Preperitoneal lipoleiomyoma of the abdominal wall in a postmenopausal woman

Objective: Extrauterine leiomyomas are rare events. These tumors may be eas ily misdiagnosed as ovarian tumors at the clinical investigation. We presen t the first case of an otherwise healthy postmenopausal woman, hysterectomi zed 20 years ago, who developed a preperitoneal lipoleimoyoma in the 30-yea r-old scar of a Pfannenstiel incision. The patient received continuous horm one replacement therapy (HRT) for 5 years with 1.25 mg conjugated estrogen and 5 mg medrogeston per day. Methods: In sections of the tumor, immunohist ochemical reactions with antibodies against actin, desmin, vimentin, estrog en and progesterone receptors and factor VIII related antigen was performed . Results: Histologic findings revealed cellular fascicles of spindle-shape d smooth muscle cells in a whorled arrangement. Mitotic figures were absent . Central degenerative changes and focal edema were observed. Between muscl e fascicles, a significant amount of fat cells (20% of tumor volume) was vi sible. Leiomyocytes showed immunohistochemicaly positive reactions with act in, desmin, vimentin, and steroid hormone receptors. Based on these finding s, the tumor was diagnosed as lipoleiomyoma. Conclusions: Origin of the tum or of smooth muscle cells of vessels located in the abdominal wall and deve lopment under influence of oral steroids seems most probable. HRT appears t o promote the development of extrauterine leiomyomas in postmenopausal wome n. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.