Enlarged firm UTERUS in a Menopausal Woman presents with pelvic pain

• Dr.K.Malleswar Rao, MD,DGO• CIVIL SURGEON SPECIALIST(Ob & Gyn) & Head of

the Dept.,• ESI Hospital,• Sanathnagar,• HYDERABAD.

Enlarged firm UTERUS in a Menopausal Woman presents with pelvic pain

• Venkateshwaramma w/o B.Kishore babu,• Female, 50years,• Reg.No:2794,• I.P.No:3558910,• Plot No:127, Hydernagar,Kukatpally, Hyderabad.• Samrakshana Electricals, Hyderanagar, Kukatpally,

Hyderabad.

Enlarged firm UTERUS in a Menopausal Woman presents with pelvic pain

• Presented with lower abdominal & pelvic pain of 6months duration.

• Para 3,Live 3.Attained menopause 10yrs back. No significant past medical history.

• Vital data: Normal, P/A:NAD, P/S:Cervix & Vagina healthy, P/V:Uterus enlarged,MP,Mobile.

• CLINICAL DIAGNOSIS: Fibroid Uterus

Enlarged firm UTERUS in a Menopausal Woman presents with pelvic pain

• INVESTIGATIONS:1. CUA: NAD, Stool Occult blood: Negative, BT&CT: 1’4’’ & 4’15’’,2. Hb% 13gm%, PCV: 37%,3. Bl.Sugar: 141mg%,4. Bl.Urea: 15mg%,S.Cr: 0.9mg%,5. Uric acid: 4.7%,6. A Rh(D) +ve,HIV & HbsAg: Negative,7. Urine C/S: Sterile,8. ECG: NAD, DD&C: NAD.

Enlarged firm UTERUS in a Menopausal Woman presents with pelvic pain

• ULTRASOUND SCAN:

Pelvis: Uterus RV, Bulky 50mm*48mm, Echogenic lesion in the uterus s/o ?Ca. Endom. Both adnexal regions are normal. No ascites. No lymphadenopathy.

Abdomen: NAD.

Enlarged firm UTERUS in a Menopausal Woman presents with pelvic pain

Pre-operative Evaluation:• Cardiologist’s opinion: ECG & Chest X-

ray:WNL, 2D Echo: Normal Study and Cardiac Status Normal.

• Anesthetist's opinion: Fit for regional anesthesia.

Enlarged firm UTERUS in a Menopausal Woman presents with pelvic pain

• Total Hysterectectomy was done on26-4-’04 by abdominal route.

• Per-operative findings: Uterus size corresponds to 8weeks gestations, soft.

• Both ovaries & other adnexae are grossly normal.

• Grossly, submucous lipoma about 5-6cm size found arising from the posterior wall of uterus.

LIPOMA UTERUS

• Review of the literature in Medline done and many cases were reported from Indian Institutions as well as around the World even though Lipoma of the uterus is considered to be rare entity.

• Next slides reveal some of the radiological diagnostic findings.

LIPOMA UTERUS

Uterine lipoma: advantage of MRI over ultrasound

• Ultrasound suggested the presence of a uterine lipoma but MRI permitted an unequivocal diagnosis.

http://bjr.birjournals.org/cgi/content/abstract/78/925/72

LIPOMA UTERUS

Literature reviewed in Web:• Uterine lipoma (UL) is a rare tumor frequently

presenting as leiomyolipoma. Even more uncommon is the association of UL and endometrial carcinoma (EC) for which only two cases have been reported.

J Gynecol Obstet Biol Reprod (Paris). 1990;19(3):301-5.

LIPOMA UTERUS

• Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Taipei, Taiwan, R.O.C.

• Uterine lipoleiomyoma is uncommon and has received little attention from gynecologists. We report a case of uterine lipoleiomyoma with subsequent pelvic abscess after rupture of the appendix. Its clinical picture mimicked uterine malignancy.

LIPOMA UTERUS

• Pubmed database reveals 120 articles about “lipoma uterus’’ either as pure lipoma or lipoleiomyoma.

• Most uterine lipomatous tumours occur in post-menopausal women between the ages of 50 years and 70 years [1]. Most patients are asymptomatic but some experience symptoms similar to that of uterine leiomyomas of comparable size, such as pelvic discomfort, heaviness, pressure, or vaginal bleeding [2].

Lipoma/Lipoleiomyoma of the Uterus

• Some of the Lipoleiomyoma (Hamartoma, Angiolipoleiomyoma) cases as well as images are presented at Geneva Foundation for Medical Education and Research website. http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=17&cat3=635&stype=d

Summary of the case

• A 50 year old post menopausal lady presented with chronic pelvic pain with enlarged, firm uterus > clinically diagnosis of possible fibroid uterus (common condition).

• Post-operative findings reveal Sub mucous Lipoma of the uterus on gross exam (cut section) which was proved by histopathological exam subsequently.

LIPOMA UTERUS

Thank you very much for your kind attention!!