Intussuscepted Sigmoid Colonic Lipoma Mimicking Carcinoma

Huh, Kyu-Chan; Lee, T. H.; Kim, S. M.; Im, Euyi Hyeog; Choi, Young Woo; Kim, B. K.; Jung, Da-Hye; Choi, Won Joon; Kang, Young Woo

doi:10.1007/s10620-006-3208-x

Cited by 19 publications

(18 citation statements)

References 13 publications

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“…Only one-quarter of all lipomas are symptomatic [6], and those symptomatic lipomas are generally larger than 2 cm, as was the case in our patient. Symptoms can include obstruction, bleeding, or, very rarely, intussusception, as was seen in our patient [2,3].…”

Section: To the Editorssupporting

confidence: 77%

Large Colonic Lipoma Mimicking Colon Cancer and Causing Colonic Intussusception

2008

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To the Editors:Large lipomas in the left colon are a rare entity, and those that are seen usually have a classic, benign appearance. We describe a patient with a large, left-sided, lipoma that mimicked an adenocarcinoma and produced a partial intussusception as well.A 69-year-old previously healthy man presented with a 1-month history of hematochezia and a 10-lb weight loss. The patient denied any changes in bowel movement frequency; he continued to average 1-2 bowel movements per day. He denied abdominal pain, nausea, or vomiting. Previous medical history included an appendectomy and hernia repair. The patient took no medications and denied any behavioral risk factors. Family history revealed a daughter with ulcerative colitis, and no colorectal cancer.Physical examination was unremarkable. The complete blood count and the basic metabolic panel were normal. Computed tomography (CT) revealed a mass in the descending colon, with partial intussusception involving the sigmoid colon, interpreted as a likely adenocarcinoma. There was no adenopathy or evidence of metastases. Colonoscopy revealed a 7-cm, ulcerated, fungating, mass on a thick stalk, with partial intussusception just distal to the splenic flexure ( Fig. 1). Biopsies of the mass only revealed benign inflammation without malignant tissue.Because of the appearance of the lesion and the negative findings of biopsies, a repeat colonoscopy was performed. After careful evaluation, the lesion was felt to be removable via endoscopic means alone. The lesion was removed with a large snare and electrocautery in a single piece. There were no complications. Pathology revealed a 7-cm inflamed and ulcerated lipoma, with no evidence of malignancy. The patient has done well thereafter.This case demonstrates how, on rare occasions, large colonic lipomas and malignancies can be difficult to differentiate prior to resection. With regards to symptoms and endoscopic appearance, the two can be indistinguishable. Even with abdominal imaging and direct colonoscopic visualization, lipomas can imitate carcinomas.Despite being the third most common benign tumor of the colon, colonic lipomas are comparatively rare [1], with a reported incidence less than 5% [2, 3]. Colonic lipomas are positively correlated with distance from the anus. Unlike that in our patient, almost half are found in the ascending colon [4].Colonic lipomas are most frequently small and asymptomatic [5]. Only one-quarter of all lipomas are symptomatic [6], and those symptomatic lipomas are generally larger than 2 cm, as was the case in our patient. Symptoms can include obstruction, bleeding, or, very rarely, intussusception, as was seen in our patient [2,3].With barium enema, lipomas most often appear as ovoid, well-demarcated, filling defects. By the application of external pressure to the abdomen, or with physiological peristalsis, a ''squeeze-sign''-a change in the appearance of the filling defect-can sometimes be elicited. On CT scan, lipomas also typically appear ovoid, with well-defined margins, and with absor...

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Section: To the Editorssupporting

confidence: 77%

Large Colonic Lipoma Mimicking Colon Cancer and Causing Colonic Intussusception

2008

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“…Most colonic lipomas are asymptomatic and need no treatment. Only 25% of patients with colonic lipoma develop symptoms, including bowel obstruction and intussusception (8). Lipomas larger than 4 cm are considered giant and produce symptoms in 75% of cases (9,10).…”

Section: Introductionmentioning

confidence: 99%

Colonic intussusception caused by colonic lipoma: A case report

Paškauskas¹,

Latkauskas²,

Valeikaitė

et al. 2010

Medicina

112

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Intussusception is a pediatric condition that rarely presents in adults. Colonic lipomas 4 cm and more in diameter can cause colonic intussusception leading to emergency operation. Surgical resection of the involved segment must be the procedure of choice. We report a case of colonic intussusception caused by colonic lipoma in an adult. The patient underwent operation, and histopathological examination of the specimen confirmed the diagnosis of colonic submucosal lipoma.

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“…Most of the time, the discovery is fortuitous during a colonoscopy or on a colectomy [5,6]. The symptomatology is directly correlated to the size of the lipoma, often nonspecific, essentially consisting of abdominal pains, constipation and or rectal bleeding [5–9]. In a study conducted over a period of 34 years (from 1964 to 1998) that included the main series of the literature, approximately 282 cases showed abdominal pain to be present in 60% of the cases; transit disorders in 39% of the cases; and rectal bleeding in 31% of the cases.…”

Section: Discussionmentioning

confidence: 99%

Intestinal subocclusion due to colonic lipoma: a case report

Bentama¹,

Chourak²,

Chemlal³

et al. 2011

Pan Afr Med Jrnl

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Colonic lipomas are rare benign tumors infrequently met in clinical practice. Most of them are asymptomatic making frequent their fortuitous discovery. The therapeutic approach to the fortuitous discovery of a lipoma is even less clear. The treatment depends essentially on the clinical picture, on the size of the lipoma and on its location. We report the case of a 31-year old woman, which sub-occlusive accidents events revealed a lipoma of the descending colon. The diagnosis was suspected on colonoscopy and segmental colectomy was performed. The diagnosis was confirmed by histological examination. We review the literature and discuss the clinical features, diagnosis and treatment of this uncommon disease.

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Intussuscepted Sigmoid Colonic Lipoma Mimicking Carcinoma

Cited by 19 publications

References 13 publications

Large Colonic Lipoma Mimicking Colon Cancer and Causing Colonic Intussusception

Large Colonic Lipoma Mimicking Colon Cancer and Causing Colonic Intussusception

Colonic intussusception caused by colonic lipoma: A case report

Intestinal subocclusion due to colonic lipoma: a case report

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