A Case of Lipoleiomyoma in the Pouch of Douglas

Abstract

Of the leiomyomas occurring in the pelvis, uterine myomas are the most frequently occurring, and the tumor rarely arises from other organs in the pelvis. Herein, we report a case of lipoleiomyoma, a rare pathological type of leiomyoma, arising from the peritoneum lining the pouch of Douglas in a 59-year-old woman. The patient was referred to us for the treatment of a pelvic tumor that was newly detected during follow-up for a uterine myoma. Enhanced CT demonstrated a well-demarcated mass with poor enhancement on the dorsal side of the uterus, with no evidence of invasion of the adjacent organs. On laparotomy, a soft tumor covered by a thin capsule was found in the pouch of Douglas ; the tumor was not in direct contact with the uterus or other adjacent organs, except for a membrane and vessels connecting to the neck of the uterus. Pathological examination revealed abundant fat cells and spindle cells in the stroma. The spindle cells showed positive immunohistochemical staining for h-caldesmon and ER, and negative staining for PgR, MDM-2 and HBME1. Based on these findings, the tumor was diagnosed as a lipoleiomyoma arising from the pouch of Douglas.