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Lipoleiomyoma of uterus: A case report with review of
literature
Sudhamani S., Durgaprasad Agrawal, Ajita Pandit, V. M. Kiri
Department of Pathology, Dr. D. Y. Patil Medical College, Mumbai
Address for correspondence:
Dr. Durgaprasad Agrawal, Department of Pathology, Dr. D. Y. Patil Medical College, sect-5, Nerul, Navi Mumbai - 400 706, India.
E-mail: dnadiagnostics@hotmail.com
In spite of relatively common occurrence of leiomyomas of uterus, lipoleiomyomas are
rare variants of uterine leiomyoma. The incidence is variously reported as 0.030.2%.
[1]
It has to be distinguished from pure lipoma of uterus which is very rare. In this report,
we seek to discuss one such case and review literature of this distinct lesion.
A 58-year-old postmenopausal woman presented with history of something coming out of
vagina for 4 months and white discharge per vagina. On examination, there was grade II
uterovaginal prolapse with cystocele and rectocele. Cervix revealed procidential changes.
On ultrasonography, there were multiple leiomyomas of uterus, the largest measuring
4 3 2 cm. Vaginal hysterectomy was done and uterus with cervix was received for
histopathological examination.
On gross examination, external surface of uterus showed a single subserosal leiomyoma of
1 cm in diameter. Cut section of uterus showed one submucosal leiomyoma of 4 4
2.5 cm; the cut surface was gray white with yellow areas. Also, there was an intramural
leiomyoma measuring 3 3 2 cm; cut surface of both subserosal and intramural masses
were gray white with whorled appearence. Paraffin embedded sections were prepared
from all these tumors and stained with hematoxylin and eosin. Microscopically, the
sections from the submucosal mass displayed a tumor showing benign smooth muscle
cells intermingled between lobules of mature adipocytes [Figures 13]. Other tumors
showed features of typical leiomyoma. Sections from endometruim showed cystic
atrophy. Cervix was unremarkable.
DISCUSSION
Uterine leiomyomas are extremely common
neoplasms with a quoted incidence of
411% and mainly seen (40%) in women
over 50 years.
[2]
Many variants which
are the result of secondary changes have
been described and are detectable in
around 65% of cases. 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.
It is prevalent in peri-menopausal women,
often associated with multiple leiomyomas
with a preference in sub-serosa. Pathogenesis
has been variously ascribed to as mixed,
benign, heterologous or mesenchymal
neoplasm.
[3]
The lesion is benign and
the only puzzle for the pathologist could
be the unexpected presence of fat in a uterine
Figure 1: Mature adipocytes within leiomyoma (H and E, 100) Figure 2: Adipocytes intermingled with smooth muscle cells (H and
E, 100)
DOI: 10.4103/0377-4929.72075 PMID: ****
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I N D I A N J O U R N A L O F P A T H O L O G Y A N D MI C R O B I O L O G Y - 5 3 ( 4 ) , O C T O B E R - D E C E M B E R 2 0 1 0
841
tumor.
[4]
Diagnosis of pure lipoma is made when any smooth
muscle, if present, is confined to periphery of the tumor.
Figure 3: Mature adipocytes and benign smooth muscle cells (H and
E, 400)
Most of them are postoperative chance findings and the diagnosis
is made in retrospect. It is often diagnosed preoperatively as
leiomyoma or ovarian mature teratomas. Computed tomography
(CT) and magnetic resonance imaging (MRI) can assist in the
preoperative diagnosis of these lesions.
REFERENCES
1. Bajaj P, Kumar G, Agarwal K. Lipoleimyoma of broad ligament: A case
report. Indian J Pathol Microbiol 2000;43:457-8.
2. Fernandes H, Naik CN, Swethadri GK, Bangera I, Miranda D. Pure
lipoma of the Uterus: A rare case report. Indian J Pathol Microbiol
2007;50:800-1.
3. Dey P, Dhar KK. Lipomatous tumour of uterus. J Indian Med Assoc
1993;91:99.
4. Hendrikson MR, longacre AT, Kempson RL. The uterine corpus. In:
Mills SE, editor. Sternbergs Diagnostic Surgical Pathology. 4
th
ed.
Philadelphia: Lippincott Williams and Wilkins; 2004. p. 2519.
Source of Support: Nil, Confict of Interest: None declared.
Sudhamani, et al.: Lipoleiomyoma of uterus
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