Navigating diagnostic complexity: A case report on uterine lipoleiomyoma, unveiling its benign nature amidst characteristics resembling liposarcoma

ABSTRACT

Lipoleiomyomas, rare variants of uterine leiomyomas, are characterized by the presence of mature adipocytes along with benign smooth muscle cells. The literature on this is limited to a few case reports and observational studies only. Presented here is a rare case of co-existing intramural and subserosal uterine lipoleiomyoma in a post-menopausal woman who had attained menopause 25 years prior. The 75-year-old patient, with a history of hypertension and diabetes, presented with lower abdominal pain. Imaging revealed an intramural degenerated fibroid in the anterior wall, measuring 7 × 6 × 5 cm, and another subserosal fibroid, measuring 2.5 × 2 × 1.5 cm, in the posterior uterine wall. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, with microscopy revealing lipoleiomyoma with high intra-tumoral mast cells and eosinophils. This case highlights that lipoleiomyomas can present many years after attaining menopause. Diligent microscopic examination should be carried out to render an accurate diagnosis and to rule out other adipocyte-containing neoplastic lesions. This uncommon variant of uterine lipoleiomyoma poses a distinctive set of considerations for healthcare professionals, and our report seeks to contribute to the expanding knowledge base surrounding this unique condition.