|Year : 2014 | Volume
| Issue : 4 | Page : 255-258
Lipoleiomyoma: A rare variant of uterine leiomyoma
D Manimaran, Dost Mohamed Khan, Saba Yasmin, S Anuradha
Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India
|Date of Web Publication||16-Oct-2014|
Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Tiruporur Guduvanchery Main Road, Ammapettai, Nellikuppam, Kancheepuram - 603 108, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Uterine fatty tumors are rare variants of benign leiomyoma. Lipoleiomyoma, lipomyoma, fibromyolipoma are various synonyms for this lesion. They usually occur in the obese perimenopausal and postmenopausal females in the age group 50-70 years and 90% cases occur in patients older than 40 years. There were only few cases reported in the literature. These lesions are interesting due to the occasional diagnostic confusion with sarcomas and the curiosity regarding its histogenesis. We are presenting three cases of lipoleiomyoma whose age ranged from 40 to 50 years with clinical, radiologic and pathologic correlation. All three cases came with complaints of abnormal vaginal bleeding and found to have intramural heteroechoic nodule in the ultrasonogram.
Keywords: Leiomyoma, lipoleiomyoma, uterine neoplasm
|How to cite this article:|
Manimaran D, Khan DM, Yasmin S, Anuradha S. Lipoleiomyoma: A rare variant of uterine leiomyoma. Int J Health Allied Sci 2014;3:255-8
|How to cite this URL:|
Manimaran D, Khan DM, Yasmin S, Anuradha S. Lipoleiomyoma: A rare variant of uterine leiomyoma. Int J Health Allied Sci [serial online] 2014 [cited 2020 Apr 5];3:255-8. Available from: http://www.ijhas.in/text.asp?2014/3/4/255/143067
| Introduction|| |
Uterine fatty tumors (UFT) are defined as tumors composed of mature adipocytes in the entire lesion or admixed with various proportions of smooth muscle cells, fibrous tissue, and rarely blood vessels.  UFT are rare benign tumors which constitute 0.03-0.2% of uterine leiomyomas.  It is also called as lipoleiomyoma, lipomyoma, fibromyolipoma, or mixed lipoma/leiomyoma depending upon the histological constituents and very rarely present as a pure lipoma. , Leiomyomas occur in the reproductive age group whereas lipoleiomyomas occur in the perimenopausal and postmenopausal period.  We are presenting three cases of lipoleiomyoma with radiologic and clinical correlation.
| Case report|| |
A 48-year-old female presented with increased menstrual flow and lower abdominal pain for past 3 months. Ultrasonogram (USG) showed a uterine intramural nodule measuring 8 cm in diameter. Total abdominal hysterectomy with left side salpingo-oophorectomy was done.
Uterus with cervix measured 15 cm × 8 cm × 7 cm. Cut section showed cotyledonoid gray white intramural nodular lesion in the posterior wall of uterus measuring 8 cm in diameter with distinct yellow area 4 cm × 3 cm in size [[Figure 1]a cut section shows uterus with cervix and a well-defined cotyledonoid gray white nodular lesion with distinct yellow area measuring 4 cm × 3 cm]. Cervix, left ovary, and tube unremarkable. Microscopically, the nodule showed bundles and fascicles of smooth muscle cells admixed with lobules of mature adipocytes with extensive areas of hyalinization. Histopathological diagnosis was lipoleiomyoma with hyaline degeneration, chronic cervicitis, and proliferative phase endometrium.
|Figure 1: (a) Cut section shows uterus with cervix and a well defined cotyledonoid graywhite nodular lesion with distinct yellow area measuring 4 × 3 cm, (b) Cut section of uterus and cervix with a gray white nodule showing intervening yellow areas and whorly appearance|
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A 45-year-old female presented with profuse bleeding per vaginum for 6 months and lower abdominal pain for 2 months duration. USG revealed posterior uterine wall intramural nodule measuring 5.5 cm × 4.5 cm and a subserosal nodule 1 cm in diameter. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done.
Uterus with cervix measured 13 cm × 11 cm × 7.5 cm. Cut section showed an intramural nodule with white and yellow areas measuring 5 cm × 4 cm and a subserosal nodule 1 cm in diameter [[Figure 1]b cut section of uterus and cervix with a gray white nodule showing intervening yellow areas and whorly appearance]. Left ovary, right ovary, and both the tubes were grossly unremarkable. Sections from the myometrial nodules showed features of leiomyoma with larger nodule showing admixer of mature adipocytic lobules with smooth muscle bundles. Microscopic impression was secretory phase endometrium, intramural lipoleiomyoma, and subserosal leiomyoma.
A 43-year-old female presented with irregular bleeding per vaginum for 3 months and excessive bleeding for 3 days. On clinical examination, uterus was 8-10 weeks size. USG showed an intramural hyperechoic nodule in the anterior uterine wall measuring 4.6 cm × 4.5 cm with left ovarian complex cyst measuring 3 cm × 3 cm. Associated findings were hepatomegaly with fatty change and hypoplasia of the right kidney. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done.
