Lipoleiomyoma is a rare, benign uterine leiomyoma variant primarily found in postmenopausal women. These tumors are composed of smooth muscle and mature adipose tissue and are often misdiagnosed due to their resemblance to malignant tumors on imaging.

We report the case of a 60-year-old postmenopausal woman with a history of diabetes and hypertension, presenting with complaints of prolapse and intermittent spotting. Clinical evaluation revealed a hypertrophied cervix with a third-degree uterovaginal prolapse and a retroperitoneal mass. Imaging suggested a lipoleiomyoma, and histopathology confirmed this diagnosis following surgical excision. The patient also had a concurrent early stage cervical carcinoma, which was managed surgically.

Lipoleiomyomas, though benign, can mimic more serious conditions and lead to unnecessary invasive procedures. Improved recognition of their imaging characteristics can enhance diagnostic accuracy, allowing for more conservative management approaches. Our case underscores the importance of a thorough evaluation and multidisciplinary approach in the management of pelvic masses, particularly when malignant conditions coexist.