Introduction: Lipoleiomyomas are rare and asymptomatic benign tumors with an incidence of 0.03-0.2%. Pathologically, mature fat cells are mixed with smooth muscle cells. Here, we report the case of successful laparoscopic resection of uterine tumor which was preoperatively diagnosed as ovarian dermoid cyst and was diagnosed as lipoleiomyoma by perioperative pathology.
Case presentation: A 70-year-old postmenopausal women (gravida/para = 2/2) was referred to our hospital with an ovarian tumor detected by transvaginal ultrasonography and magnetic resonance imaging (MRI). Her tumor marker levels were not elevated. We scheduled a laparoscopic bilateral salpingo-oophorectomy using the TANKO method. Intraoperative findings were normal bilateral adnexa and a tumor emerging from the posterior uterine wall. After transection of the uterine body using a monopolar electric scalpel, a yellow mass was visualized and removed using Crow forceps. The tumor was excised in one piece through the umbilical trocar. The tumor underwent rapid intraoperative pathological diagnosis and was confirmed as lipoleiomyoma. We added one auxiliary trocar at the lower left abdomen to begin double-incision laparoscopic surgery. The myometrium was closed in two layers using 1-0 Monocryl® sutures. Laparoscopic tumor resection and bilateral salpingo-oophorectomy were performed. The tumor was confirmed as a lipoleiomyoma postoperatively.
Conclusion: Lipoleiomyoma should be considered in the differential diagnosis of masses in the fatty tissue, but accurate preoperative diagnosis is difficult using MRI. In addition, since malignancy is possible (leiomyosarcoma in the fatty tissue and immature ovarian teratoma), informed consent regarding the possibility of malignancy is required before surgery.
