160,158 Registered Members as of 12/17/2017.
Pelvis » Female Pelvis (Gynecology)
Uterine lipoleiomyoma
« Back to Listing
 
 
Presentation This 50 year old woman presented with pelvic pain. Her gynecologist was concerned about uterine enlargement on physical examination, and ordered a pelvic sonogram. She is perimenopausal.
 
 
 
Caption: Transverse transabdominal US of the uterus.
Description: The sonogram reveals an echogenic mass within the uterus. This could be arising from the endometrium or the myometrium. Endovaginal imaging was required, and would reveal a myometrial origin of this mass.
 
 
 
Caption: Transabdominal, transverse US of the uterus.
Description: The sonogram reveals an echogenic mass within the uterus. This could be arising from the endometrium or the myometrium. Endovaginal imaging was required, and would reveal a myometrial origin of this mass.
 
Differential Diagnosis endometrial mass: hyperplasia, polyp, cancer 
myometrial mass: lipoleiomyoma, calcified or hemorrhagic myoma (less likely)
 
Final Diagnosis Uterine lipoleiomyoma.
 
Discussion This sonogram reveals a solid, echogenic mass arising from the uterine myometrium, a variant of leiomyoma called a lipoleiomyoma. Endovaginal imaging, not shown, would be essential to confirm the myometrial origin and clearly demontrate the tissue characteristics of fat, increased echogenicity with attenuation of sound. A hypoechoic rind may be evident, due to the surrounding layer of myometrium. 

CT and MRI are used to definitively demontrate the presence of fat. In cases  where the mass is exophytic, an alternative consideration would be an ovarian teratoma. Careful scanning with endovaginal sonography would be required to demonstrate two normal ovaries, or MRI could be helpful to confirm the uterine origin.

Lipoleiomyomata are masses comprised of fat cells, smooth muscle and fibrous tissue. They are most commonly intramural in the uterine wall, but can be subserosal or cervical in origin.

These masses are very uncommon, occuring in .03 - 0.2%. While most patients are asymptomatic, some may have pain or dysfunctional uterine bleeding.
 
Case References Avritscher R, Iyer RB, Ro J and Whitman G. Lipoleiomyoma of the uterus. AJR 2001; 177: 856.
 
Other contents by this AuthorOther Cases in This Category