{"paper_id":"8a464abf-3b32-4f7c-8dc0-5bf187d4a553","body_text":"Abstract\nA case of uterine fatty tumour of 2 cm studied by transvaginal ultrasound in a 67-year-old woman \nundergone totally laparoscopic hysterectomy is here presented along with an updated review of this kind \nof tumours. A total of 226 cases from 75 publications could be found. Traditional definitions of these \ntumours are here critically reconsidered. The terminology used to define these tumours is confusing \nand reflects main radiological and pathological points of view (uterine fatty tumours [UFT] vs. lipoma/\nlipoleiomyoma). It is here stressed that these tumours by occurring in aged and overweight women are \nnot so uncommon as generally believed, can be very well recognized, as far as they are small (< 4 cm), \nby transvaginal ultrasound while CT and MR become more specific for decision making in case of larger \nsize tumours. Symptoms largely vary from none to sudden lump enlargement or bleeding or pain. An \nassociation with malignancy has been found in 10% suggesting a radical treatment (hysterectomy) in \nmost cases.     \nA Case Report and Review of the Literature on Uterine Fatty Tumours \n(UFT): A Field of Heterogeneous Data\nPublication History:\nReceived: June 27, 2014\nAccepted: October 04, 2014\nPublished: October 06, 2014\nKeywords:\nUterine lipoma, Lipoleiomyoma, \nUterine fatty tumors, Uterine \nmyomas\nCase Report Open Access\nCase Report\n Since first description by Lobstein in 1816 until 1966 only 131 cases \nof lipomatous uterine tumours (UFT) were initially reported. From \nthe 70’s up to date this number has been progressively growing to \nat least 357 cases around the world. The first preoperative study on \na case of uterine “fatty” tumour has been described by Jacobs and \nMarkowitz in 1988 [1] and since then the preoperative imaging study \nof these tumours has significantly increased due to the expansion \nof the radiological technologies and diffusion of ultrasonography \nin routine gynaecologic activity. Uterine fatty tumours (UFT) or \nlipoleiomyomas (LLM) are a kind of leiomyomas with prevalent \nfatty component occurring mostly in peri-menopausal and post-\nmenopausal obese women. Many clinical and pathological aspects of \nthese uncommon uterine nodules have been already reported [2-6]. \nNonetheless literature largely varies with a prevalence of radiological \ncase-reports for clinical data and histo-pathological review analysis \non pathogenesis investigation. Little or nothing about UFT is found \nin important gynaecological journals. Moreover it is not clear which \ndiagnostic tool among ultrasound, CT and MR should be best utilized \nfor clinical follow up of these nodules [7,8], whether hysterectomy \nshould or not always warranted [9,10] and how frequently a malignant \ntransformation of these tumours should also be expected [3,11]. We \nreport here a single case of UFT along with a full literature review \non this topic with the aim to help gynaecologists in the clinical \ncounselling of these tumours.\n  A 67 year old woman with no clinical symptoms or relevant medical \nhistory (menopause at 54 y.o., hypercholesterolemia and overweight \n[BMI=28.9]) was found with a 1.9 cm hyper echoic uterine nodule \non the intramural/subserosal margin of anterior wall. This little \nhyper echoic nodule was clearly distinguished from the surrounding \nmyometrium without showing any posterior acoustic shadow. \nContrary to that generally reported this lesion appeared not to be \nencased in hypo echoic ring (Figure 1). The discovery of this nodule \nwas made occasionally during routine transvaginal ultrasound (US). \nFollowing CT and MR (images here not reproduced) a presumptive \ndiagnosis of uterine fatty tumour was made and patient advised \nto undergo surgery. A totally laparoscopic hysterectomy with \nbilateral adnexectomy was performed and successively the resulted \nhistopathological analysis confirmed the benign nature of the \nlesion. Pathological findings: grossly, uterus weight of 76 grams and\n*Corresponding Author: Dr. Luca Bernardini, Department of Obstetrics and \nGynecology, Saint’Andrew Hospital, ASL 5, Via Vittorio Veneto 197, 19100, La \nSpezia, Italy; E-mail: ostgin-sarzana@libero.it\nCitation: Bernardini L, Zacutti A, Gorji N, Giannoni ML, Accorsi F, et al. (2014) \nA Case Report and Review of the Literature on Uterine Fatty Tumours (UFT): A \nField of Heterogeneous Data. Int J Gynecol Clin Pract 1: 101. doi:  http://dx.doi.