|Year : 2013 | Volume
| Issue : 2 | Page : 114-115
Pure lipoma of uterus: A case report with review of literature
Anubhav Garg, S Sudhamani, VM Kiri, Ajita A Pandit
Department of Pathology, Padmashree Dr. D. Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai, India
|Date of Web Publication||23-Jul-2013|
Department of Pathology, Padmashree Dr. D. Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai - 400 706, Navi Mumbai
Source of Support: None, Conflict of Interest: None
Even though lipoma is the most common soft tissue tumor, pure lipoma primary to uterus is very rare. Most reported cases have been of mixed type, consisting of admixture with smooth muscle or fibrous tissue. Preoperative diagnosis is seldom made and usually comes to light only on pathological study. We report a case of a 60 year old woman presenting with lump in abdomen. CT scan report was suggestive of leiomyoma with fatty degeneration. Gross showed fatty tumor in the uterus and microscopy confirmed the diagnosis of pure lipoma of uterus.
Keywords: Lipoma, pure lipoma, uterine tumor, uterus
|How to cite this article:|
Garg A, Sudhamani S, Kiri V M, Pandit AA. Pure lipoma of uterus: A case report with review of literature. J Sci Soc 2013;40:114-5
| Introduction|| |
The incidence of uterine fatty tumors varies from 0.03-0.2%.  This includes mixed lipoma and pure lipoma of uterus, the latter being exceptionally rare.  Only few cases have been reported in literature.  The diagnosis of pure lipoma should only be made when smooth muscle, if any is confined to the periphery of the tumor.  The histogenesis is unclear. Preoperative diagnosis if any should be confirmed by histopathology, as these tumors can mimic a variety of other uterine neoplasms including malignancy.
| Case Report|| |
A 66 year old post menopausal woman presented with chief complaint of lump in abdomen since 15 years. On examination a firm non tender mass was felt in hypogastrium. Ultrasonography was suggestive of leiomyoma whereas CT scan report suggested the possibilities of leiomyoma with fatty degeneration or liposarcoma.
We received Total abdominal hysterectomy with bilateral salpingo-oophorectomy specimen.
On gross examination, uterus measure 16 × 16 × 14 cms. External surface of the body of the uterus was bulky. Cut section through the body of the uterus showed an intramural fatty tumor measuring 16 × 14 cm obliterating the endometrial cavity with thin rim of the myometrium at the periphery [Figure 1]. Bilateral tubes and ovaries were unremarkable.
Microscopic examination reveals a benign tumor composed of mature adipocytes separated by thin fibro vascular septae. Myometrium showed no features of leiomyoma. There was no evidence of atypia or malignancy in the adipocytes. Endometrium showed atrophic changes. Cervix, both tubes and ovaries were unremarkable [Figure 2].
Based on these histopathological findings, the diagnosis of pure uterine lipoma was made.
| Discussion|| |
Pure lipomatous tumors of uterus are very rare. They have to be differentiated from more common mixed tumors such as lipofibroma, lipoleiomyoma and fibromyolipoma. 
Pure lipoma shows well encapsulated mature adipocytes interspersed by thin fibrous septae.  Myometrium is thinned out with few fibers of smooth muscle cells at the periphery of the tumor. It can be confused preoperatively with leiomyoma (most common), ovarian teratoma or lipoleiomyoma.
Imaging techniques offer little help in accurate diagnosis as only few isolated reports diagnosed on MRI are there.  The clinical manifestations are similar to leiomyoma, except that pure lipoma are seen more commonly in post menopausal women, with 90% occurring in patients above 40 years. 
In our case, the radiological diagnosis was lipoleiomyoma or liposarcoma.
The histogenesis is an enigma and various theories have been proposed. These include misplaced embryonic fat cells, fatty metaplasia of smooth muscle or connective tissue cells, proliferation of perivascular fat cells, fatty infiltration or degeneration of connective tissue etc. 
Pure lipoma attend great size before coming into clinical attention and are mistaken for carcinomas due to the old age of the patient, rapid progression, and pressure effects.
Arghya et al. in 2009 reported a case of pure lipoma with calcified areas  and Di Gesu et al. in 1998 found uterine lipoma in association with endometrial carcinoma.  The tumors are usually of intramural type and uterine fundus is the preferred location. The tumor may rarely be found in the cervix or in subserosal area. 
In our case, the entire uterus was occupied by the tumor, compressing the thinned out myometrium to the periphery and distorting the endometrial cavity.
A morphological and histological analogy has been drawn between uterine fatty tumors and renal angiolipomas explaining these tumors as hamartomas or most recently choristomas. 
Pure lipoma of uterus even though rare has to be kept in the differential diagnosis of uterine neoplasms especially in post menopausal women.
| References|| |
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|3.||Vamseedhar A, Shivalingappa DB, Suresh DR, Geetha RL. Primary pure uterine lipoma: A rare case report with review of literature. Indian J Cancer 2011;48:385-7. |
|4.||Fernandes H, Naik CN, Swethadri GK, Bangera I, Miranda D. Pure lipoma of the uterus: A rare case report. Indian J Pathol Microbiol 2007;50:800-1. |
|5.||Di Gesu› G, Cormio G, Di Vagno G, Melilli GA, Renzulli G, Selvaggi L. Pure lipoma of the uterus in association with endometrial carcinoma. Eur J Obstet Gynecol Reprod Biol 1998;80:199-200. |
[Figure 1], [Figure 2]