A Large Pure Uterine Lipoma: Its Diagnosis by Pelvic MRI and Histopathology

Abstract

The patient is a 74-year-old female previously diagnosed with an ovarian tumor at age 55. No changes were noted for one year; however, she was lost to follow-up. Eighteen years later, she presented to a local clinic complaining of diffuse abdominal and flank pain. Abdominal and pelvic ultrasound, CT, and gynecological examination showed a fatty pelvic tumor of approximately 12 cm in diameter. A left ovarian teratoma was suspected, and per the patient’s request, she was transferred to Kobe Adventist Hospital for further evaluation and treatment. Pelvic MRI revealed no ovarian enlargement; however, a mass in the uterine body was appreciated with a high signal on T1 and T2 images and signal dropout in the fat suppression images, a finding most consistent with a uterine lipoma. A total hysterectomy and bilateral salpingo-oophorectomy was performed, and histopathological examination confirmed the preliminary diagnosis. No complications were observed during the postoperative period. A pure uterine lipoma is an extremely rare tumor with only a few cases reported worldwide. It is a benign tumor; however, it can sometimes be misdiagnosed as a malignant neoplasm. Pelvic MRI appears to be a useful tool in order to make the correct diagnosis preoperatively.

Pure Uterine Lipoma: A Report of a Rare Entity

“…However, the uterine lipoma may arise in the subserosal or submucosal location. Ultrasound examination and computed tomography scan may provide a clue to the diagnosis [ 8 ]. Magnetic resonance imaging has a higher accuracy as it can distinguish lipoma from other similar lesions like a liposarcoma.…”

“…However, our patient had a history of genital tract bleeding and abdominal mass that were concerning for a malignancy. The prognosis of pure uterine lipoma is excellent as the risk of malignant transformation is negligible [ 8 ]. Surgical intervention may not be needed in asymptomatic patients and close observation is sufficient [ 5 ].…”

Uterine lipoma: A case report

“…Lau [ 8 ] advocates that MRI is the superior imaging modality for these lesions due to its multiplanar capability, tissue-specific characteristics and ability to distinguish between adnexal tissues, uterus and pelvic fat. However, the consensus from the literature supports confirmatory histopathological diagnosis to exclude other uterine neoplasms, particularly malignancies [ 2 , 10 ].…”