Operation done : 30 cm mass with fat and muscle

  - Lipoleiomyoma from broad ligament

Lipoleiomyomas are uncommon variants of
uterine leiomyomas.  Lipoleiomyomas are
composed of mature adipocytes with intermixed smooth muscle cells.

These tumors tend to occur more often in
postmenopausal women, and these patients are typically obese and asymptomatic.

If these patients are symptomatic, they
most commonly present similar to uterine leiomyomas, with symptoms such as
menstrual disturbances, pelvic pain or pressure, constipation or incontinence,
as well as a palpable mass if the lesion is large enough.

Lipoleiomyomas are most commonly seen on
imaging in the uterine corpus, but there have been reports in the literature of
lipoleiomyomas occurring in the broad ligament, cervix and retroperitoneum. The
differential diagnosis for a fat containing lesion of the uterus includes a
lipoleiomyoma, mature ovarian teratoma, benign lipoma and benign or malignant
degeneration of ordinary leiomyomas.

The histogenesis of a lipoleiomyoma is
still a mystery, but it is regarded as a distinctive, true neoplasm. Possible
theories include lipoblastic differentiation of misplaced embryonic fat cells,
metaplastic changes of connective tissue or smooth muscle fibers into
adipocytes, and finally, pluripotent cell migration along the uterine nerve and
vessels and fatty infiltration. The positivity for estrogen and progesterone
receptors supports the fatty tissue being related to the female genital organs.
Another study comprised of 76 lipoleiomyomas showed adipocytes staining
positive for desmin and vimentin, as well as estrogen and progesterone
receptors, which supports smooth muscle cells transforming into adipose cells.
Based on the commonality of positive staining of adipocytes for vimentin in the
recent literature, their shared conclusion is that lipoleiomyomas probably
result from smooth muscle cell metaplasia into fat cells that possibly
originates from a totipotent mesenchymal cell. Lipoleiomyomas have also been
hypothesized to be more common in patients with metabolic disorders with a
hyperestrogenic state, such as hyperlipidemia, hypothyroidism, diabetes
mellitus and postmenopausal lipid metabolism changes.

Another study reported three patients where
liposarcoma arose in uterine lipoleiomyomas.  There are reports of lipoleiomyomas coexisting
with gynecologic malignancies, as well as with estrogen changes and metabolic
disorders, meaning that a further evaluation may be warranted when a fatty
uterine tumor is discovered

On sonography, lipoleiomyomas typically
appear as hyperechoic avascular masses with a hypoechoic rim from the uterine
myometrium. On CT, the masses have intralesional macroscopic fatty contents. An
MRI can also be done to show the fatty content of the tumor, and fat
suppression techniques can be used to confirm the fat within the tumor.

The treatment for lipoleiomyomas depends on
the presenting symptoms. If asymptomatic, no treatment is needed, as
lipoleiomyomas can be managed conservatively. The most common treatment
performed in the literature is a hysterectomy.