Lipoma of Uterus

1
Enlarged firm UTERUS in a Menopausal Woman
presents with pelvic pain

• Dr.K.Malleswar Rao, MD,DGO
• CIVIL SURGEON SPECIALIST(Ob Gyn) Head of the
  Dept.,
• ESI Hospital,
• Sanathnagar,
• HYDERABAD.

2
Enlarged firm UTERUS in a Menopausal Woman
presents with pelvic pain

• Venkateshwaramma w/o B.Kishore babu,
• Female, 50years,
• Reg.No2794,
• I.P.No3558910,
• Plot No127, Hydernagar,Kukatpally, Hyderabad.
• Samrakshana Electricals, Hyderanagar, Kukatpally,
  Hyderabad.

3
Enlarged firm UTERUS in a Menopausal Woman
presents with pelvic pain

• Presented with lower abdominal pelvic pain of
  6months duration.
• Para 3,Live 3.Attained menopause 10yrs back. No
  significant past medical history.
• Vital data Normal, P/ANAD, P/SCervix Vagina
  healthy, P/VUterus enlarged,MP,Mobile.
• CLINICAL DIAGNOSIS Fibroid Uterus

4
Enlarged firm UTERUS in a Menopausal Woman
presents with pelvic pain

• INVESTIGATIONS
• CUA NAD, Stool Occult blood Negative, BTCT
  14 415,
• Hb 13gm, PCV 37,
• Bl.Sugar 141mg,
• Bl.Urea 15mg,S.Cr 0.9mg,
• Uric acid 4.7,
• A Rh(D) ve,HIV HbsAg Negative,
• Urine C/S Sterile,
• ECG NAD, DDC NAD.

5
Enlarged firm UTERUS in a Menopausal Woman
presents with pelvic pain

• ULTRASOUND SCAN
• Pelvis Uterus RV, Bulky 50mm48mm, Echogenic
  lesion in the uterus s/o ?Ca. Endom. Both adnexal
  regions are normal. No ascites. No
  lymphadenopathy.
• Abdomen NAD.

6
Enlarged firm UTERUS in a Menopausal Woman
presents with pelvic pain

• Pre-operative Evaluation
• Cardiologists opinion ECG Chest X-rayWNL, 2D
  Echo Normal Study and Cardiac Status Normal.
• Anesthetist's opinion Fit for regional
  anesthesia.

7
Enlarged firm UTERUS in a Menopausal Woman
presents with pelvic pain

• Total Hysterectectomy was done on26-4-04 by
  abdominal route.
• Per-operative findings Uterus size corresponds
  to 8weeks gestations, soft.
• Both ovaries other adnexae are grossly normal.
• Grossly, submucous lipoma about 5-6cm size found
  arising from the posterior wall of uterus.

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10
LIPOMA UTERUS

• Review of the literature in Medline done and many
  cases were reported from Indian Institutions as
  well as around the World even though Lipoma of
  the uterus is considered to be rare entity.
• Next slides reveal some of the radiological
  diagnostic findings.

11
LIPOMA UTERUS

• Uterine lipoma
• advantage of MRI over ultrasound
• Ultrasound suggested the presence of a uterine
  lipoma but MRI permitted an unequivocal
  diagnosis.
• http//bjr.birjournals.org/cgi/content/abstract/78
  /925/72

12
LIPOMA UTERUS

• Literature reviewed in Web
• Uterine lipoma (UL) is a rare tumor frequently
  presenting as leiomyolipoma. Even more uncommon
  is the association of UL and endometrial
  carcinoma (EC) for which only two cases have been
  reported.
• J Gynecol Obstet Biol Reprod (Paris).
  199019(3)301-5.

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LIPOMA UTERUS

• Department of Obstetrics and Gynecology, Far
  Eastern Memorial Hospital, Taipei, Taiwan, R.O.C.
  
• Uterine lipoleiomyoma is uncommon and has
  received little attention from gynecologists. We
  report a case of uterine lipoleiomyoma with
  subsequent pelvic abscess after rupture of the
  appendix. Its clinical picture mimicked uterine
  malignancy.

14
LIPOMA UTERUS

• Pubmed database reveals 120 articles about
  lipoma uterus either as pure lipoma or
  lipoleiomyoma.
• Most uterine lipomatous tumours occur in
  post-menopausal women between the ages of 50
  years and 70 years 1. Most patients are
  asymptomatic but some experience symptoms similar
  to that of uterine leiomyomas of comparable size,
  such as pelvic discomfort, heaviness, pressure,
  or vaginal bleeding 2.

15
Lipoma/Lipoleiomyoma of the Uterus

• Some of the Lipoleiomyoma (Hamartoma,
  Angiolipoleiomyoma) cases as well as images are
  presented at Geneva Foundation for Medical
  Education and Research website.
  http//www.gfmer.ch/selected_images_v2/detail_list
  .php?cat117cat3635styped

16
Summary of the case

• A 50 year old post menopausal lady presented with
  chronic pelvic pain with enlarged, firm uterus gt
  clinically diagnosis of possible fibroid uterus
  (common condition).
• Post-operative findings reveal Sub mucous Lipoma
  of the uterus on gross exam (cut section) which
  was proved by histopathological exam subsequently.

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LIPOMA UTERUS

• Thank you very much for your kind attention!!