A Case of Giant Mesenchymal Uterine Tumor: Lipoleiomyoma

Abstract

Patient: Female, 66-year-old Final Diagnosis: Lipoleiomyoma Symptoms: Abdominal pain • pollakiuria and abnormal vaginal bleeding Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Rare disease Background: Uterine lipoleiomyoma is a rare benign tumor composed of varying proportions of smooth muscle fibers and mature adipocytes, without identification of hemorrhage, necrosis, or cyto-architectural atypia. It is part of the leiomyomas category, with an incidence of 0.03–0.2%. The pathogenesis of this lesional category is still unclear, but there are several theories that could explain the occurrence. Magnetic resonance imaging is the most useful diagnostic imaging method. There are a number of pathologies whose exclusion is necessary, with the differential diagnosis being made mainly based on microscopic examination and completed with immunohisto-chemical tests. Their treatment, when necessary, is surgical, with an excellent post-therapeutic evolution and prognosis. Case Report: We present the case of an elderly, postmenopausal patient who presented with abdominal pain, abnormal vaginal bleeding, and pollakiuria. The associated pathologies of the patient correspond to those mentioned in the literature, the particularities of the case being given by the large size of the tumor and the association with 2 other typical leiomyomas. Immunohistochemical markers used to exclude other diagnoses (desmin, h-caldesmon, S100, calretinin, MDM2, CD34) confirmed the diagnosis of uterine lipoleiomyoma. Because the patient was symptomatic and a large nodular mass was identified by ultrasound, surgical treatment was performed. Conclusions: Although it is a benign lesion with an excellent prognosis, the pathogenetic mechanisms are not fully known. Theories of pathogenesis range from misplacing embryonic adipocytes to connective tissue fatty degeneration, and further studies are needed to establish the origin of this lesion.

Lipoleiomioma uterino

“…El lipoleiomioma del útero fue descrito inicialmente como miolipoma del tejido blando en 1991 (1) . Al igual que el leiomioma típico, es una lesión benigna y bien definida, pero con gran cantidad de tejido adiposo (4)(5)(6) .…”

“…A diferencia de los leiomiomas típicos que tienden a producirse predominantemente en mujeres en edad reproductiva y disminuyen en la menopausia, estos tumores son de crecimiento muy lento, en gran medida asintomáticos y continúan su crecimiento luego de la menopausia (9) . Por lo tanto, el lipoleiomioma es más frecuente en mujeres perimenopáusicas y menopáusicas entre 50 y 70 años (5,6) . En general, la mayoría de las pacientes son asintomáticas y el diagnóstico se realiza de forma incidental.…”

Laparoscopic resection of a uterine lipoleiomyoma

“…Although imaging studies play an important role in identifying the fat component and determining the site of the lesion, the definitive diagnosis is based on histopathological examination 1 . The treatment of uterine lipoleiomyomas depends on the symptoms and the size of the tumor 2 . Lipoleiomyomas carry an excellent prognosis.…”

“… 1 The treatment of uterine lipoleiomyomas depends on the symptoms and the size of the tumor. 2 Lipoleiomyomas carry an excellent prognosis. When asymptomatic, no surgical intervention is usually required.…”

Estrategias para mejorar los resultados reproductivos tras síndrome del folículo vacío: a propósito de un caso clínico

“…Hay descrita causas multifactoriales. En primer lugar, habría que descartar errores en la administración de la medicación para la maduración ovocitaria entre 34 y 38 horas antes de la punción folicular ('SFV falso') (6) . Cabiendo está la posibilidad en este caso de que no se haya aplicado correctamente la inyección de hCG recombinante.…”