Angiolipomas are benign tumors comprising fatty tissue and blood vessels, in varying proportions. It is most frequently located in the subcutaneous layers of the trunk and limbs, often occurring in multiple lesions. The prognosis is favorable, with essentially no recurrences. Pelvic angiolipomas are extremely rare, with only one case-report described in literature.

We present the case of a 60 years-old woman, presenting with a debilitating pelvic pain in the previous 10 years. Her pain was constant, rated as 8/10, independent from bladder filling level, and did not alleviate with voiding or any other measure. The patient was not able to point a precise location of the pain, and rather described it as present in the whole pelvis. She reported a slightly increased urinary frequency and urgency at times, with no incontinence and reported constipation, controlled with dietetic measures. The patient denied history of urinary infections or hematuria. She had been submitted in 2013 to a hysterectomy via Pfannenstiel incision due to uterine myomas, as well as an appendicectomy as a child. Her medical records were otherwise unremarkable. The bloodwork, urine analysis, gynecological exam, uroflowmetry and urethrocystoscopy were completely normal, as was a pelvic ultrasound, which showed a bladder with thin walls with a capacity of 420 mL and a post-micturition residue of 20 mL. A pelvic magnetic resonance was performed, which revealed a 47 x 38 x 28 mm mass between the external iliac vessels and the obturator nerve on the right side. This was hyperintense in T2, with intermediate intensity in T1, suggestive of a pelvic Schwannoma. After discussion of the results with the patient, an excision of the mass was proposed, which the patient accepted.

A pelvic exploration and excision of the mass was performed through the same Pfannenstiel incision which the patient had already performed for the hysterectomy. The dissection was performed without entering the peritoneum, and the excision of the mass was conducted with the help of a neurosurgery team, using microscopic surgery. There was no clear association between a nerve and the mass, and since it was clearly encapsulated, the dissection planes around It were relatively free. 
The post-operative period was uneventful, and the patient reported an immediate reduction in pelvic pain on the first post-op day, which she clearly distinguished from the pain of the surgical incision. The bladder catheter was removed on D1 post-op and the patient was discharged on D2. 3 weeks after the surgery, she reported a complete remission of the pain. The histologic analysis revealed a pelvic Angiolipoma.

Pelvic angiolipomas and other benign tumors are rare causes of chronic pelvic pain. However, the diagnosis and excision of such masses may result in a strong improvement of symptoms and quality of life.

Sarikcioglu L, Demirel BM, Ozsoy U, Gurer EI, Oguz N, Ucar Y. Angiolipoma located inside the obturator canal and supplied by the umbilical artery. Ann Anat. 2007;189(1):75-8. doi: 10.1016/j.aanat.2006.07.005. PMID: 17319612
Khalife T, Hagen AM, Alm JEC. Retroperitoneal Causes of Genitourinary Pain Syndromes: Systematic Approach to Evaluation and Management. Sex Med Rev. 2022 Oct 1;10(4):529-542. doi: 10.1016/j.sxmr.2022.06.009. PMID: 37051972

Continence 12S (2024) 101643
DOI: 10.1016/j.cont.2024.101643