\norg/10.15344/2394-4986/2014/101\nCopyright: © 2014 Bernardini et al. This is an open-access article distributed \nunder the terms of the Creative Commons Attribution License, which permits \nunrestricted use, distribution, and reproduction in any medium, provided the \noriginal author and source are credited.\nInternational Journal of\nGynecology & Clinical Practices\nLuca Bernardini1*, A Zacutti1, N Gorji2, ML Giannoni1, Francesca Accorsi1 and E Volpi1 \n1Department of Obstetrics and Gynecology, Saint’ Andrew Hospital, ASL 5, Via Vittorio Veneto 197, 19100, La Spezia, Italy\n2S.C. Anatomia ed Istologia Patologica, Saint’ Andrew Hospital, ASL 5, Via Vittorio Veneto 197, 19100, La Spezia, Italy\nInt J Gynecol Clin Pract                                                                                                                                                                                          IJGCP , an open access journal                                                                                                                                          \nISSN: 2394-4986                                                                                                                                                                                                       Volume 1. 2014. 101                                            \n                                     Bernardini L, Int J Gynecol Clin Pract 2014, 1: 101\n                                     http://dx.doi.org/10.15344/2394-4986/2014/101   \nFigure 1: TSV ultrasound showing a typical hyperechogenic \nintramural nodule of 2 cm.  \ndimensions of 7 × 4 × 3 cm, at the cut surface with a yellowish \nintramural nodule of corpus uteri of 1.9 cm in diameter, with well-\ndefined edges but non encapsulated; the overlying endometrium \nwas atrophic and the cervix showed no significant macroscopic \nchanges (Figure 2). Microscopically the tumour was predominantly \nmade up of mature adipose tissue mingled with bundles of \nsmooth muscle (positive for smooth muscle actin antibody \nat immunohistochemistry). The diagnosis of lipoleiomyoma \nwas made. The patient gave her informed consent to the study.\n\n\nInt J Gynecol Clin Pract                                                                                                                                                                                          IJGCP , an open access journal                                                                                                                                          \nISSN: 2394-4986                                                                                                                                                                                                       Volume 1. 2014. 101                                            \n   Overall a total of 226 fatty tumours of the uterus including lipomas, \nlipoleiomyomas, liposarcomas and endometrial cancers associated \nwith lipoleiomyomas could be retrieved from the literature. We \nstarted reviewing data from the study of Willen et al 1978 [2] (the \nfirst 131 cases of UFT from 1816 to 1966 were excluded). This has \ncorresponded to 75 independent studies here separately reported in \n3 different tables: Table 1 for all clinical studies (n=46), Table 2 for \npathological review data analysis (n=16) and Table 3 for malignant \nuterine tumours with fatty component and endometrial cancers \ncoincidental with benign fatty tumours (n=13). Mean patient age, \ntumour size and incidence of UFT (which varied accordingly to the \ncriteria used being low -0.03%- in hysterectomy