Scholarly article on topic 'A rare case of pure uterine giant lipoma'

A rare case of pure uterine giant lipoma Academic research paper on "Chemical sciences"

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Academic research paper on topic "A rare case of pure uterine giant lipoma"

Taiwanese Journal of Obstetrics & Gynecology 55 (2016) 145—146

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Taiwanese Journal of Obstetrics & Gynecology

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Research Letter

A rare case of pure uterine giant lipoma

Antonio Pellegrino a, Gianluca Raffaello Damiani a'b'c'd' *, Cecilia Pirovano a, Massimo Stomati e, Antonio Cappello b, Massimo Tartagni d, Maria Grazia Pezzotta

a Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Lecco, Italy b Department of Radiology, Alessandro Manzoni Hospital, Lecco, Italy c Department of Anatomy, Alessandro Manzoni Hospital, Lecco, Italy d Department of Obstetrics and Gynecology, University of Bari, Italy e Department of Obstetrics and Gynecology, Dario Camberlingo Hospital, Brindisi, Italy

ARTICLE INFO

Article history: Accepted 24 June 2015

Dear Editor,

We encountered a rare case of uterine pure giant lipoma. Pure lipoma of the uterus is a very rare entity with an estimated occurrence of 0.03—0.12% [1,2]. To date, the histogenesis of lipo-matous tumors has not been determined.

A 73-year-old woman complained a sensation of pelvic heaviness and severe urge incontinence.

Ultrasound showed an enlarged uterus, 16 weeks' size, with a round hyperechogenic lesion of 15 cm x 14 cm, compressing the bladder and a bladder compression. Endometrial thickness was dislocated by the voluminous lesion. Magnetic resonance imaging (Figure 1A) showed the presence of two lesions with low-intensity signals (4 cm x 3.2 cm; 2 cm x 2.8 cm) and another one with a high-intensity signal on T1-weighted images (15 cm x 12 cm). A hysteroscopic specimen showed atrophic endometrium. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Hysterectomy revealed an enlarged uterus (19 cm x 11 cm x 13 cm) due to the presence of three globular masses, which appeared as well-circumscribed intramural tumors.

The lipoma was the largest of these globular masses, soft in consistency and homogeneously yellow (Figure 1B). No smooth muscle cells or fibrous elements were present intratumorally (Figure 1C, D); therefore, it was diagnosed as a pure lipoma [1].

Although the fat cells showed slight variety in size, no overt nuclear atypia or mitotic figures were detected. In our case, the coexistence of both leiomyomas and a pure lipoma may be linked to estrogens, progestogens and a number of local growth factors as well, which could stimulate the growth of lipomas as it is demonstrated for leiomyomas. As fat tissue is not native to the uterus, various theories of histogenesis have been proposed. According to the literature, fatty metaplasia of the connective tissue or the smooth muscle cells seems to be the most plausible histogenetic cause involved in the development of uterine lipomas [3,4]. Multivacuolated lip-oblasts were seen. Smooth muscle cells in the surrounding tissue were reactive to actin, desmin, and vimentin. Estrogen receptor, and progesterone receptor were present; focal actin and desmin were found in granular or filament form in the cytoplasm of the fat cells. Preoperative diagnosis of uterine lipomas is generally very difficult. The absence of nonadipose components and the presence of a homogeneous mass with a large amount of fat, may indicate a pure lipoma. In our case, since the lesion was homogeneous and consisted entirely of fat, we suspected that it was a pure lipoma.

Magnetic resonance imaging is the best imaging modality for diagnosing lipomatous tumors and for distinguishing between mixed and pure types [5]. In recent years, characteristic chromosomal abnormalities have been found in adipose tumors. Lipomas are frequently characterized by aberrations of the 12q13 approximately q15 chromosomal region and often by rearrangements of the HMGA2 gene. These rearrangements include the formation of chimeric genes that fuse the 5' region of HMGA2 with a variety of partners, such as LPP (3q28) or NFIB (9p22) [6]. To improve data in literature regarding the histological origin of the tumor, we suggest to not fix the entire surgical specimen in formalin, to allow cyto-genetic analysis.

* Corresponding author. Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy. E-mail address: damiani14@alice.it (G.R. Damiani).

http://dx.doi.org/10.1016/j.tjog.2015.12.011

1028-4559/Copyright © 2016, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A. Pellegrino et al. / Taiwanese Journal of Obstetrics & Gynecology 55 (2016) 145—146

Figure 1. (A) Axial T1-weighted image shows a well circumscribed mass of high signal intensity. (B) A submucosal, well circumscribed lipoma with soft yellow-cut surface. (C, D) Mature adipocytes of lipoma arranged in large confluent nodules. The transition zone between lipoma and leiomyoma is clearly visible.

Conflicts of interest

The authors have no conflicts of interest relevant to this article. References

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[2] Robertson JW, Barber H. Lipoma of the uterus. Am J Obstet Gynecol 1953;65: 920—2.

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