Case Report DOI: 10.18231/2394-6792.2019.0030 Indian Journal of Pathology and Oncology, January-March, 2019;6(1):158-160 158 A rare case of intrauterine lipoma: A masterful masquerade Varun Bajaj 1 , KC Singh 2,* , Rony Chakravarty 3 1 Graded Specialist, 2,3 Classified Specialist, Dept. of Pathology, Dept. of Obstetrics and Gynaecology, 1,3 Military Hospital, Wellington, Tamil Nadu, 2 6 Airforce Hospital, Coimbatore, Tamil Nadu, India *Corresponding Author: KC Singh Email: malvithain@gmail.com Received: 12 th July, 2018 Accepted: 2 nd August, 2018 Abstract Introduction: Pure lipomas of the uterus are exceedingly rare, and their origin is of deep interest in terms of histogenesis. The tumours often pose a diagnostic challenge and a host of differentials are made on clinical and radiological assessment. The authors present a case of a pure uterine lipoma detected at a peripheral Airforce hospital. Materials and Methods: Case report with clinical, ultrasound and histopathological findings. Conclusion: A rare case with a controversial histogenesis and recently described chromosomal anomalies adds to our knowledge of this uncharacteristic lesion in the uterine corpus. Keywords: Hamartoma, Leiomyoma, Lipo-leiomyoma. Introduction Uterine Lipomas are exceedingly rare entities with a handful of reported cases worldwide. 1 First described in 1816 by Lobstein, overall incidence of lipomatous tumours in the uterus has been reported to be 0.02-0.03 %. 2,3 The typical clinical profile is an elderly female (50-70 years age) who has attained menopause and presenting with symptoms and signs of a pelvic mass. Histological spectrum of these lesions though variates from a pure lipoma, lipo-leiomyoma to a lipofibroma. 4 Although presence of mature adipocytes in the uterine wall is not uncommon a full blown pure lipomatous lesion seldom shapes up. Largest clinicopathological case series on lipomatous tumours of uterus is of ten cases of which only one was a pure lipoma. 5 Sefarini et al have described the radiological findings of these tumours in a case series of eleven cases. 6 Considered hamartomatous by most authors these lesions can masquerade as more sinister lesions and cause doubt in the mind of the treating surgeon and cause a malignancy scare in the patient. Case Report 58 years old post-menopausal lady with comorbidities in the form of Diabetes Mellitus and Hypertension presented to the emergency department of a peripheral Airforce hospital with complaints of pain abdomen and acute retention of urine. On examination her vital parameters were stable, and a mass was palpated in the lower abdomen parallel to the midline corresponding to approximately a 14-16 weeks gravid uterus. Haematological and Biochemical profile of the patient showed a controlled diabetic state with HbA1c of 6.5%. Imaging of the abdomen revealed a large, homogenous, well defined, hyperechoic mass with partially hypoechoic rim. There was no evidence of internal vascularity within the lesion. Based on the imaging a possibility of a lipo- leiomyoma with hydroureter and hydronephrosis was suggested. (Fig. 1) A laparotomy to visualise the uterus and subsequent total hysterectomy was decided as the treatment choice in view of bothersome symptoms being experienced, post-menopausal age group being in favour and reproductive desire being non- existent post family completion. Per operatively Uterus corresponding to 16 weeks of gestational size was seen impacted onto the pelvis compressing the ureters and the bladder. Ovaries appeared to be normal. The uterine specimen was sent to Military Hospital Laboratory for histopathological examination. Gross examination of the specimen revealed an enlarged uterus measuring 13 x 11 x 9 cm with a short cervix of 2 cm length. Serosal surface of the uterus was globular and smooth. Cut surface showed a globular mass measuring 9.5 x 9 x 9 cm completely replacing the uterine parenchyma and pushing the myometrium to a 1 cm rim around the mass. Endometrial cavity was not visible. The mass was yellowish in colour, had a firm consistency with no infiltration into surrounding uterine wall on gross. (Fig. 2) Microscopic examination showed a lobulated tumour composed of mature adipocytes with fine septal vascularity. No lipoblasts were noted. No spindle cell component was appreciated on extensive sectioning. Based on the above findings a diagnosis of Lipoma of the uterus was given. (Fig. 3) Post operatively the patient’s symptoms were alleviated and recovery was uneventful.