However, the extrauterine location including broad ligament is the rarest site reported by this time. [7]

It is prevalent in perimenopausal and postmenopausal women, often associated with multiple leiomyomas like in our case. [6]

The clinical features are uncertain due to its rarity. Most patients are asymptomatic and are diagnosed incidentally, but among the symptomatic ones, abdominal discomfort, pelvic pain, palpable mass, and abnormal per vaginal bleeding are the most common symptoms, similar to those caused by leiomyomas. [7]

Our case presented with symptoms of leiomyoma, and diagnosis of lipoleiomyoma on histopathologic evaluation was incidental.

There are many controversies in the pathogenesis and origin of tumor cells in uterine lipoleiomyoma. [3] Lipoleiomyomas were reported as hamartomas in the past, but now many theories have been postulated regarding their histogenesis, such as lipomatous metaplasia, metaplasia in pericapillary pluripotential mesenchymal cells, and perivascular extension of fat along the blood vessels. [8] Nevertheless, immunohistochemical studies indicated a complex histogenesis of lipoleiomyoma which might arise from immature mesenchymal cells or from transformation of smooth muscle cells into adipocytes. It was also demonstrated that lipoleiomyomas may be associated with some metabolic disorders including hyperlipidemia, hypothyroidism, and diabetes mellitus. This suggests that changes in lipid metabolism after menopausal transition promote abnormal intracellular lipid storage and may play a role in the development of lipomatous change in leiomyomas. [7]

Sieinski summarized different theories regarding the origin of lipomatous tumors in uterus as follows: [3]

  1. Misplaced embryonal mesodermal rests with a potential for lipoblastic differentiation
  2. Lipoblast or pluripotential cells migrating along uterine arteries and nerves
  3. Adipose metaplasia of stromal or smooth muscle cells in a leiomyoma.


Histopathologically, three types of uterine tumors with lipomatous component are seen: [3]

  1. Pure lipoma consisting of adipocytes and very few scattered smooth muscle cells
  2. Lipoleiomyoma with a variable amount and distribution of adipocytes and smooth muscle cells
  3. Angiomyolipoma with prominent vascular structures admixed with adipocytes and smooth muscle cells.


The differential diagnosis of the lipomatous mass in the pelvis includes benign cystic teratoma, malignant degeneration of cystic teratoma, non-teratomatous lipomatous ovarian tumor, benign pelvic lipomas, liposarcomas, and lipoblastic lymphadenopathy. Association of lipomatous uterine tumors and endometrial carcinomas with lipoleiomyosarcoma arising in uterine lipoleiomyomas has been reported. [1]

The principal significance of these lesions is that the intermingling of wisps of smooth muscles between lobules of mature fat may suggest alternative diagnosis of well-differentiated liposarcoma, but recognition of spindled elements consisting of mature smooth muscle rather than atypical hyperchromatic spindle cells of liposarcoma is a critical observation to arrive at the correct diagnosis. [8]

The long-term follow-up of patients with uterine lipoleiomyoma demonstrated that these lesions are benign without any recurrences or disease-related deaths, if they are diagnosed as the only pelvic pathology. On the other hand, among patients with uterine lipoleiomyoma in two largest series, 18.8% of patients were reported to have associated gynecologic malignancies which may originate from uterus, cervix, or ovaries. Therefore, the patients with uterine lipoleiomyoma should be subjected to detailed clinical and pathological evaluation in order not to overlook a coexistent gynecologic malignancy. [7]





Lipoleiomyomas are the incidental findings and are associated with conventional leiomyomas. There is no specific clinical presentation. Usually, lipoleiomyoma presents with symptoms similar to those caused by conventional leiomyoma. These are benign tumors and should be differentiated from other uterine tumors. It is the histopathologic evaluation that confirms the diagnosis.

 
  References Top

1.Manjunatha HK, Ramaswamy AS, Kumar BS, Kumar SP, Krishna L. J Mid-Life Health 2010;1:86-8.  Back to cited text no. 1
    
2.Avritscher R, Iyer RB, Ro J, Whitman G. Lipoleiomyoma of the uterus. Am J Roentgenol 2011;177:856.  Back to cited text no. 2
    
3.Bolat F, Kayaselcuk F, Canpolat T, Erkanli S, Tuncer I. Histogenesis of lipomatous component in uterine lipoleiomyomas. Turk J Pathol 2007;23:82-6.  Back to cited text no. 3
    
4.Tsushima Y, Kita T, Yamamoto K. Uterine lipoleiomyoma: MRI, CT and ultrasonographic findings. Br J Radiol 1997;70:1068-70.  Back to cited text no. 4
    
5.Bindra R, Sharma N. Uterine Lipoleiomyoma. Internet J Gynecol Obstet 2010;12:(2). DOI: 10.5580/555.  Back to cited text no. 5
    
6.Sudhamani S, Agrawal D, Pandit A, Kiri VM. Lipoleiomyoma of uterus: A case report with review of literature. Indian J Pathol Microbiol 2010;53:840-1.  Back to cited text no. 6
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7.Salman MS, Atak Z, Usubutun A, Yuce K. Lipoleiomyoma of broad ligament mimicking ovarian cancer in a postmenopausal patient: Case report and literature review. J Gynecol Oncol 2010;21:62-4.  Back to cited text no. 7
    
8.Bajaj P, Kumar G, Agarwal K. Lipoleiomyoma of broad ligament: A case report. IJPM, 2000;43:457-8.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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