and higher -0.8-2.1%- \nin uterine leiomyomas studies) along with symptoms and methodology \nused for preoperative tumour study and detection are summarized in \ntable 4. No association whatsoever between aging and tumour size has \nbeen noted (Table 1). Despite being a tumour associated with aging \nwe observed a prevalence of 23% in women younger than 54 years. As \nfor all the other uterine fibroids, clinical signs largely varied including \noccasional discovery in asymptomatic patients, bleeding, abdominal \nor pelvic pain, pelvic mass discovery, liver problems, anaemia, disuria, \nand constipation. Despite UFT are said to recur more frequently in \noverweight and obese perimenopausal women, specific details on \nbody weight or BMI have in general not been reported. Diagnosis and \nradiological follow up has been obtained in different ways including a \nvariable utilization of multiple technologies such as US, CT, MR. All 3 \nof these have been employed only in 16/46 independent case reports. \nUS either by transvaginal (TSV-US) or abdominal (TA-US) route was \nused in 42/46 studies but TVS has been applied only in 19 occasions. \nThe use of TVS alone as unique diagnostic technique has been used \nonly in 4 studies (for a total of 10 patients) while MR alone, as unique \ndiagnostic tool, in 2 studies (for a total of 10 patients). Hysterectomy \nhas been generally the rule for most patients but 9 (7 study reports). \nBy a pathologist point of view, most of the uterine fatty tumours were \nlipoleiomyomas (n=135), less frequently occurred lipomas (n=18), \nangiomyolipomas (n=4), and others (1 atypical lipoleiomyoma, 1 \nbizarre epitheliod lipoleiomyoma and 1 plexiform lipoleiomyoma, 1 \ngiant lipoleiomyoma, 1 myolipoma of round ligament). An intramural \nor subserosal location has been found in most cases despite the \npossibility to encounter everywhere around the uterus these tumours \n(round ligament, cervix, or as pelvic mass). Satellite fibroid tumours\nor leiomyomas were described in 33% of the cases. Notably, in 4/18 \nlipomas a concomitant presence of an endometrial cancer was \ndiscovered. To the date, liposarcomas and lipoleiomyosarcomas have \nbeen found to be described in at least 8 independent studies for a total \nof 19 patients.\nDiscussion\n  In the last months the number of publications on UFT has grown \na lot with increasing online diffusion of radiological images [12-14]. \nIn these imaging reports, lipoleiomyomas are defined as uncommon, \nbenign tumours not requiring surgical treatment. Most data on these \ntumors have been published on radiology medicine journals or reviews \nof pathology archives. Little is given on gynaecological journals. This \nis of matter since for gynaecologists it would be of value a prompt \nrecognition and counselling of these tumours when performing \nultrasound. This is truer in case of overweight peri-menopausal \nwomen who have fibroids in almost 80% of the cases [15]. Since the \nincidence of UFT in older patients is higher than 1% it is questionable \nto consider UFT as uncommon tumours as yet. Particularly, when \nthe aging trend of the world population is considered. As far as it \nrefers to clinical management a dramatic variability is from one study \nto another. This is a consequence of the variability of the tumour \nsize, presence or not of symptoms and interpretation of imaging \ninvestigation results. As originally reported by Pham et al [16] and \nothers [17,18] when these fatty tumours are small (2-5 cm) and of \ncertain uterine origin, transvaginal ultrasound is very sensitive and \nthere is no need of additional and more specific technologies (CT and \nMR). Since correct diagnosis can only be expressed after histologic \nexamination and malignancy be found, we believe that in general \nhysterectomy should be always done. Myomectomy could be an \noption only for younger patients scheduled to special infertility cures \n(i.e. oocyte donation cycles). The review of literature data shows \nthat the percentage of UFT occurring in women < 54 years is