Pedunculated myolipoma incidentally found in hernial sac: a case report

A case of a very rare adipocytic tumor found during corrective surgery for incisional abdominal hernia is presented. Because of uterine leiomyomas the patient underwent total abdominal hysterectomy 14 years before. During surgery of incisional hernia, a part of small intestine along with a pedunculated tumor was found in hernial sac. The tumor was attached to the medial intra-abdominal peritoneum. On examination, the tumor presented as a totally encapsulated dimorphic benign neoplasm composed of mature adipocytes and well-differentiated smooth muscle cells. Lipoblasts, floret-like giant cells, nuclear atypia, mitosis or proliferation of medium-sized arteries with thick muscular walls were not observed. Tumor cells were negative for HMB45, estrogen and progesterone. The diagnosis of myolipoma was established. This tumor commonly presents as a large quiescent mass in retroperitoneum in adult females and to our knowledge this is the first report of myolipoma in hernial sac. Characteristic findings, differential diagnosis, prognosis and the possible origin of such a neoplasm are discussed.