Uterus with cervix measured 11 cm × 8 cm × 4 cm. An intramural nodule in the anterior wall of uterus measuring 4.5 cm × 4 cm with pale yellow and whorly appearance was noted [[Figure 2]a cut section of uterus and cervix with a pale yellow well-defined intramural nodule having a whorly appearance]. Left ovary showed a cyst measuring 3 cm in diameter filled with serous fluid. Right ovary grossly unremarkable. Both tubes measured 5 cm × 1 cm and were distended with reddish brown material. Sections from the intramural nodule showed bundles and fascicles of smooth muscle cells admixed with mature adipocytic lobules [[Figure 2]b Photomicrograph shows mature adipocytes admixed with bundles and fascicles of smooth muscle cells, (H and E, ×10)]. Histopathological impressions were adenomyosis, intramural lipoleiomyoma, pseudodecidual change endometrium, chronic cervicitis, serous cyst left ovary, and bilateral tubal endometriosis.
|Figure 2: (a) Cut section of uterus and cervix with a pale yellow well-defined intramural nodule having a whorly|
appearance, (b) photomicrographs show mature adipocytes admixed with bundles and fascicles of smooth muscle cells (H and E, ×10)
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| Discussion|| |
Leiomyoma of the uterus is a very common benign tumor arising from myometrial smooth muscle cells constituting around 77% of cases of hysterectomy specimens. There are many variants of leiomyoma like cellular, atypical, plexiform, myxoid, epithelioid, vascular, and one among that is lipoleiomyoma. Lipoleiomyomas are similar to myolipoma of soft tissue first described in 1991 by Manjunatha HK et al.  Lipoleiomyoma was considered as hamartomas or more appropriately choristomas in the past due to its morphological and histogenetic similarities with renal angiomyolipomas.  But it is now regarded as a true neoplasm with tumor metaplasia.  Because fatty tissue is not a part of normal myometrium, many theories have been suggested regarding its histogenesis but the exact pathogenesis is obscure and it is a curiosity for pathologists. Fatty metamorphosis, lipomatous degeneration, lipomatous metaplasia of smooth muscle cells, metaplasia in pericapillary pleuri-potential mesenchymal cells, and perivascular extension of peritoneal or retroperitoneal fat along the blood vessels are some among them.  It can also be associated with various lipid metabolic disorders or estrogen deficiency states as occurs in peri- or postmenopausal period. 
These tumors can occur in the myometrium usually intramural but can occur anywhere in the uterus, cervix, ovary, or rarely in the broad ligament.  They are commonly seen in postmenopausal women with high incidence of concomitant leiomyoma and are an incidental finding in histopathology. The clinical and radiological differential diagnosis for lipomatous tumors in the pelvis are benign and malignant teratoma with the lipomatous component, nonteratomatous lipomatous ovarian tumor, benign pelvic lipomas, liposarcoma, and lipoblastic lymphadenopathy.  These tumors can be diagnosed preoperatively with the help of USG, computed tomography (CT), and magnetic resonance imaging (MRI). USG show hyperechoic areas surrounded by hypoechoic rind. , CT show a well-defined heterogeneous mass with fat density. MRI show well-defined heterogeneous mass with high signal intensity on T1-weighted sequences and low signal intensity on fat-saturated or T2-weighted images. ,
Clinical presentation is similar to leiomyoma and is usually asymptomatic but can present with a palpable mass, uterine bleeding, pelvic pain, increased urinary frequency, and constipation probably related to the size of the lesion.  These tumors are benign, but there were reports that they can turn into liposarcoma.  Comparison of our cases with cases in the literature is shown in [Table 1].
|Table 1: Comparison of lipoleiomyoma cases in the literature with the present cases|
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Most of the cases in the literature occurred in the intramural site and postmenopausal age group with abnormal uterine bleeding, pelvic mass, and abdominal pain as clinical presentation. All of our patients were in the perimenopausal age with irregular vaginal bleeding as main clinical presentation and were intramural in location. One of our cases grossly showed intramural cotyledonoid nodular lesion with a distinct fatty area which is a rare presentation so far not reported in the literature. All the cases were incidentally made out in the gross and microscopic examination. Preoperative diagnosis of lipoleiomyoma by radiological imaging will help in differentiating it from other fatty neoplasms in the pelvis.
| Conclusion|| |
Lipoleiomyomas are rare benign uterine tumors with similar clinical presentation as leiomyoma. Very rarely liposarcoma can arise from preexisting lipoleiomyoma. These tumors should be differentiated from fatty ovarian tumors, leiomyoma with degenerative changes, and uterine sarcomas. Though the management of this lesion is same as leiomyoma, the curiosity regarding its histogenesis continues. According to many studies, tumor metaplasia which is a well-recognized entity, might explain the phenomena.
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[Figure 1], [Figure 2]