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Lipoleiomyoma of the Uterus

¹ Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Box 57, 1515 Holcombe Blvd., Houston, TX 77030.
² Division of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030.

Received March 15, 2001; accepted after revision April 2, 2001.

 
Address correspondence to R. B. Iyer.

Introduction

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A 48-year-old asymptomatic woman with a history of left segmental mastectomy for infiltrating ductal carcinoma presented for imaging to investigate pelvic pain. CT showed a 5-cm well-circumscribed complex mass situated between the uterus and the bladder. Sonography showed the mass to be markedly echogenic (Fig. 1A). On MR imaging, the mass was seen to arise from the lower uterine segment (Figs. 1B and 1C); the lesion had areas of increased signal intensity on T1-weighted images that suppressed on the fatsaturated images. A core needle biopsy was performed under sonographic guidance. Pathology revealed mature fat and smooth muscle, consistent with a uterine lipoleiomyoma (Fig. 1D).

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A. —48-year-old woman with uterine lipoleiomyoma. Sagittal sonogram shows hyperechoic mass (arrow) arising from anterior lower uterine segment.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B. —48-year-old woman with uterine lipoleiomyoma. Axial T1-weighted MR image shows high-signal, well-circumscribed mass (arrow) in lower uterine segment.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C. —48-year-old woman with uterine lipoleiomyoma. Sagittal T2-weighted MR image also shows mass (arrow) posterior to bladder (B).

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D. —48-year-old woman with uterine lipoleiomyoma. Photomicrograph of pathology specimen shows mass composed of mature fat and smooth muscle. (H and E, x20)

Uterine lipoleiomyoma is a rare benign tumor. The reported incidence varies from 0.03% to 0.2% [1]. Lipoleiomyomas of the uterus are typically found in postmenopausal women and are associated with ordinary leiomyomas. The signs and symptoms are similar to those caused by leiomyomas of the same size, such as a palpable mass, hypermenorrhea, and pelvic pain. Most patients are asymptomatic [2]. Uterine lipoleiomyomas are most frequently found in the uterine corpus and are usually intramural. Lipoleiomyomas can be found anywhere in the uterus or cervix and may be subserosal [3].

Lipoleiomyomas are composed histologically of variable amounts of smooth muscle, fat cells, and fibrous tissue. Fatty metamorphosis of smooth muscle cells of leiomyomas is the most likely cause for the development of lipoleiomyomas [4].

The sonographic appearance of leiomyomas is that of a hyperechoic mass partially encased by a hypoechoic rind. The rind is thought to represent a layer of myometrium surrounding the fatty component [1, 5]. CT shows more specific findings, revealing a well-circumscribed, predominantly fatty mass with areas of nonfat soft-tissue density arising from the uterus [1,2,3,4,5]. On MR imaging, the lipomatous nature of the lesion is suggested by high signal intensity on T1-weighted images and chemical shift artifacts in the lesion. The fatty components may be confirmed using fat-suppression techniques [3, 5, 6].

Imaging plays an important role in determining the intrauterine location and fatty nature of lipoleiomyomas. Imaging is used to differentiate uterine lipoleiomyomas from cystic ovarian teratomas because teratomas are usually surgically excised, whereas lipoleiomyomas require no therapy [5].

References

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1. Prieto A, Crespo C, Pardo A, Docal I, Calzada J, Alonso P. Uterine lipoleiomyomas: US and CT findings. Abdom Imaging 2000;25:655 -657[Medline]
2. Oppenheimer DA, Carroll BA, Young SW. Lipoleiomyoma of the uterus. J Comput Assist Tomogr 1982;6:640 -642[Medline]
3. Aizenstein R, Wilbur AC, Aizenstein S. CT and MRI of uterine lipoleiomyoma. Gynecol Oncol 1991;40:274 -276[Medline]
4. Tsushima Y, Kita T, Yamamoto K. Uterine lipoleiomyoma: MRI, CT and ultrasonographic findings. Br J Radiol 1997;70:1068 -1070[Abstract]
5. Dodd GD III, Budzik RF. Lipomatous uterine tumors: diagnosis by ultrasound, CT, and MR. J Comput Assist Tomogr 1990;14:629 -632[Medline]
6. Ishigami K, Yoshimitsu K, Honda H, et al. Uterine lipoleiomyoma: MRI appearances. Abdom Imaging 1998;23:214 -216[Medline]

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