Uterine lipoleomyoma homogeneous enhancing lesion

1. Case Presentation

2. 73 yrs old Female ,
 h/o post menopausal bleeding x 4 yrs
h/o continuous BPV x 3 months
K/C/O HTN
H/O Cholecystectomy done
P/V examination : 14-16 weeks uterus, freely mobile, enlarged.
CA 125: 9.4U/ml (normal)

6.  Large intramural Hyperechoic mass with posterior acaustic attenuation
in the uterus, with hypoechoic peripheral rim without any intralesional
colour vascularity.
Ist possibility
 Lipomatous Uterine tumor
- uterine lipoma
-Uterine lipoleiomyoma
 Closest D/D of echogenic gynaecological mass : ovarian dermoid

19.  Based on findings of
 Well defined heterogenous mass in fundus and body of uteerus with fat
and soft tissue density areas and foci of coarsec calcification-
 Ist possibility: lipoleiomyoma.

20.  Lipomatous uterine tumors – uncommon benign neoplasm
 Incidence – 0.03% to 0.2%
 Subdivided into 2 types: pure or mixed lipomas
 Mixed: lipoleiomyoma, angiomyolipoma, fibrolipoma.
 3rd group: liposarcoma( V. rare)
 Mixed lipoma: contain variable amount of fat, fibrous tissue and
smooth muscles
 m/c: mixed type; lipoleiomyoma

21. Uterine lipoleiomyoma
 Typically seen in postmenopausal women
 b/w 50-70 yrs of age
 Symptoms similar to leiomyoma.
 Palpable mass, urinary frequency, constipation, pelvic discomfort,
uterine bleeding or hypermenorrhea
 Malignant degeneration : extremely rare
 m/c location: uterine corpus
 Usually intramural

22. Pathogenesis
 Remains unclear
 Several theories proposed
 Misplaced embroyonic fat cells
 Perivascular extension of peritoneal or retroperitoneal fat
 Lipocytic differentiation of primitive connective or mesenchymal tissue.
 Metaplasia of smooth muscle cells or connective tissue into
adipose cells

23. Imaging findings
On usg :
 Lesion is echogenic , partially enclosed by hypoechoic rim.
 Rim represents layer of myometruium.
 Posterior acaustic attenuation
 Poor vascularity on colour doppler
 CT
 Predominently fat containing mass arising from uterus
 Well marginated
 Often contains areas of soft tissue density.

25.  MRI
 Secondary to fatty component, hyperintensity on T1 weighted images
and chemical shift artifacts are noted.
 Fat suppression techniques can be useful

29. Thank You