AJR 2001; 177:856
© American Roentgen Ray Society
Radiologic-Pathologic Conferences of
The University of Texas
M. D. Anderson
Cancer Center |
Lipoleiomyoma of the Uterus
Rony Avritscher1,
Revathy B. Iyer1,
Jae Ro2 and
Gary Whitman1
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
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).
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].
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