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Lipoma of The Uterus
LIPOMA OF THE UTERUS
WAYNE H. DECKER, M.D., NEw YoRK, N. Y. (From the Obstetrical and Gynecological Service [Third Surgical Division], and the Depart· ment of Pathology, Bellevue Hospital and the Department of Obstetrics and Gynecology, New York University College of Medicine)
J IPOMAS L labeled
of the uterus are rare. In 1857 a drawing by Lebertl in a pathological atlas was as representing adipose tissue in the uterus. This appears to be the first recorded case. Since that time there have been sporadic reports in the literature, mostly from Europe at the turn of this century. In 1903 Seydel2 reviewed the literature and found 10 cases of fatty tumors of the uterus. Three other cases he felt should not be included because they were not studied histologically. In 1917 a case was presented by Elkin and Haythorna as well as three more quoted from the literature. Peterson4 in 1922, in an exhaustive review of mixed tumors of the uterus, found 31 fatty tumors, including all of the above cases. Only 10 of these he felt were pure lipomas. In a more recent review by Ritter and Stringer5 13 cases were added from the literature as well as one of their own. At least two of these would appear to be fatty degeneration of fibromyomas. Since that time two more cases have been presented in the literature and one of these (Peake's6) appears to be a degenerated fibromyoma. Since 1857 there are, therefore, 23 lipomas of the uterus reported in the literature. L. L. (8435-51), a 50-year-old Negro woman, was admitted to Bellevue Hospital Feb. 26, 1951, because of descensus of the uterus. The past history was not significant except that the patient had had two spontaneous abortions 28 years before, followed by a normal delivery of a term child by a midwife. The patient had an uneventful menopause in 1947. She had never had a surgical operation. Significant physical findings were confined to the pelvis. There was a complete prolapse of the uterus, which was felt to be normal in size. There were a small cystocele and rectocele. Operation.-A vaginal hysterectomy, anterior colporrhaphy, an
012 to the lipoma but this is attributed to dispersion of fat on 1\f.'t\tioning the tissue. No intra<"el· Iular fat ean be detected in tlw muscle <'ells or in tlw eon nee! ive tissuf•. Section of the <'ervix showed a duonie inflammatory reaction with areas of epidermiza· tion. Comment.-Clinically lipomas of the uterus are of little significance. :M.ost tunwrs recorded are found in postmenopausal women. Probably the youngest was the case of Reich and Nechtow7 in a patient 39 years old. The interest rests in their origin. Robert .Meyer, discussing Seydel's paper, pointed out that there is no fat found in the normal uteru~ except that which he has demonstrated extending from the parametria into th<• uteru~ along with an
r')g. 1.--Lipoma of the uterus, showing typieal adipoRe tissue <·ells.
Thi~ is in accordance with the \Voltlian duct theory of Wilms. These authors al>
Brunnings,H• in reporting an early case, ascribed the tUinor to metaplasia of fat cells from muscle cells, a view hehl also hy Lockyern and Yon }'ranqut\.12 The only other author
Volume 63 Number 4
LIPOMA 0.1!' UTERUS
Ul3
who lends support to this theory is Peake, who felt he was able to show a gradual change of smooth-muscle cells into alveolar fat. It would seem that this more probably represents fatty degeneration of muscle cells, rather than true metaplasia. Starry113 studying another tumor, was able to demonstrate small amounts of fat in the connective tissue. He could not demonstrate fat in. muscle cells. He believes that the tumor had its origin in connective tissue, possibly a specially differentiated lipogenic type. A case has been recorded by Pollack,H who feels that the tumor was probably due to omental fat which was caught in a wound of the uterus at a previous operation.
