A 50-year-old postmenopausal woman presented with increased frequency of per vaginal bleeding since 6 months and distension of abdomen since 15 days. The patient's history revealed that she had attained menarche at the age of 14 years, had regular menstrual cycles of 4–5 days duration and moderate intensity at 28 days interval. She attained menopause 2 years back.
Gynecological examination revealed no abnormalities of the vulva, cylindrical vaginal portion of the cervix and no evident pathological change was detectable with clinical examination. Findings of ultrasonography examination suggested bulky uterus with thickened endometrium of 6 mm and hyperechoic mass suggestive of myoma of posterior wall of uterus, measuring 3.5 cm in diameter. In addition, transvaginal sonography revealed hyperechoic lesion of 3.5 × 3.5 cm in the posterofundal region. Also, there were two small subserosal leiomyomas of 0.5 cm diameter each. Both the ovaries showed follicular cysts measuring 3.3 × 3.3 cm each and tubes were normal in appearance.
All the standard serological and hematological parameters were within normal range. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy because of multiple leiomyomas.
On gross examination of the specimen, the uterus measured 8.5 × 6.1 × 5 cm and had three intramural and subserosal well-circumscribed round masses. The biggest nodule which was measuring 3.5 cm in diameter differed from a typical appearance of uterine leiomyoma by being pale yellow and having a somewhat softer consistency on its cut surface
. The other two leiomyomas, each of 0.5 cm diameter, showed a coarsely whorled pattern with grayish white appearance on their cut surface. The serosal surfaces of the uterus were normal. Cut section of ovaries showed follicular cysts of 3.5 cm diameter each. The fallopian tubes appeared grossly normal.
Sectioned surface of uterine lipoleiomyoma showing distinct pale yellow appearance
Histological examination of the biggest nodule showed a mixture of bland, spindle-shaped smooth muscle cells without nuclear atypia in a whorled pattern with admixed mature adipocytes. The nuclei of the smooth muscles were elongated and had finely dispersed chromatin and small nucleoli. Between these muscle cells, a significant amount of fat cells were visible. The adipose component was entirely mature without any lipoblasts [Figures –]. Based on the above findings, the tumor was diagnosed as a benign lipoleiomyoma. Sections from the other fibroids showed classical histomorphology of conventional uterine leiomyomata. The endometrium showed changes of simple hyperplasia without atypia. Sections from both the ovaries showed follicular cysts with the tubes being unremarkable histologically.
Well-circumscribed proliferation of bland, spindle-shaped smooth muscle cells without nuclear atypia in a whorled pattern with admixed mature adipocytes (H and E, ×10)
Smooth muscle cell proliferation admixed with mature adipocytes (H and E, ×40)