|Year : 2019 | Volume
| Issue : 3 | Page : 254-255
Lipoleiomyoma – A rare benign neoplasm
Sakshi Daga, Suresh Phatak, Konika Chaudhari
Department of Radiodiagnosis, JNMC, Wardha, Maharashtra, India
|Date of Submission||07-Apr-2019|
|Date of Decision||10-Jun-2019|
|Date of Acceptance||30-Jul-2019|
|Date of Web Publication||2-May-2020|
Dr. Sakshi Daga
Department of Radiodiagnosis, JNMC, Sawangi Meghe, Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
Lipoleiomyomas are quite rare benign neoplasms, accounting for 0.03%–0.2% incidences. Here, we report the case of a 45-year-old female who presented with complaints of abnormal uterine bleeding and pelvic pain. Imaging plays a crucial role in the diagnosis of such conditions. Ultrasonography serves as an initial imaging modality of choice for such benign neoplasms. Magnetic resonance imaging confirms the uterine origin and fatty component of tumor.
Keywords: Lipoleiomyomas, magnetic resonance imaging, ultrasonography
|How to cite this article:|
Daga S, Phatak S, Chaudhari K. Lipoleiomyoma – A rare benign neoplasm. J Datta Meghe Inst Med Sci Univ 2019;14:254-5
| Introduction|| |
Lipoleiomyomas are the uncommon uterine benign neoplasms, seen usually in perimenopausal and postmenopausal females. Histologically, they are composed of variable amounts of adipocytes and smooth muscle cells separated by the thin fibrous tissue. Imaging plays a crucial role in the diagnosis of such condition. Ultrasound is an initial modality of choice. Other imaging modality such as magnetic resonance imaging (MRI), especially with its fat suppression technique and sequences, helps in verification of the diagnosis.
| Case Report|| |
A 45-year-old obese female presented to the gynecological outpatient department in our hospital with complaints of abnormal uterine bleeding and lower abdominal pain. Her laboratory investigations were within normal limits. She was further referred to the radiology department. Grayscale ultrasound revealed a well-circumscribed intramural hyperechoic uterine lesion in the anterior myometrium measuring approximately 2.8 cm × 1.5 cm in size. The mass was surrounded by hypointense myometrial rim [Figure 1]a. On color Doppler, no vascularity noted [Figure 1]b. Bilateral ovaries appeared normal. Grade II fatty liver was also seen in the abdomen. Provisional diagnosis of lipoleiomyomas was made. MRI was performed with 1.5 T unit. MRI showed a well-defined mass lesion of 2.8 cm × 1.9 cm arising from the anterior wall of the uterus appearing hyperintense on T1-weighted imaging [Figure 2]a and T2-weighted imaging T2WI [Figure 2]b with suppression (hypointense) on fat saturation sequences [Figure 2]c.
|Figure 1: (a) Gray scale ultrasound reveals a well-circumscribed intramural hypoechoic uterine lesion in the anterior myometrium measuring approximately 3 cm × 1.5 cm in size. (b) Color Doppler ultrasound reveals no vascularity within the lesion|
Click here to view
|Figure 2: (a-c) Well-defined mass lesion of size 2.8 cm × 1.9 cm arising from the anterior wall of the uterus appearing hyperintense on T1-weighted imaging (a) and T2-weighted imaging(b) with suprression (hypointense) on proton density fat saturation suggesting fatty nature(c)|
Click here to view
| Discussion|| |
Lipoleiomyomas primarily occur in the obese perimenopausal and postmenopausal age group. They are basically subtype of fibroids and composed of smooth muscles cells intermixed with fat cells or adipocytes. Based on the contents, lipoleiomyomas can be histologically divided into pure lipomas, lipomas with mesodermal components, and liposarcomas. The exact etiology is unknown, but they are thought to be due to fatty metaplasia of smooth muscle cells in leiomyoma rather than fatty degeneration. Hyperoestrogenemia is a contributing factor to such condition.
Lipoleiomyomas are similar to leiomyomas in clinical presentation and course. Patients present with complaints of menstrual abnormalities, acute or chronic pelvis pain, and palpable mass or urinary complaints. They can occur anywhere in the uterus and cervix, uterine corpus being the most common site.
Lipoleiomyomas need to be differentiated from other benign and malignant neoplasms of the uterus and adnexa. Imaging plays an important role in determining the size, site, and composition of such benign neoplasms and largely influences the treatment options. Ultrasound is an initial imaging modality of choice. A uterine leiomyoma on grayscale ultrasound appear as a well-defined hyperechoic lesion surrounded by a hypoechoic rim where hyperechoic component represents the fatty component and hypoechoic rim represents the myometrial layer surrounding fatty component. The tumor appears poorly vascular on color Doppler.
MRI is highly specific in delineating fatty component of lipoleiomyomas. MRI shows a well-demarcated mass appearing hyperintense on both T1 and T2WI. Further confirmation of the fatty component can be done using fat saturation sequences where fat saturates out.
| Conclusion|| |
Lipoleiomyomas are clinically similar to leiomyomas. They are usually small and asymptomatic, not requiring any treatment. However, those which areas are larger and symptomatic may require surgical excision. Imaging modalities such as ultrasound and MRI play a crucial role in such benign uterine neoplasms, determine its size, composition, and location, and help it to differentiate from other benign and malignant uterine and adnexal neoplasms.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Karaman E, Çim N, Bulut G, Elçi G, Andıç E, Tekin M, et al
. A case of giant uterine lipoleiomyoma simulating malignancy. Case Rep Obstet Gynecol 2015;2015:926-61.
Nazir HM, Mehta S, Seena CR, Kulasekaran N. Uterine lipoleiomyoma: A report of two cases. J Clin Imaging Sci 2017;7:26.
] [Full text]
Ghosh B, McKeown B, Gumma A. Lipoleiomyoma. BMJ Case Rep 2011;2011. pii: bcr0820114577.
Avritscher R, Iyer RB, Ro J, Whitman G. Lipoleiomyoma of the uterus. AJR Am J Roentgenol 2001;177:856.
Kitajima K, Kaji Y, Imanaka K, Sugihara R, Sugimura K. MRI findings of uterine lipoleiomyoma correlated with pathologic findings. AJR Am J Roentgenol 2007;189:W100-4.
[Figure 1], [Figure 2]