Rare Case of Cervical Lipoleiomyoma

Abstract

Surgery is like hunting, if you are going for a rabbit, be ready to face a tiger. Abdomen is like a magic box, clinicians suspect one thing, radiologists conclude other thing and surgeons surprise us by extracting something else. CASE REPORT: A 35 years old 1,2 female, Para 3 Living 3 with tubectomy done 12 years back having all full term vaginal deliveries came with chief complaints of pain in abdomen and discomfort in vagina since 4 months. There was no history of any menstrual or bowel, bladder complaints. General and systemic examinations were within normal limits. On per abdominal examination liver and spleen were not palpable, umbilicus was in normal position, and there was a firm mass arising from pelvis about 18 weeks' pregnancy size, mobile, non-tender, no evidence of ascites. On per speculum examination, cervix was taken up and not visualized. There was bogginess in posterior fornix of vagina. On per vaginal examination, cervix was pinpoint ; retro pubic and taken up, about 18 weeks' pregnancy size mass was felt. The movements of mass were transmitted to cervix; uterus could not be made out separately. Her lab profile values were within normal limits with hemoglobin 10.5 gm%. On ultrasonography findings 3 there was huge isoechoic mass of size 112 x 80 millimeters occupying right pelvic region and extending upwards probably arising from right ovary, uterus normal, and left ovary normal-findings suggestive of ? Right ovarian dermoid. 4 On computed tomography, right ovary showed well defined circular lesion of 115 x 105 millimeter with regular borders without calcification, uterus-normal, left ovary-normal-findings suggestive of right Ovarian Dermoid Cyst. 4

Lipoleiomyomas of the Uterine Cervix: A New Series including the First Recurrent Case and the First Systematic Literature Review

“…In detail, two patients (6%) revealed a uterine prolapse (3rd grade in our first case; unknown degree in the other patient) [40]; the ages of these women were 43 and 74 years, respectively. Moreover, the cervix was described as elongated in two additional premenopausal patients (35 and 39 years of age, respectively) [25,32] and distorted in another 35-year-old woman [29], while a 58-year-old lady experienced a 3rd-degree vaginal prolapse [22] (total of women with utero-vaginal abnormalities: six cases, 19%). Three patients (10%) presented with cystocele [40], which was associated with uterine prolapse ± rectocele in 2/3 (67%) cases.…”

“…The majority of cases were diagnosed in Asia (27/44, 61%), followed by North America (9/44, 20%), Europe (6/44, 14%), and Africa (2/44, 5%), while no cases were reported in other continents. The majority of cases were described in India (13/44, 30%) [19][20][21][22]25,27,[30][31][32][33][34]36,39], the United States (9/44, 21%) [16,28,38], and Turkey (8/44, 18%) [15,17,18,23]. According to our review, cervical LLMs were not described in North America, except for the United States, while the two African cases were reported in North Africa (one in Egypt and one in Morocco) [29,35].…”

“…The age range of the reported 31 patients was 35-74 years (mean: 46.5 years; median: 43 years). Ten women (32%) were clearly or probably postmenopausal [20,22,23,28,31,37,[40][41][42], while 21/29 (68%) cases were pre-or peri-menopausal [18,19,21,[24][25][26][27]29,30,[32][33][34][35][36]38,39]. Information about parity was available in only 16 (52%) cases [18,19,21,25,28,29,31-33, 35,36,38,41,42]; 15/16 (94%) women were multiparous [18,19,21,25,28,29,[31][32][33]35,36,41,42], while only 1 (6%) of 16 patients had only one child [38]; no woman was clearly nulliparous.…”

“…The most frequent symptoms were vaginal bleeding (11/31, 36%) [19][20][21]26,29,30,35,36,39,41] and pelvic/abdominal pain (10/31, 32%) [19][20][21]23,[29][30][31][32][33]37], followed by urinary disturbances (6/31, 19%) (1 not otherwise specified [22]; 2 stress incontinence [25]; 1 difficulty in micturition [30]; 2 hesitancy/difficulties in passing urine [19,34]). Occasionally, patients experienced low abdominal distension (three cases, including one due to a concomitant ovarian tumor) [37,38,40], vaginal discomfort (one case) [32], inguinal pain (one case) [18], or dyspepsia (one case) [33] at presentation.…”

“…The time interval between the onset of symptoms and the clinical exam ranged from 1 week to 10 months. Thirteen patients (42%) complained of one symptom [18,22,23,25,26,31,[34][35][36][37][39][40][41], six women (19%) experienced two symptoms [20,21,29,32,33], and two patients (6%) presented three symptoms [19,30]. In nine (29%) cases, data about clinical symptoms were unavailable [24,27,28,38,40], while one (3%) patient was clearly asymptomatic [42].…”