Giant Fat-Predominant Uterine Lipoleiomyoma Mimicking a Pure Lipoma: A Multimodality Imaging Case Report.

Uterine lipoleiomyoma is a rare benign lipomatous variant of leiomyoma composed of mature adipose tissue and smooth muscle fibers. Fat-predominant variants are uncommon and may closely resemble pure uterine lipoma on imaging. We report the case of a 44-year-old woman presenting with progressive lower abdominal fullness. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a large intramural fat-containing lesion arising from the uterine fundus with subtle internal soft tissue strands and no suspicious malignant features. Multiple smaller intramural fibroids were present peripherally. Based on imaging characteristics, a diagnosis of fat-predominant lipoleiomyoma was favored. Given the large size of the lesion and progressive abdominal fullness, the patient underwent a hysterectomy, and histopathological examination confirmed the diagnosis. This case highlights the characteristic imaging findings of uterine lipoleiomyoma and emphasizes the importance of recognizing benign fat-containing uterine lesions to improve diagnostic confidence and avoid unnecessary intervention.