Citation: BJOG: An International Journal of Obstetrics and Gynaecology. 2013, 120, 268
Author: Mohammed R.O.; Kubwalo B.; Maurice Y.; Doyle M.
Abstract: Case A 62-year-old woman presented with intermittent lower abdominal pain with no bowel or urinary symptoms. She had a vaginal hysterectomy 25 years previously for prolapse. Pelvic USS showed an 8.5 cm complex pelvic mass posterior to the vaginal vault. Serum tumour markers (CA125 CEA and CA199) were normal. She underwent laparoscopic bilateral salpingo - oophorectomy. Macroscopic examination showed a large ovarian mass weighing 236 g with a rubbery cut surface and intact capsule. Microscopy showed interlacing spindle shaped cells and collagen with the presence of adipose tissue.
Immunochemistry revealed a strong reaction to desminand actin and a diagnosis of a lipoleiomyoma of the ovary was made. Discussion Primary leiomyoma is a rare tumour of the ovary and accounts for 0.5-1% of benign ovarian neoplasms. Lipoleiomyomas are even rarer with only about three cases reported in the English literature. In this case, the ovarian tissue was completely replaced by the tumour and there was no normal ovarian tissue visualised. The presence of smooth muscle cells which was strongly positive for desmin and the presence of fat lobules confirmed the diagnosis of a lipoleiomyoma in this patient. Adipose tumours of the ovary are very rare and mostly benign. Clinically, these tumours are asymptomatic and may cause discomfort when they attain a large size. They are often found in menopausal and post menopausal women. Structurally, lipoleiomyomas are microscopically similar to a leiomyoma with (Figure Presented) varying amounts of adipose tissue which may represent metaplasia. Lipoleiomyomas of the uterus are more common than that of the ovary where they are thought to represent uterine tumour metaplasia within a leiomyoma. Because of its rarity, this condition can pose diagnostic difficulty on clinical and radiological grounds and must be distinguished from more common pathology such as an ovarian fibroma. The presence of adipose tissue might also confuse pathologists. Another important differential is a leiomyosarcoma which its macroscopic appearance and clinical picture may imitate. Care must be taken to distinguish it from a penduculatedsubserosal parasitic fibroid which has lost its uterine attachment and is attached to the ovary. Treatment is surgical excision with an excellent prognosis.
