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Pelvic Lipomatosis Detected on Bone Scintigraphy

Radiology Regional Center Fort Myers, FL 33901
University of Pennsylvania Medical Center Philadelphia, PA 19104

A 72-year-old man with newly diagnosed prostate cancer, but no other known urologic disorders, presented for bone scintigraphy as part of his initial tumor staging. After the administration of 0.925 GBq of technetium-99m–labeled methylenediphosphonate, scintigrams of the skeleton (Figs. 2A and 2B) were obtained and revealed no osseous metastases. However, note was made of a prominent right renal collecting system with bilateral dilated and tortuous ureters. Furthermore, the urinary bladder was elevated from the pelvic floor and had a narrowed neck, causing an appearance similar to that of an inverted pear or gourd and suggesting the diagnosis of pelvic lipomatosis. However, pelvic fluid collections or lymphadenopathy could not be ruled out solely on the basis of the scintigraphic findings. CT of the abdomen and pelvis was performed (Figs. 2C and 2D). It showed dilated and tortuous ureters, prominence of the perivesical and perirectal fat with elevation of the urinary bladder from the pelvic floor, narrowing and elongation of the bladder neck, elongation and straightening of the rectum, but no evidence of pelvic lymphadenopathy or fluid collection. This constellation of CT findings has been described in the literature as pathognomonic of pelvic lipomatosis [1]. Further imaging or biopsy was therefore believed to be unnecessary. In light of the reported difficulties in performing radical retropubic prostatectomy and pelvic lymphadenectomy in patients with pelvic lipomatosis [2], brachytherapy for prostate cancer was elected. Therefore, surgical or histopathologic confirmation of the pelvic lipomatosis was not obtained.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A. —72-year-old man with pelvic lipomatosis. Whole-body bone scan in anterior projection shows right hydronephrosis, dilated ureters, and elevation of urinary bladder.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B. —72-year-old man with pelvic lipomatosis. Scintigram of abdomen and pelvis in anterior projection shows elongation of bladder neck, elevation of bladder, dilated and tortuous ureters, and right hydronephrosis.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C. —72-year-old man with pelvic lipomatosis. Contrast-enhanced CT scan of pelvic inlet shows prominent perivesical and retroperitoneal fat and dilated right ureter.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D. —72-year-old man with pelvic lipomatosis. Contrast-enhanced CT scan of lower pelvis shows pelvic lipomatosis with narrowing and elongation of bladder neck and rectum.

Pelvic lipomatosis is an uncommon disorder in which nonmalignant fibrofatty tissue proliferates in the pelvis, particularly in the perivesical and perirectal spaces. African-American males of all ages are most commonly affected [3]. Urinary obstruction, deep venous thrombosis, and constipation are known complications of this disorder [3]. Furthermore, approximately 75% of patients with pelvic lipomatosis also have proliferative cystitis (specifically, cystitis glandularis), considered by many to be a premalignant condition that may give rise to adenocarcinoma of the urinary bladder [4]. Pelvic lipomatosis has been reported to complicate prostatectomy, cystoscopy, and other pelvic interventions due to the distortion of the urethra and bladder neck, obliteration of the normal fascial planes, and overproliferation of fibrous adipose tissue throughout the pelvis [2].

We describe a patient with prostate cancer and pelvic lipomatosis that was first detected on bone scintigraphy. Bone scans are commonly used in the staging of prostate cancer, and pelvic lipomatosis has been shown to complicate radical prostatectomy and other pelvic surgeries. Therefore, radiologists, urologists, and nuclear physicians should be aware of these findings so that appropriate surgical planning can be under-taken and the urologic complications of this disorder monitored appropriately.

References

1. Susmano DE, Dolin EH. Computed tomography in the diagnosis of pelvic lipomatosis. Urology1979; 13:215 –220[Medline]
2. Parfitt HE Jr. Radical prostatectomy in the presence of pelvic lipomatosis. J Urol1984; 131:504 –506[Medline]
3. Heyns CF. Pelvic lipomatosis: a review of its diagnosis and management. J Urol1991; 146:267 –273[Medline]
4. Heyns CF, De Kock ML, Kirsten PH, van Velden DJ. Pelvic lipomatosis associated with cystitis glandularis and adenocarcinoma of the bladder. J Urol 1991;145:364 –366[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sam, J. W. Articles by Ramchandani, P. Search for Related Content PubMed PubMed Citation Articles by Sam, J. W. Articles by Ramchandani, P. Social Bookmarking                      What's this?