References Lebert; quoted by Seydel.2 Seydel, 0.: Ztschr. f. Geburtsh. u. Gynlik. 60: 274, 1903. Elkin, C. W. W., and Haythorn, S. R.: Surg., Gynec. & Obst. 25: 72, 1917. Peterson, A. J.: J. Lab. & Clin. Med. 8: 369, 1922. Ritter, F. G., and Stringer, S. V.: AM. J. OBST. & GYNEC. 40: 501, 1940. Peake, C. A.: J. Internat. Coil. Surg. 6: 205, 1943. Reich, W. J., and Nechtow, M. J.: AM. J. OBST. & GYNEC. 62: 157, 1946. Knox, M.: BulL Johns Hopkins Hosp. 12: 3, 1901. Merkel, H.: Beitr. z. Path. Anat. u.z. allg. Path. 29: 274, 1903. Brunnings: Verhandl. d. deutsch. Gesellsch. f. Gyniik. 8: 348, 1899. Lockyer, C. H. J.: Lewis. Practice of Surgery, Hagerstown, Md., 1940, W. F. Prior Company, Inc., vol. XI. 12. Von Franque: Verhandl. d. deutsch. Gesellsch. f. Gynlik. 9: 491, 1901. 13. Starry, 1'1•• G.: Surg., Gynec. & Obst. 41: 642, 1925. 14. Pollack: Wein. ·klin. Wchnschr. 68: 122, 1903. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
WAYNE H. DECKER, M.D., NEw YoRK, N. Y. (From the Obstetrical and Gynecological Service [Third Surgical Division], and the Depart· ment of Pathology, Bellevue Hospital and the Department of Obstetrics and Gynecology, New York University College of Medicine)
J IPOMAS L labeled
of the uterus are rare. In 1857 a drawing by Lebertl in a pathological atlas was as representing adipose tissue in the uterus. This appears to be the first recorded case. Since that time there have been sporadic reports in the literature, mostly from Europe at the turn of this century. In 1903 Seydel2 reviewed the literature and found 10 cases of fatty tumors of the uterus. Three other cases he felt should not be included because they were not studied histologically. In 1917 a case was presented by Elkin and Haythorna as well as three more quoted from the literature. Peterson4 in 1922, in an exhaustive review of mixed tumors of the uterus, found 31 fatty tumors, including all of the above cases. Only 10 of these he felt were pure lipomas. In a more recent review by Ritter and Stringer5 13 cases were added from the literature as well as one of their own. At least two of these would appear to be fatty degeneration of fibromyomas. Since that time two more cases have been presented in the literature and one of these (Peake's6) appears to be a degenerated fibromyoma. Since 1857 there are, therefore, 23 lipomas of the uterus reported in the literature. L. L. (8435-51), a 50-year-old Negro woman, was admitted to Bellevue Hospital Feb. 26, 1951, because of descensus of the uterus. The past history was not significant except that the patient had had two spontaneous abortions 28 years before, followed by a normal delivery of a term child by a midwife. The patient had an uneventful menopause in 1947. She had never had a surgical operation. Significant physical findings were confined to the pelvis. There was a complete prolapse of the uterus, which was felt to be normal in size. There were a small cystocele and rectocele. Operation.-A vaginal hysterectomy, anterior colporrhaphy, an
012 to the lipoma but this is attributed to dispersion of fat on 1\f.'t\tioning the tissue. No intra<"el· Iular fat ean be detected in tlw muscle <'ells or in tlw eon nee! ive tissuf•. Section of the <'ervix showed a duonie inflammatory reaction with areas of epidermiza· tion. Comment.-Clinically lipomas of the uterus are of little significance. :M.ost tunwrs recorded are found in postmenopausal women. Probably the youngest was the case of Reich and Nechtow7 in a patient 39 years old. The interest rests in their origin. Robert .Meyer, discussing Seydel's paper, pointed out that there is no fat found in the normal uteru~ except that which he has demonstrated extending from the parametria into th<• uteru~ along with an
r')g. 1.--Lipoma of the uterus, showing typieal adipoRe tissue <·ells.
Thi~ is in accordance with the \Voltlian duct theory of Wilms. These authors al>
Brunnings,H• in reporting an early case, ascribed the tUinor to metaplasia of fat cells from muscle cells, a view hehl also hy Lockyern and Yon }'ranqut\.12 The only other author
Volume 63 Number 4
LIPOMA 0.1!' UTERUS
Ul3
who lends support to this theory is Peake, who felt he was able to show a gradual change of smooth-muscle cells into alveolar fat. It would seem that this more probably represents fatty degeneration of muscle cells, rather than true metaplasia. Starry113 studying another tumor, was able to demonstrate small amounts of fat in the connective tissue. He could not demonstrate fat in. muscle cells. He believes that the tumor had its origin in connective tissue, possibly a specially differentiated lipogenic type. A case has been recorded by Pollack,H who feels that the tumor was probably due to omental fat which was caught in a wound of the uterus at a previous operation.
References Lebert; quoted by Seydel.2 Seydel, 0.: Ztschr. f. Geburtsh. u. Gynlik. 60: 274, 1903. Elkin, C. W. W., and Haythorn, S. R.: Surg., Gynec. & Obst. 25: 72, 1917. Peterson, A. J.: J. Lab. & Clin. Med. 8: 369, 1922. Ritter, F. G., and Stringer, S. V.: AM. J. OBST. & GYNEC. 40: 501, 1940. Peake, C. A.: J. Internat. Coil. Surg. 6: 205, 1943. Reich, W. J., and Nechtow, M. J.: AM. J. OBST. & GYNEC. 62: 157, 1946. Knox, M.: BulL Johns Hopkins Hosp. 12: 3, 1901. Merkel, H.: Beitr. z. Path. Anat. u.z. allg. Path. 29: 274, 1903. Brunnings: Verhandl. d. deutsch. Gesellsch. f. Gyniik. 8: 348, 1899. Lockyer, C. H. J.: Lewis. Practice of Surgery, Hagerstown, Md., 1940, W. F. Prior Company, Inc., vol. XI. 12. Von Franque: Verhandl. d. deutsch. Gesellsch. f. Gynlik. 9: 491, 1901. 13. Starry, 1'1•• G.: Surg., Gynec. & Obst. 41: 642, 1925. 14. Pollack: Wein. ·klin. Wchnschr. 68: 122, 1903. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.