not \ninsignificant (23%) (3). A conservative management is mandatory \nin conditions contraindicating surgery when surveillance by means \nof ultrasonography, CT, and MR is rather coupled to uterine artery \nembolization [19,15]. When clinical manifestations such as sudden \nlump enlargement or pelvic masses are present, the implementation \nwith CT and MR becomes mandatory. Despite the very high \nspecificity of MR for detecting origin and mass constitution (fat \ntissue), the diagnosis is made only after excluding other pelvic masses \n(benign cystic ovarian teratoma, malignant degeneration of cystic \nteratoma, lipomatous ovarian tumour, pelvic lipoma, liposarcoma and \nlipoblastic lymphadenopathy) [9,10,20,21]. CT and MR have allowed \nvalid follow up of pelvic masses in one patient with severe medical \ncontraindication to surgery [7] but pitfalls in imaging interpretation \nmay always happen and one case with fatal consequences due to \nunnecessary surgery (lipoleiomyoma misdiagnosed as liposarcoma \n- patient died post hysterectomy) has been reported [22]. Although \nmost fibroids regress after the menopause the  UFT are more \nfrequent in elderly women. It has been estimated that the prevalence of \nuterine lipoleiomyoma in patients older than 80 years is close to 10% \n(5/50 uterine lipoleiomyomas) [3] and it is well known that elderly \nwomen have a higher risk of perioperative morbidity and mortality. \nTherefore sometime correct counselling of these lesions is not easy \nin particular considering the finding of an association with sarcomas \nand endometrial cancers in 10% of the cases. Literature description \nof the lipomatous uterine tumours is highly variable as much as it is \nthe biology of these tumours, the histotype and also the criteria used \nCitation: Bernardini L, Zacutti A, Gorji N, Giannoni ML, Accorsi F , et al. (2014) A Case Report and Review of the Literature on Uterine Fatty Tumours (UFT): A \nField of Heterogeneous Data. Int J Gynecol Clin Pract 1: 101. doi:  http://dx.doi.org/10.15344/2394-4986/2014/101\n       Page 2 of 7\nFigure 2: Macroscopic pathology of fatty tumour.\n\n\n          \nInt J Gynecol Clin Pract                                                                                                                                                                                          IJGCP , an open access journal                                                                                                                                          \nISSN: 2394-4986                                                                                                                                                                                                       Volume 1. 2014. 101                                            \nCitation: Bernardini L, Zacutti A, Gorji N, Giannoni ML, Accorsi F , et al. (2014) A Case Report and Review of the Literature on Uterine Fatty Tumours (UFT): A \nField of Heterogeneous Data. Int J Gynecol Clin Pract 1: 101. doi:  http://dx.doi.org/10.15344/2394-4986/2014/101\n     Page 3 of 7\nNo. of \ncases\nSize Age Symptoms US\n(TA + TSV)\nCT MR Surg. Histology Fibroids References\n2 7 cm Abdominal pain\nlump growth\nTA yes yes yes Lipoma no Bachor, Baczako. Geburtshife Frauenheilkd \n46;842-3, 1986\n1 2 cm\n5 cm\nAsymptomatic TA yes no yes Lipoma no Jacobs and Markowitz. AJR:150;1335-1336, \n1988\n2 TA\nTA\nyes\nyes\nyes\nyes\nyes\nyes\nLipoma\nLipoleiomyoma\nno\nno\nDodd III and Budzik. AJR:155;317-322,1990\n1 yes yes yes Lipoleiomyoma Aizenstein et al. Gynecol Oncol:40;274-6, \n1991\n1 TA no no yes Lipoleiomyoma no Ekici, Vicdan. Int J Gynaecol \nObstet:42;167-71, 1993\n1 9 cm 59 Abnormal liver enzymes TA yes yes yes Lipoleiomyoma yes Villanueva et al. Abdom Imaging:18;402-3, \n1993\n1 43 TA no no yes Lipoleiomyoma no Pham et al. Can Assoc Radiol:44;463-5,1993\n1 20 cm 44 Asymptomatic yes yes Myolipoma of the \nround ligament\nno Sonobe et al. Virchows Arch:427;455-458, \n1995\n1 TA yes yes yes Lipoma no Alonso et al. Ginecol Obstet Mex:63;30-2, \n1995\n11 