Lipoleiomyoma of the uterus – a case report

IntroductionLipoleiomyoma (LL) is a rare, benign neoplasm, which most frequently occurs in postmenopausal women and is predominantly located in the uterus. However, extrauterine locations have been reported as well, e.g., in the broad ligament of the uterus, ovary, and peritoneum. Usually, LL is found in association with ordinary uterine leiomyomas.The incidence of this neoplasm is estimated at 0.03–0.2%. Clinical manifestations of LL are identical to those of uterine myomas. Most frequently, symptoms include: palpable mass in the pelvis minor, pelvic pain, and abnormal uterine bleedings. The majority of patients do not report any symptoms. LL is an extremely rare, benign tumor of the uterus. When asymptomatic, it does not require treatment.AimThis paper aimed at presenting a very rare case of LL in a postmenopausal patient.Materials and MethodsThis case has been described on the basis of the medical documentation concerning the patient (case record No 24285/2010), hospitalized in the Department of Oncology and Gynecologic Oncology, Health Care Institution of the Ministry of Internal Affairs and Administration (ZOZ MSWiA) with the Warmia and Mazury Oncology Center in Olsztyn.Case studyThe patient, 56-years old, multipara, was admitted to the Department with a preliminary diagnosis of uterine myomas, causing pain and discomfort within the region of pelvis minor. Ultrasonography (USG) showed a hyperechoic lesion, about 35 mm in diameter, well-circumscribed by a hypoechoic rim, located in an enlarged uterus. The remaining part of the uterus showed a heterogeneous echogenic pattern. During hospitalization at the Department, the patient was operated on. The amputation of the uterine corpus was performed, without uterine adnexa. Histopathological test involving the postoperative uterus specimen detected LL.Results and discussionLL cases are reported as examples of neoplasms diagnosed accidentally in the postoperative specimens. Cases of complex diagnostics, with the use of USG, as well as computed tomography (CT) and magnetic resonance imaging (MRI), when LL is suspected, are extremely rare.In postmenopausal women, suffering from hypothyroidism, diabetes or hyperlipidemia, lipomyomas in the uterus are more frequently found. It is suggested that metabolic changes occurring in postmenopausal women are a likely cause for the development of adipose tissue metamorphosis in LL.Detection of adipose tissue in the tumor mass confirms the diagnosis of LL. Usually, LL is initially recognized as uterine myoma, and depending on the coexisting symptoms, may be treated surgically.Diagnostic difficulties and the importance of differential diagnosis towards other tumors located in the pelvis minor are highlighted. Asymptomatic course and lack of characteristic clinical manifestations of the tumor, with a simultaneous characteristic image in USG, CT and MRI are emphasized.ConclusionsWhen palpable mass is detected during a manual pelvic examination in postmenopausal patients, a gynecologist should consider the possibility of LL. A characteristic USG image, i.e., a hyperechoic lesion with a hypoechoic rim, detected in the uterus should be regarded as an indication for considering such diagnosis.The final diagnosis is established on the basis of a histopathological test involving the tissue specimen.