Colonic mucosal pseudolipomatosis: Are we aware of it?

Abstract

Objective: Colonic mucosal pseudolipomatosis is rare, and its pathogenesis is controversial. A number of mechanisms, including mechanical injury during an endoscopic procedure or chemical injury by disinfectant, seem to contribute to its pathogenesis. Results:We found pseudolipomatosis in 14 of 1370 colonoscopy cases (1.02%). Of these 14 patients, 8 were male and 6 were female. The male patients were between 24 and 66 years, with a mean of 39; the female patients were between 26 and 58 years, with a mean of 42. Conclusion:Many endoscopists are unaware of the lesion, and the diagnosis is generally possible only after pathological assessment of multiple biopsies taken from suspect lesions. Here we report and discuss colonic pseudolipomatosis incidentally found in a series of patients undergoing routine colonoscopy, and we underline the endoscopic pattern and diagnostic difficulties.

Unusual mucosal lesion: A case of rectal pseudolipomatosis in a 60-year-old patient

“…The diagnosis of pseudolipomatosis could be challenging and misleading especially when both endoscopists and pathologists are not aware of it. 2,4,11 The clinical presentation is often asymptomatic or related to associated diseases (diarrhea, constipation and so on). The characteristic endoscopic findings in colic pseudolipomatosis are white or yellow, flat to slightly elevated plaques, phenomenon described as the “snow white sign.” 1,6 However, these characteristic endoscopic patterns may be absent like in our current patient.…”

“…These spaces are embedded in the lamina propria and intermingled with inflammatory cells without destruction of glandular structures, and usually the inflammatory cells seem to line the empty spaces suggesting vascular structure or adipocytes. 1,2,4,7 Also, these spaces could have discrete eosinophilic amorphous content. 7 We have found focally empty spaces with these eosinophilic content in our current case.…”

“…At histologic analysis, pseudolipomatosis consists of variable-sized optically empty spaces resembling adipocytes embedded in the lamina propria. 1,2 The frequency of pseudolipomatosis varies around 0.3%–1.7% in endoscopic series; however, the exact incidence of this lesion is difficult to assess because of its rarity and likely its diagnosis is often overlooked by pathologists and endoscopists. 2–4 Colic pseudolipomatosis is often diagnosed incidentally or it is found in patients with gastrointestinal disorders such as diarrhea, constipation, abdominal pain or rectal bleeding.…”

Pseudolipomatosis of the Colon and Cecum Followed by Pneumatosis Intestinalis

“…Kim et al identified 12 cases with colonic pseudolipomatosis among 1,276 colonoscopies (0.94%) ( 2 ). The reported frequency ranges from 0.02% to 1.7% among all colonoscopies performed ( 2 , 3 , 6 - 9 ). Several mechanisms, such as chemical injury by a disinfectant, particularly hydrogen peroxide, and mechanical injury during an endoscopic procedure, have been hypothesized for the pathogenesis of colonic pseudolipomatosis ( 2 , 10 , 11 ).…”

Multiple Raised White Plaques in the Right Colon

“…Medical literature does not suggest a predilection for a specific age or sex in the prevalence of reported cases of colonic pseudolipomatosis. 5…”