Indian Journal of Pathology and Microbiology
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Year : 2017  |  Volume : 60  |  Issue : 1  |  Page : 128-129
Lipoleiomyoma of the uterus


1 Department of Pathology, School of Medicine, Mahsa University, Kuala Lumpur, Malaysia
2 Department of Pathology, Clinipath Laboratory, Malaysia

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Date of Web Publication14-Feb-2017
 

How to cite this article:
Karikalan B, Pasupathi T. Lipoleiomyoma of the uterus. Indian J Pathol Microbiol 2017;60:128-9

How to cite this URL:
Karikalan B, Pasupathi T. Lipoleiomyoma of the uterus. Indian J Pathol Microbiol [serial online] 2017 [cited 2017 May 29];60:128-9. Available from: http://www.ijpmonline.org/text.asp?2017/60/1/128/200052


Lipomatous tumors are very rare benign neoplasms of the uterus.[1],[2] Lipoleiomyomas are a subgroup of these lipomatous uterine tumors that also include lipomas and fibromyomas. They are very uncommon and occur in obese women of perimenopausal and postmenopausal age group. The tumor is composed of variable proportions of lobules of mature adipocytes and interlacing bundles of benign smooth muscle cells.[2],[3],[4] Here, we report lipoleiomyoma of the uterus diagnosed in a 61-year-old patient.

A 61-year-old female patient presented with distended abdomen for the past 1 month. She attained menopause 9 years back. The patient's menstrual history revealed a regular menstrual cycle of 28-day duration with a bleeding phase that lasts for 4–5 days with a moderately intense bleeding.

On examination, there was a vague lower abdominal mass measuring about 8 cm × 7 cm in dimension. Vulva, vagina, and cervix revealed no abnormalities. Ultrasound examination showed a large hyperechoic mass occupying whole of the uterus, measuring about 8 cm in diameter suggestive of benign leiomyoma.

Routine hematological and clinical pathological parameters of the patient were within normal limits. The patient was taken for total abdominal hysterectomy with bilateral salpingo-oophorectomy and specimen sent for histopathological examination.

Gross examination of the specimen showed uterus with cervix measuring about 20 cm × 14 cm. Cross section of the specimen showed undiscernable thickness of compressed endometrium. A very large leiomyomatous nodule was seen filling up the entire uterus, showing classical feature of an abundant softer lipomatous component within, and exhibiting extensive yellowish areas. The entire leiomyoma measured 13 cm × 24 cm. No necrosis or hemorrhagic congestion noticed [Figure 1]. Cervix showed tiny nabothian cysts. Both ovaries and tubes were grossly normal.
Figure 1: Large leiomyomatous nodule showing abundant lipomatous component

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Microscopic examination of the large leiomyoma shows extensive areas of mature adipocytes arranged diffusely and in lobular configuration, intermixed with smooth muscle component in variable proportion; the latter displaying smooth muscle fibers arranged in interlacing, wavy, and feather-stitch pattern with bland-appearing nuclei. Occasional congested blood vessels were seen within the smooth muscle component without any atypical change. There was no evidence of pleomorphism, atypia, or the presence of lipoblasts within the lipid content of the leiomyoma [Figure 2] and [Figure 3]. Endometrium showed nonsecretory endometrial glands with a compact dense stroma. Myometrium had thickened blood vessels. Cervix showed normal stratified squamous epithelium with chronic cervicitis and retention mucous cystic change of the endocervical glands below. Both ovaries were atrophic, and both tubes were unremarkable.
Figure 2: Mature adipocytes intermixed with smooth muscle component (H and E, ×10)

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Figure 3: Mature adipocytes intermixed with smooth muscle component (H and E, ×40)

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Lipoleiomyoma is an uncommon fatty tumor, first described as myolipoma of soft tissue by Meis and Enzinger in 1991. Myolipomas are composed of admixture mature adipose tissue and benign smooth muscle bundles. They are called as lipoleiomyomas when they occur in the uterus.[5] Cervix and ovaries are the other areas of occurrence of lipoleiomyomas.[2] It is said that metamorphosis of smooth muscle cells into mature adipose tissue in leiomyomas or myometrium results in the formation of lipoleiomyomas.

Although pathogenesis of these tumors remains obscure, immunohistochemical studies suggest that these tumors might have resulted from transformation of smooth muscle into mature adipose tissue. The other possibility is the origin of these tumors from immature mesenchymal tissue.[1],[4]

Thus, histopathological examination is the confirmatory test to diagnose lipoleiomyomas though imaging studies may help distinguish these tumors from other lipomatous tumors that occur in the pelvic region.

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Lin KC, Sheu BC, Huang SC. Lipoleiomyoma of the uterus. Int J Gynaecol Obstet 1999;67:47-9.  Back to cited text no. 1
    
2.
Rollasson TP, Wilkinson N. Non neoplastic conditions of myometrium and pure mesenchymal tumors of the uterus. In: Fox H, Wells M, editors. Haines and Taylor Obstetrical and Gynaecological Pathology. 5th ed. Edinburgh: Churchill Livingstone; 2003. p. 531.  Back to cited text no. 2
    
3.
Scurry JP, Carey MP, Targett CS, Dowling JP. Soft tissue lipoleiomyoma. Pathology 1991;23:360-2.  Back to cited text no. 3
    
4.
Gentile R, Zarri M, De Lucchi F, Bellone F, Lapertosa G. Lipoleiomyoma of the uterus. Pathologica 1996;88:132-4.  Back to cited text no. 4
    
5.
Oh MH, Cho IC, Kang YI, Kim CY, Kim DS, Cho HD, et al. A case of retroperitoneal lipoleiomyoma. J Korean Med Sci 2001;16:250-2.  Back to cited text no. 5
    

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Correspondence Address:
Barani Karikalan
Department of Pathology, School of Medicine, Mahsa University, Kuala Lumpur
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.200052

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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