TA (n=5)\nTSV (n=6)\nno no yes Lipoleiomyoma 2/11 Serafini et al. J Ultrasound Med:15;195-99, \n1996\n1 8 cm 73 Pelvic Mass TA yes yes yes Lipoleiomyoma no Tsushima et al. British J Rad:70;1068-1070, \n1997\n1 62 Cholelithiasis yes yes yes Lipoleiomyoma no Ishigami et al. Abdom Imaging:23;214-216, \n1998\n2 6.8 cm\n5.5 cm\n55\n62\nAsymptomatic\nBleeding\nTA\nTA\nyes\nyes\nyes\nyes\nLipoleiomyoma\nLipoleiomyoma\nyes\nyes\nPrieto et al. Abdom Imaging:25;655-657, \n2000\n1 Large tumor yes yes Lipoleiomyoma no Su et al. Eur J Gynaecol Oncol:22;439-40, \n2001\n1 5 cm 48 Pelvic pain TA yes yes Biopsy Lipoleiomyoma no Avritsher et al. AJR:177;856-857, 2001\n1 51 Bleeding TSV no no yes Angiolipoma no Braun et al, 2002\n1 5.5 cm 67 Low Haematocrit\nWarfarin therapy\nTSV yes no UFT° yes Chan et al. JHK Coll Radiol:6;30-32, 2003\n1 67 Abdominal pain yes yes yes Lipoma no Al-Maghrabi et al. Saudi Med J:25;1492-4, \n2004\n1 10 cm 65 Pelvic mass TA yes yes yes Lipoleiomyoma no Chawla et al. Applied Radiology Online \n38-40, April 2004\n1 7.8 cm 62 Bleeding TA yes no yes Lipoma no Lau and Thoeni. British J Rad:78;72-74, 2005\n1 7 cm 75 Abdominal pelvic pain TSV yes yes yes Lipoma yes Coumbaras et al. Abdom \nImaging:30;239-241, 2005\n1 TA Lipoma Harish et al. Indian J Pathol \nMicrobiol:48;377-8,2005\n1 5 cm 53 Bleeding and pain TSV no no yes Lipoleiomyoma yes Alper et al. Malta Medical J:17;40-41, 2005\n1 5 cm 65 Bleeding and abdominal \nlump growth\nTSV no no yes Lipoma no Deb et al. MJAFI:61;385-386, 2005\n1 12 cm 72 Pelvic mass TA yes no yes Lipoleiomyoma no Arikawa et al. Kurume Med J:53;37-40, 2006\n1 17 cm 52 Pelvic mass TSV yes yes yes Lipoma no Fujimoto et al. J Obstet \nGynaecol:32;520-523,2006\n1 12 cm 60 Pelvic mass TSV yes yes yes Lipoma yes Fernandes et al. Indian J Pathol \nMicrobiol:50;800-1, 2007\nTable 1 continued..\n\nCitation: Bernardini L, Zacutti A, Gorji N, Giannoni ML, Accorsi F , et al. (2014) A Case Report and Review of the Literature on Uterine Fatty Tumours (UFT): A \nField of Heterogeneous Data. Int J Gynecol Clin Pract 1: 101. doi:  http://dx.doi.org/10.15344/2394-4986/2014/101\nInt J Gynecol Clin Pract                                                                                                                                                                                          IJGCP , an open access journal                                                                                                                                          \nISSN: 2394-4986                                                                                                                                                                                                       Volume 1. 2014. 101                                            \n       Page 4 of 7\nTable 1: Clinical case reports.\n9 9 cm\n10 cm\n10 cm\n9 cm\n4 cm\n3.5 cm\n6 cm\n6.5 cm\n4.5 cm\n65\n76\n64\n47\n55\n49\n64\n70\n55\nAbdominal pain\nAbdominal pain\nAbdominal pain\nAbdominal pain\nBleeding\nBleeding\nBleeding\nDysuria\nAnaemia\nno no yes yes Lipoleiomyoma 6/9 yes Kitajima et al. AJR:189;W100-104, \n2007\n1 TA yes yes no UFT° no Erdem et al. Magn Reson \nImaging:25;1232-6, 2007\n1 11 cm 60 Cholecystitis TA yes no yes Lipoleiomyoma no Chakravarty-Vartak et al. BHJ Epub \nApril 2007\n1 18 cm 80 Asymptomatic TA yes yes yes Lipoleiomyoma no Fujiwaki et al. Arch \nGynecolObstet:277;471-474, 2008\n1 55 cm 43 Constipation TA no no yes Lipoleiomyoma no Akhulut  et al. Arch Gynecol \nObstet:278;291-295, 2008\n1 2 cm 66 Asymptomatic TVS yes no no UFT° no Mylona et al. Eur Clinics \nObsteGynaecol: 3;135-136,2008\n1 8 cm 68 Asymptomatic TA yes yes yes Lipoleiomyoma no Loffroy et al. GynecolObstetInvest: \n66;73-75;2008\n1 5 cm 48 Abdominal pain TA no no yes Lipoma  + ovarian \nthecoma\nno Vilallonga et al. Hindawi Publish Corp \nID 340603, 2009\n1 58 Abdominal pain and \nBleeding\nyes Lipoleiomyoma Mignogna et al. Arch Gynecol \nObstet:280;1071-74, 2009\n1 4.8 cm 57 Abdominal pain TA no yes yes Lipoma yes Akyildiz et. Korean J Pathol:44;679-81, \n2010\n1 3.5 