Eur Clinics Obstet Gynaecol

DOI 10.1007/s11296-008-0078-0

REVIEW ARTICLE

Uterine lipoleiomyoma: transvaginal ultrasound

and computed tomography findings of an unusual entity
S. Mylona & N. Giannoulakos & N. Roppa-Lepida &
A. Koutsodimitropoulou & N. Batakis

Received: 14 February 2008 / Accepted: 30 July 2008

# European Board and College of Obstetrics and Gynaecology 2008

Abstract Uterine lipoleiomyoma is a rare benign tumor. It Case report

can be easily misdiagnosed as an ovarian origin teratoma
on radiological imaging studies. We report a case of a A 66-year-old post-menopausal woman (gravida 2, parity
patient with a uterine lipoleiomyoma as an incidental 2), was admitted to our department with lower abdominal
finding. Diagnosis of uterine lipoleiomyoma is possible pain and low rate enterorrhagia. No vaginal bleeding,
with the use of ultrasound and computed tomography discharge, or pain in the perineum was noted. She attained
scanning of the abdomen and pelvis. menopause at 53 years.
She underwent an abdominal CT scan (Picker 5000,
Keywords Uterus . Lipomatous uterine tumors . Philips, Eindhoven, The Netherlands) with 10-mm contig-
Lipoleiomyoma . Ultrasound . Computed tomography uous slices. The examination showed a well-circumscribed,
spherical mass arising from the left posterior uterine wall.
The mass was slightly inhomogeneous with attenuation
Introduction values suggestive of a mainly fat containing lesion
(−110HU), but some soft tissue attenuation components
Lipomatous tumors of the uterus are rare [1], benign were also present (Fig. 1a).
neoplasms most commonly seen in peri- or postmenopausal No enhancement of the lesion after injection of contrast
women. The histological spectrum includes pure lipomas, medium was noted (Fig. 1b).
lipoleiomyomas, and fibromyolipomas. Transvaginal ultrasound revealed a 1.85×2.4 cm well-
We report a case of a patient with an incidental finding circumscribed, with regular margins, homogeneously
of a fat containing mass of the uterus. A diagnosis of hyperechoic mass with posterior shadowing and surrounded
lipoleiomyoma was made using radiological imaging (trans- by a hypoechoic rim—thought to represent a layer of
vaginal ultrasound (TVUS) and computed tomography myometrium surrounding the fatty component [4, 5]—in
(CT)). the isthmus of the uterus (Fig. 2a).
Endometrial cavity was dilated containing anechoic
fluid, probably due to obstructed cervical canal (Fig. 2b,c).
Color Doppler sonography showed complete absence of
S. Mylona : N. Giannoulakos (*) : N. Roppa-Lepida : N. Batakis
flow inside the lesion (Fig. 2d).
Department of Radiology, Hellenic Red Cross Hospital,
Athens, Greece A diagnosis of uterine lipoleiomyoma was indicated.
e-mail: [email protected] Unfortunately, MRI was contraindicated because patient
had incompatible metallic cardiac valves and a pacemaker.
A. Koutsodimitropoulou
Because of comorbid patient’s cardiac problems, hysterec-
Department of Obstetrics and Gynecology,
General Hospital Nikaia-Piraeus, tomy was not considered. Management consisted of
Athens, Greece continued follow-up.
 Eur Clinics Obstet Gynaecol

Most uterine lipoleiomyomas are found in postmeno-

pausal women.
They are usually asymptomatic, but if not, the clinical
presentation of lipoleiomyomas is similar to that of
leiomyomas (increased micturition frequency, constipation,
and pelvic discomfort) depending mostly to the size of the
lesion. Vaginal bleeding is present almost at 50% of the
cases [3].
They are found most frequently in the uterus corpus and
are usually intramural [4]. Many are found in association
with uterine leiomyoma.
Identification of the uterus as the organ of origin is the
key to differentiate the lipomatous lesions of the uterus
from fat-containing lesions of the ovary such as benign
cystic ovarian teratomas, malignant degeneration of benign
cystic ovarian teratomas, or nonteratomatous lipomatous
ovarian tumors.
Such a differentiation is crucial because ovarian dermoid
tumors need surgical treatment, while lipomatous uterine
tumors are generally asymptomatic and do not necessitate
surgery.
In the even rarer case of a pedunculated or subserosal
uterine lipoleiomyoma differentiation must include other
lipomatous lesions of the pelvis such as benign pelvic
lipoma, liposarcoma, extradrenal myelolipoma in a pelvic
location, lipoblastic lymphadenopathy, and retroperitoneal
cystic harmatoma [6].
When the uterus is undoubtedly the organ of origin, MRI
is the imaging modality of choice for the differentiation of
Fig. 1 a CT shows an inhomogeneous mainly fat-density tumor lipoleiomyoma from pure lipoma [7].
arising from uterus. b After injection of contrast medium no The presence of a homogenous mass with a large amount
enhancement of the lesion is noticed of fat without presence of nonadipose components is
suggestive of a pure lipoma while the demonstration of a
heterogenous mass with fat and nonfat soft-tissue content is
more likely a lipoleiomyoma.
Discussion Fat saturation techniques, MR diffusion studies or even
spectroscopy confirm the diagnosis at equivocal cases [8].
Lipomatous tumors of the uterus are rare, benign neoplasms.
They can be classified as pure or mixed lipomas. The mixed
tumors (lipoleiomyoma and fibromyxolipoma) contain var- Conclusion
iable amounts of fat, fibrous tissue, and smooth muscle.
Uterine lipoleiomyma is a rare tumor, with a reported Lipoleiomyoma is a rare benign uterine tumor. Diagnosis
incidence of 0.03% to 0.2% [2]. Fatty metaplasia of the using ultrasonography and/or CT scanning is possible,
connective tissue or smooth muscle cells seems to be the but the use of MRI if available, can be particularly
cause for the development of the lipoleiomyoma [2]. helpful.
Eur Clinics Obstet Gynaecol

Fig. 2 a Longitudinal, transva-

ginal ultrasound image of the
uterus demonstrates a well-
circumscribed, echogenic mass
with surrounding hypoechoic
rim in the isthmus of the
uterus. b, c Endometrial cavity
dilatation, probably due to
lesion-caused, cervical canal
obstruction d Color Doppler
sonography showing complete
absence of flow inside the lesion

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