卵巣成熟奇形腫の術前診断で手術を行うも子宮腫瘍と判明し腹腔鏡下子宮全摘出術を行った脂肪平滑筋腫の1例

抄録

  Ovarian mature teratomas present various risks, such as acute abdomen, and hence surgery is the usual protocol. On the other hand, uterine lipoleiomyoma is a variant of uterine leiomyoma, and surgery is not always performed in postmenopausal cases. We report a case of postmenopausal uterine lipoleiomyoma, preoperatively diagnosed as ovarian mature teratoma, and treated surgically. A 71-year-old woman presented a 5.5-cm mass on the left dorsal side of the uterus that was fat suppressed on magnetic resonance imaging. The preoperative diagnosis was mature teratoma of the left ovary.

  Laparoscopic bilateral salpingo-oophorectomy was planned, but we changed the operative procedure to laparoscopic hysterectomy and bilateral salpingo-oophorectomy. This was because the mass was identified as a uterine mass as no swelling was observed in either ovary during surgery. Pathological examination of the excised specimen revealed lipoleiomyoma. It may be difficult to distinguish uterine lipoleiomyomas from ovarian mature teratomas when the lipoleiomyomas are subserosal. In this case, the tumor was presumed to have originated from the uterus based on the findings of the pelvic examination, and we were able to discuss the operative procedure options in advance. One of the merits of laparoscopic surgery in this case was that the burden of changing the surgical procedure was less than that with laparotomy; however, at the same time, preoperative exclusion of malignant disease was considered important. In the diagnosis of tumors containing fat, the differential diagnosis of lipoleiomyoma should be considered.