Clinicopathological features and management of colonic lipomas

Abstract

Introduction:Colonic lipomas are benign tumors of adipose tissue that are often asymptomatic, but they may present with rectal bleeding or obstructive symptoms. These tumors are unique in that they are rarely encountered within the gastrointestinal system and can mimic malignant tumors in appearance. Surgical resection and endoscopic removal of tumors have been shown to be successful in their management.Patient concerns:In this report, we present 3 cases of colonic lipomas, 2 of which are located in the cecum and the other within the sigmoid colon. The presenting symptoms of the patients included abdominal pain, constipation, and dyspepsia.Diagnosis:Patients typically presented with anemia and an elevated C-reactive protein count. Colonoscopic and computerized tomography findings were used for diagnosis.Interventions:Hemicolectomy was performed, depending on the localization, and the pathologic specimens were consistent with lipoma.Outcomes:Surgical resection was curative in all patients. The postoperative period was uneventful in all patients and all patients are symptom-free and alive at 3 years follow-up.Conclusion:Colonic lipomas are benign mesenchymal tumors of the gastrointestinal system with a male predominance and are observed within the fourth to sixth decades of life. Various genetic abnormalities have been reported and they have been linked to the formation of intussusception. The squeeze sign on radiological imaging, cushion sign and tenting sign in colonoscopy, and naked fat sign during pathologic examination is helpful towards reaching a diagnosis. Surgical resection is the treatment of choice but minimally invasive endoscopic approaches have also been shown to be successful.

Characterizing colon lipomas: Insights from a retrospective analysis of clinical presentation and management strategies

“…The infrequent occurrence of colon lipomas necessitates meticulous diagnosis and management to circumvent possible complications and elevate the standard of patient care. [13] Our study reveals a pronounced prevalence of colon lipomas in the ascending colon, at 52%. The implications of this anatomical preference, although not the primary focus of our investigation, merit in-depth exploration in subsequent research endeavors.…”

Concurrent cecal lipoma and Crohn's disease in a pediatric patient: A conservative approach

“…However, the gold standard of differentiation continues to be biopsy with the "naked fat sign" being identified by the presence of mature fat cells in the biopsy specimen of the lipomatous tumor. 1,9,10 Radiographic evidence suggesting sarcolipoma as opposed to lipoma includes considerable lesion size, the existence of thick septa, the presence of nodular and/or globular areas resembling nonadipose masses, and a reduced proportion of fat content. 11 Colonic lipomas have been reported to become symptomatic after reaching a diameter greater than 2 cm with lipomas greater than 4 cm always producing associated symptoms.…”

“…Nonetheless, previous theories have proposed a connection between soft tissue injury and the formation of lipomas. These theories suggest that either pseudolipomas may form due to the herniation of adipose tissue or preadipocytes may proliferate in response to cytokine release 1 . Increased inflammation and cytokine release in the setting of IBD may thus play a role in development of lipomata; however, this relationship has yet to be developed in literature.…”

“…It is also important to distinguish lipoma from sarcolipoma as the latter poses a significant threat to life. Unlike sarcolipoma, lipoma typically exhibits a “cushion sign,” when pressing into the mass results in pillowing 1 . The “tenting sign” manifests when pulling a section of the tumor results in a tent‐like shape.…”

“…The “tenting sign” manifests when pulling a section of the tumor results in a tent‐like shape. However, the gold standard of differentiation continues to be biopsy with the “naked fat sign” being identified by the presence of mature fat cells in the biopsy specimen of the lipomatous tumor 1,9,10 . Radiographic evidence suggesting sarcolipoma as opposed to lipoma includes considerable lesion size, the existence of thick septa, the presence of nodular and/or globular areas resembling nonadipose masses, and a reduced proportion of fat content 11 …”