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Indian Journal of Cancer, Vol. 48, No. 3, July-September, 2011, pp. 385-387 Letter to Editor Primary pure uterine lipoma: A rare case report with review of literature A Vamseedhar1, DB Shivalingappa2, DR Suresh3, RL Geetha4 1 Department of Pathology, Sree Siddhartha Medical College, Tumkur, India Code Number: cn11110 PMID: 21921355 DOI: 10.4103/0019-509X.84936 Sir, Pure uterine lipoma is a rare benign neoplasm and only a few cases have been reported in the literature. [1],[2],[ 3] The histogenesis of these lesions is still debatable. The clinical manifestations do not usually differ greatly from those caused by leiomyomas, except that they affect postmenopausal women. [4] Preoperative diagnosis is difficult and should be confirmed postoperatively on histopathology, which is also important to rule out the possibility of malignancy. [2],[4] A 63-year-old postmenopausal woman presented with intermittent vaginal bleeding and intermittent abdominal pain of one-year duration. Gynecological examination revealed no abnormalities of the vulva or the cylindrical vaginal portion of the cervix. The uterine cavity was slightly big in size. The left and the right adnexae were non-palpable, and there was marked tenderness to palpation on the right, and no evident pathological change was detectable on clinical examination. Findings of the vaginal ultrasound examination suggested a well-delineated, 6-cm hyperechoic mass, with a semi-solid characteristic, located intramurally in the posterior wall of the uterus. Endometrial biopsy showed scanty material with no evidence of malignancy. Hysterectomy with bilateral salpingo-oophorectomy was performed with a provisional diagnosis of uterine malignancy. Laparotomy revealed an enlarged uterus with a globular fundal mass. The mass was soft-to-firm in consistency and the surface was smooth and glistening with no adhesions. Both ovaries were atrophic. The hysterectomy specimen measured 11 × 6 × 5 cms, with globular enlargement of the fundus. The cut surface showed a well-circumscribed, homogenous yellow, greasy mass in the intramural region measuring 6 cms in diameter, with displacement of the endometrial cavity toward the lower pole [Figure - 1]. No areas of necrosis or hemorrhages were seen. A histopathological examination showed a thin atrophic endometrium. The intramural tumor was composed of only mature adipose tissue. No smooth muscle cells or fibrous elements or lipoblasts were seen within the tumor [Figure - 2]. A final diagnosis of primary pure uterine lipoma was considered. Lipomatous or fatty tumors are rare benign neoplasms of the uterine corpus. [1],[2],[3],[4],[5] The histogenesis of these lipomatous tumors in the uterine wall continues to be an enigma. [5] As fat tissue is not native to the uterus, various theories of histogenesis have been proposed. These include misplaced embryonic fat cells, metaplasia of the muscle or connective tissue cells into the fat cells, lipocytic differentiation of specific primitive connective tissue cells, proliferation of perivascular fat cells accompanying the blood vessels into the uterus, inclusion of the fat cells into the uterine wall during surgery or fatty infiltration or degeneration of the connective tissue. [6] Most of the lipomatous tumors are asymptomatic. Moreover, some uterine lipomas may present with urinary frequency. More than half the cases first present with uterine bleeding, [4],[5] and a smaller proportion, as in our patient, with abdominal pain, when these tumours reach larger dimensions. They are often misdiagnosed as carcinomas due to the old age of the patients, rapid progression of abdominal swelling, abdominal pain, and the well-circumscribed, hyperechoic texture on ultrasonography (USG). Preoperative diagnosis can be made to avoid unnecessary surgery by current imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). [7] The diagnosis of primary pure lipoma on histopathology should be made only if the smooth muscle cells are confined to the periphery. Uterine lipomas have an excellent prognosis and can be considered for the differential diagnosis of uterine mass in postmenopausal women. References
Copyright 2011 - Indian Journal of Cancer The following images related to this document are available:Photo images[cn11110f1.jpg] [cn11110f2.jpg] |
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