Pelvic lipomatosis: a rare cause of suprapubic mass

Pelvic lipomatosis with cystitis glandularis managed with cyclooxygenase-2 inhibitor: A case report

BACKGROUND

Pelvic lipomatosis (PL) is a rare benign condition with characteristic overgrowth of histologically benign fat and invasion and compression of pelvic organs, often leading to non-specific lower urinary tract symptoms (LUTS). Approximately 40% of patients with PL have cystitis glandularis (CG). The cause of PL combined with CG is poorly understood, and there is currently no effective treatment. Refractory CG with upper urinary tract obstruction even requires partial or radical bladder resection.

CASE SUMMARY

In this case, a patient suffering from PL with CG was treated by transurethral resection of bladder tumour (TUR-BT) and oral administration of celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor. The LUTS were alleviated, and the cystoscopy results improved significantly. Immunohistochemistry showed up-regulated COX-2 expression in the epithelium of TUR-BT samples, suggesting that COX-2 may participate in the pathophysiological process of PL combined with CG.

CONCLUSION

We report for the first time that celecoxib may be an effective treatment strategy for PL combined with refractory CG.

Measuring diagnostic accuracy of imaging parameters in pelvic lipomatosis

OBJECTIVES

To study whether the individual radiological findings can help predict diagnosis of pelvic lipomatosis (PL) or, specifically appreciate its progression.

METHODS

Data from 32 clinically proven cases of PL and 25 controls were collected. Two reviewers were recruited for a blinded evaluation, image features were recorded in terms of: (1) bladder shape; (2) bladder-rectosigmoid morphological indexes including ratio of superior-inferior to anterior-posterior length of bladder (SI/AP), angle between anterior and posterior wall (AAP), relative length of posterior urethra (rLPU), angle between bladder and seminal vesicle (ABS) and rectosigmoid morphological index (RMI); (3) secondary complications. Results were evaluated by an unpaired t test and ROC analysis.

RESULTS

The sensitivity and specificity were 40.6% and 100% for pear and banana-shaped bladder, 62.5% and 100% for SI/AP, 40.6% and 100% for AAP, 62.5% and 100% for ABS, 78.1% and 72% for rLPU, 59.4% and 96% for RMI, respectively. These radiological findings partially correlated with the severity of disease weighted by hydronephrosis and treatment grade. Image analysis demonstrated high prevalence of glandular cystitis (100%) and hydronephrosis (73.4%).

CONCLUSION

We conclude that PL is a progressive disease involving multiple pelvic organs with high prevalence of intractable cystitis and hydronephrosis. The imaging characteristics can help predict diagnosis and, specifically appreciate progression.

[Pelvic lipomatosis: cause of bladder rupture]

We have a case of pelvic lipomatosis in a patient suffering from right flank pain and urinary syndrome. Before completing the diagnostic test, abdominal traumatism forced to perform a laparotomy of emergency. We found a great deal of retropubic mass with bladder rupture and thickened walls caused by perivesical fat. The anatomopathological diagnosis was pelvis lipomatosis. This is an unusual case of bladder rupture after slight traumatism.

[Pelvic lipomatosis: clinical review and report of 4 new cases]

First described by the end of the fifties, pelvic lipomatosis is an uncommon disease that develops as a result of an excessive proliferation of benign fat tissue within the perivesical and perirectal spaces. The compressive effect on the urinary, and to a lesser degree, the digestive and vascular structures result in the well-known symptoms. Diagnosis is reached through X-ray studies, primarily computerised tomography. Contribution of four new cases in young males diagnosed through imaging studies as well as biopsies in three of them. Evolution has been varying, with medical control of symptoms in two cases and renal function impairment due to upper obstructive uropathy in the other two.

Pelvic lipomatosis: diagnosis and characterization by magnetic resonance imaging

While the number of reported cases of pelvic lipomatosis has been relatively small, this entity's prevalence is probably underestimated. Disease progression can cause hydroureteronephrosis and renal failure, and clinical follow-up is mandated after diagnosis. Diagnosis is based on detection of characteristic findings in conventional radiographs and computed tomographic (CT) images. We report here the magnetic resonance imaging (MRI) features of pelvic lipomatosis in 5 male patients, 2 of whom ultimately required placement of a ureteral stent to alleviate mechanical obstruction. Multiplanar MRI not only allows diagnostic confirmation comparable to that possible with CT but also provides delineation of cephalad displacement of the bladder base, elongation of the bladder neck and posterior urethra, and elevation of the prostate gland. The MR images show characteristic medial and superior displacement of the seminal vesicles and show fatty tissue separating the prostate gland from the rectum. The noninvasive nature and low biological risk of MRI are desirable features, particularly when serial evaluation of pelvic anatomic distortion is necessary.

Pelvic lipomatosis: 9-year followup in a woman

Pelvic lipomatosis is uncommon in female subjects. The symptoms and signs are vague in all patients but radiologic studies, especially pelvic computerized tomography, should provide data for the diagnosis and obviate operative intervention. All patients should have careful followup to rule out obstructive uropathy.

Pelvic lipomatosis: diagnosis using computed tomography

Pelvic lipomatosis is a rare, benign disease in which the characteristic roentgenographic findings may mimic those of pelvic malignancy. In the past more than two-thirds of reported cases have been explored surgically for diagnosis. We present 2 cases to demonstrate how the definitive diagnosis of pelvic lipomatosis can be made with the aid of computed tomography to avoid invasive techniques.

Pelvic lipomatosis: diagnosis by computerized tomography scan

Pelvic lipomatosis is a rare, relatively self-limiting disease characterized by the overgrowth of unencapsulated lipomatous tissue within the pelvis. The diagnosis is suggested, but not substantiated, by the striking roentgenographic changes noted on barium enema and intravenous pyelogram. Previously, pelvic laparotomy with tissue diagnosis was essential for documenting the disease. We report three cases in which computerized tomography was utilized as a safe, noninvasive and accurate method of diagnosis. The role played by partial venous obstruction is discussed in addition to rectal bleeding as a mode of presentation.

Pelvic lipomatosis: 5-year followup

Followup of 5 cases presented in 1971 and report of 8 additional cases confirm the initial conclusions that pelvic lipomatosis is a benign but potentially progressive process leading to ureteral obstruction. Young black subjects are affected most commonly. More than 40 per cent of the patients have required permanent urinary diversion.

Pelvic lipomatosis: effect of diet

Pelvic lipomatosis is a disease of dense infiltration of benign fatty tissue within the confines of the deep bony pelvis. A case is reported of an obese, hypertensive, thirty-nine-year-old black man with the typical clinical and radiographic features of pelvic lipomatosis. Prolonged fasting produced an extensive weight loss and profound resolution of his presenting symptoms, signs, and radiologic abnormalities. Subsequent regain of weight resulted in the reappearance of the disorder, confirming that pelvic lipomatosis may be a disease of accelerated and excessive fat deposition which can be reversed by dietary restriction. The literature pertaining to pelvic lipomatosis is reviewed in detail.

Lipoplastic lymphadenopathy simulating malignant lymphoma and pelvic lipomatosis: Report of a case and review of the literature

The second known cases of pelvic lipoplastic lymphadenopathy is presented. Roentgenographic studies including lymphangiography were instrumental in the diagnostic evaluation but a histopathologic diagnosis was essential to exclude a neoplastic process. The etiology and natural history of this disease are indeterminant but seemed to pursue a benign 17-year course in our patient. A retroperitoneal lymph node dissection is not indicated unless encroachment on adjacent pelvic viscera causes mechanical obstruction.