cm 50 Bleeding TSV no no yes Lipoleiomyoma yes Manjunatha et al. J Midlife \nHeath:1;86-88, 2010\n1 6 cm 70 Abdominal pain TA no no yes Lipoma (calcified) no Bandopadhyay et al. J Turkish-\nGerman Gynecol Assoc:11;113-4, \n2010\n1\n1\n14 cm\n6 cm\n61\n63\nPelvic mass\nAbdominal pain Bleeding\nTA\nTSV\nyes\nno\nno\nno\nyes\nyes\nLipoleiomyoma\nLipoma\nno\nno\nBindra, Sharma. The Internet J of \nGynecol Obstet: 12, 2010\nVamseedhar et al. India J Cancer:48; \n385-387, 2011\n1 9 cm 70 Bleeding and pelvic mass TA CT no yes Lipoleiomyoma no Terada T. Ann Diagn Pathol: Epub \nJune 6;2011\n3 2.4 cm\n12 cm\n2.4 cm\n79\n61\n72\nCholecistic pain\nAbdominal pain-\ncholecistic pain\nIntermittent abdominal \npain\nTA\nTA\nTSV\nyes\nyes\nyes\nyes\nyes\nyes\nno\nno\nno\nUFT°\nUFT°\nUFT°\nno\nno\nno\nChu et al. World J Radiol:4;58-62,2012\n1 3 cm Asymptomatic TSV yes yes no UFT° no Antony J. hcp.obgyn.net 2012\n2 9 cm\n1.5 cm\n58\n60\nDysuria\nUterine prolapse\nno\nno\nno\nno\nno\nno\nyes\nyes\nLipoleiomyoma\nLipoleiomyoma\nno\nno\nSingh et al. JCDR:6;718-719, 2012\n1 2 cm 37 Pelvic pain TSV yes yes no UFT° no Loberant et al. Imaging Science Today \n2012\n70^ 7.7* 57*\n\nCitation: Bernardini L, Zacutti A, Gorji N, Giannoni ML, Accorsi F , et al. (2014) A Case Report and Review of the Literature on Uterine Fatty Tumours (UFT): A \nField of Heterogeneous Data. Int J Gynecol Clin Pract 1: 101. doi:  http://dx.doi.org/10.15344/2394-4986/2014/101\nInt J Gynecol Clin Pract                                                                                                                                                                                          IJGCP , an open access journal                                                                                                                                          \nISSN: 2394-4986                                                                                                                                                                                                       Volume 1. 2014. 101                                            \n       Page 5 of 7\nNo. of \ncases\nAge Size Symptoms Histology Fibroids Incidence Study period References\n4 + 21 \ncases \nliterature\n56\n47\n64\n61\n62*\n8 cm\n8 cm\n18 cm\n7 cm\n7 cm*\nBleeding\nAbdominal Pain\nAsymptomatic\nBleeding\nLipoleiomyoma\nLipoleiomyoma\nLipoma\nLipoleiomyoma\nno\nno\nyes\nno\n1965-1976 Willen et al. Virch Arch A Path \nAnat Histol:377;351-361, 1978\n3 83\n80\n73\n20 cm\n2.5 cm\n2 cm\nEnlarged abdomen\nAsymptomatic\nBleeding\nLipoleiomyoma\nLipoleiomyoma\nLipoleiomyoma\nyes\nyes\nno\n3/54000 (0.005%) 1979-1982 Pounder. J Clin  \nPathol:35;1380-1383, 1982\n1 Translocation\nChromos 12\nLipoleiomyoma yes Havel et al. Virch Arch B Cell \nPath:57;77-79, 1989\n1 55 Cholecystic pain Atypical lipoleiomyoma Lin and Hanai. Pathol \nInternational: 41; 164-169. 1991\n1 Bizarre epitheliod\nLipoleiomyoma\nBrooks et al. Int J Gynecol  \nPathol:11;144-9, 1992\n10 9 lipoleiomyomas\n1 lipoma\nResta et al. Pathol Res \nPract:190;378-83, 1994\n5 78\n67\n73\n74\n60\n5.3 cm\n7 cm\n3.5 cm\n3.6 cm\n1 angiomyolipoma\n4 lipoleiomyoma\n2/5 Shintaku. Pathol Int:46; 498-502, \n1996\n1 Lipoleiomyoma\n1 Lipoleiomyoma 0.8% Gentile et al. \nPathologica:88;132-4, 1996\n1 Lipoleiomyoma 0.28% (fibroids)\n0.39% (hysterectomies)\nDellachà et al. \nPathologica:89;737-41, 1997\n17 45-74 6/17 angiomyolipomas 10/17 0.35% 1983-2003 Lin et al. Int J Gynaecol \nObstet:67;47-9, 1999\n1 57 11 cm Bleeding Plexiform lipoleiomyoma Morelli et al. Arch Gynecol \nObstet:274;117-118, 2006\n50 54* 4.6* cm Lipoleiomyoma 2.1% 1998-2004 Wang et al. Int J Gynecol \nPathol:25;239-42, 2006\n3 Lipoleiomyoma Kondi-Pafiti et al. Eur j Gynaecol \nOncol:27;73-7, 2006\n10 53* 4.75* cm Pain, Bleeding Lipoleiomyoma 1.4% 1999-2007 Bolat et al. Turkish J Pathol: 23: \n82-86, 2007\n2 47\n66\n9 cm\n30 cm\nLipoleiomyoma\nGiant lipoleiomyoma\nno\nno\nTerada T. Appl  \nImmunohistochem Mol Morphol: \nEpub Jan 26, 2012\n132^ 65* 9.6*\nTable 2:  Pathology review studies.