Path Quiz Case59                 

           Diagnosis:  

            Dr Sampurna Roy MD

           Path Case 59 History and Images:

Lipoleiomyomas of the uterus are extremely rare tumour and occur in different locations including cervix.

These are characterized by scattered islands of mature fat cells which may represent ‘lipomatous’ metaplasia of a pre-existing leiomyoma .

Lipoleiomyomas generally occur in obese  perimenopausal or postmenopausal women and the patients often have a high incidence of gallbladder disease.  

Uterine lipoleiomyomas are often diagnosed preoperatively as uterine myomas or ovarian mature teratomas.

The key to distinguishing the tumors from lipoleiomyomas is to ascertain the primary site of development - uterus or adnexa.

When a large uterine tumour is found in a postmenopausal woman, the possibility of malignancy should be considered.

Microscopic features: 

Image1 ; Image2 ; Image3 ; Image4 ; Image5 ; Image6

Histologically these tumours consist of smooth-muscle tissue admixed with varying amounts of mature adipose tissue, which do not show cytological atypia.

The smooth-muscle cells are most commonly of the spindle-cell type, but rarely epithelioid cells are seen.

The fat cells are mature adipocytes.

In some cases immature fat cells and lipoblasts with marked nuclear atypia are seen.

Rarely cartilagenous differentiation or anomalous arterial blood vessels, resembling those seen in renal angiomyolipoma are noted.

Lipoleiomyoma with the latter features should be distinguished from angiolipoleiomyoma, a tumour that is seen in cases of tuberous sclerosis and is most likely of a choristomatous nature.

 Intravascular leiomyomatosis with histologic features of a lipoleiomyoma has been rarely reported.