\n^ Total n of cases   * mean values\n\nCitation: Bernardini L, Zacutti A, Gorji N, Giannoni ML, Accorsi F , et al. (2014) A Case Report and Review of the Literature on Uterine Fatty Tumours (UFT): A \nField of Heterogeneous Data. Int J Gynecol Clin Pract 1: 101. doi:  http://dx.doi.org/10.15344/2394-4986/2014/101\nto study their incidence [23,24]. Despite all the UFT appear similar \n(with a bright yellow colour and soft tissue consistency) they show, \nafter microscopy, different histological constitution. The high range of \nhistopathological appearance has caused a proliferation of synonyms \nfor UFT. The more common synonyms include lipoleiomyoma, \nmyolipoma, lipofibroma, lipomyoma, fibromyolipoma, mixed lipoma, \nand lipomatosis of the stroma of a uterine fibroid. According to DJ \nPounder (1982) [25] uterine fatty tumours (UFT) may be defined as \ntumours composed entirely or in part of adult type adipose tissue. \nSmooth muscle and fibrous tissue are usually intermixed. The presence \nof fat in the uterine corpus is not exceptional and in fact it is known \nthat some leiomyomas have an adipose tissue component in variable \nproportions associated to smooth muscular fibres. These are known as\nInt J Gynecol Clin Pract                                                                                                                                                                                          IJGCP , an open access journal                                                                                                                                          \nISSN: 2394-4986                                                                                                                                                                                                       Volume 1. 2014. 101                                            \n       Page 6 of 7\nlipoleiomyomas and have to be considered aside from the pure lipomas \nwhich exclusively comprise of mature adipose tissue. The pathogenesis \nhowever remains obscure. Immunocytochemical studies confirm \nthe complex histogenesis of these tumours, which may directly arise \nfrom pluripotent mesenchymal cells or from direct transformation of \nsmooth muscle cells into adipocytes [26,27]. Probably we are dealing \nwith tumour-types having different pathogenesis and therefore \ndifferent biological susceptibility to oncogenes. A number of various \nlipid metabolic disorders or other associated conditions with estrogen \ndeficiency as occur in peri or post menopausal period possibly \npromote abnormal intracellular storage of lipids [28]. As shown by \nTerada [24] the fatty tissue of lipoma is not degenerative but active \nproliferative tissue and could be responsible of local productions of \nestrogens and increased risk of malignant transformation. Wang et \nal [3] studying 50 patients with UFT for a 7 years period of time have \nreported that these tumours have an uneventful clinical course and \nshould be confidently regarded as benign. Nevertheless, liposarcomas \nof the uterus, although extremely rare, exist and are shown to likely \narise from malignant transformation of a lipoleiomyoma [29] and \nhave to be added to the differential diagnosis of benign lipomatous \ntumours (UFT), myxoid mesenchymal tumours, and malignant \nmixed Mullerian tumours of the uterus. The striking observation of \nendometrial cancers found in concomitance with lipomas, as here \nreported, has an independent and different oncological implication. \nDeeper investigation on this field is requested before making progress \non the oncological risk of the UFT which remain rare tumours \nundergoing hysterectomy most of the times.  \nConclusion\n  UFT are not so uncommon and always benign neoplasm as generally \nstated. The histogenesis of these lesions is still controversial. The \nclinical manifestations do not usually differ from those caused by \nleiomyomas, except that they affect overweight and obese peri-\nmenopausal and aged postmenopausal women. Data on body weight \nand BMI, however, are missing and should better be given in future. \nPreoperative diagnosis it is not difficult as far as these tumours are \nof small size and appear hyperechogenic intramural nodules at \ntransvaginal ultrasound. A more difficult task is in case of big and \nsubserosal tumours whose accurate diagnosis requires CT and MR \nimaging. Diagnosis of pure lipoma rather lipoleiomyoma should be \nmade only postoperatively on histopathology which is also important \nto rule out the possibility of malignancy. The adoption of proper \nterminology (“uterine fatty tumours - UFT)” definition in clinical \nstudies and “lipoma” or “lipoleiomyoma” after histology, should be \nrespected.  \nTotal number of \ncases (357 cases)\n1816 -1966 = 131\nMean age (years) Prevalence  \nin women < \n54 y.o.\nMean size  (cm) Pre-op radiol \nstudies (46)\nIncidence of \nlipoma\nSymptoms Leiomyomas\n1966-2012 = 226 Table 1 (47 cases) = 57 \nTable 2 (16 cases) = 65 \nWillen st. (21 cases) = 62 \nWang study (50 cases) = 54 \nBolat study (10 cases) = 53 \n23% (19/83) Table 1 (46 cases) = 7.7 \nTable 2 (14 cases) = 9.6 \nWillen study (21 cases) = 7 \nWang study (50 cases) = 4.6 \nBolat study (10 cases) = 4.75 \n16/46 (us+ct+mr)\n4/46  tsv us only\n2/46  mr only\n15% (18/121 \ncases)\n34% (17/50) \npain or pelvic \nmass\n22% (11/50) \nno symptoms\n20% (10/50) \nbleeding\n10% (5/50) \ncholecistic \nproblems\n33.3% (34/102)\nTable 4: Summary of principal variables on UFT.\nNo. of \ncases\nHistology Reference\n1 Uterine lipoma and \nendometrial cancer\nTlolka Pluszczyk et al.Patologia \nPolska:36;223-227, 1968 \n1 Uterine sarcoma with \nliposarcomatous diff.\nBapat et al. Int J Gynaecol \nObstet:28;71-5, 1989\n1 Uterine lipoma and \nendometrial cancer\nDouvier et al. J Gynecol Obstet Biol \nReprod:19;301-305, 1990\n2 Sarcomas with both lipo \nand leiomyo-sarcoma cells\nSuster et al. Am J Surg \nPathol:17;905-911, 1993\n1 Liposarcoma of the uterus Schneebauer et al. GynakolGeburt \nRundsch:36;90-91, 1996\n1 Uterine lipoma and \nendometrial cancer\nDi Gesù et al.Eur J Obstet Gynecol \nReprod Biol:80;199-200, 1998\n9 Lipoleiomyosarcoma Folpe, Weiss. Am J Surg \nPathol:26;742-9, 2002\n1 Pleomorphic liposarcoma Levine et al. Int J Gynecol \nPathol:22;407-411, 2003\n1 Liposarcoma Karateke et al. Int J Gynecol \nCancer:15;1230-1234, 2005\n1 Uterine lipoma and cervical \ncancer\nDilek et al. Int J Gynecol \nCancer:16;445-7, 2006\n1 Lipoleiomyosarcoma AbhimanyuJha et al. NJ Obstet \nGynaecol:2;67-70, 2007\n1 Uterine lipoleiomyoma and \nendometrial cancer\nBolat et al. Turkish J Pathol:2382-86, \n2007\n3 Liposarcoma arising in \nuterine lipoleiomyoma\nMcDonald et al. Am J Surg \nPathos:35;221-227, 2011\nTable 3: UFT: Oncological data (association with uterine cancers \nin 24/226 cases = 10%).\n\nCitation: Bernardini L, Zacutti A, Gorji N, Giannoni ML, Accorsi F , et al. (2014) A Case Report and Review of the Literature on Uterine Fatty Tumours (UFT): A \nField of Heterogeneous Data. Int J Gynecol Clin Pract 1: 101. doi:  http://dx.doi.org/10.15344/2394-4986/2014/101\nInt J Gynecol Clin Pract                                                                                                                                                                                          IJGCP , an open access journal                                                                                                                                          \nISSN: 2394-4986                                                                                                                                                                                                       Volume 1. 2014. 101                                            \n       Page 7 of 7\nReferences\n1. Jacobs JE, Markowitz SK (1988) CT diagnosis of uterine lipoma. AJR Am J \nRoentgenol 150: 1335-1336.\n2. 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(2011) \nLiposarcoma arising in uterine lipoleiomyoma: a report of 3 cases and \nreview of the literature. Am J Surg Pathol 35: 221-227.","source_license":"CC0","license_restricted":false}