Submucosal lipoma of the large intestine masquerading as a colonic malignancy

Abstract

Lipomas of the alimentary tract are rare tumours that can mimic malignant lesions. They are often small and asymptomatic although larger tumours can present with intusussception or as abdominal masses. We present a case of a transverse colon submucosal lipoma masquerading as a colonic adenocarcinoma leading to resection.A 74 year-old-man was referred urgently for assessment with altered bowel habits, and lower abdominal discomfort along with a positive Faecal-Occult-Blood sample. Colonoscopy demonstrated a large polypoidal lesion at the hepatic flexure with ulceration. Biopsies were inconclusive. A staging CT scan confirmed a 3.3 x 4.3 x 3.4cm Polyp with colonic wall thickening suspicious of malignancy. An extended right hemi-colectomy was performed. Histology showed a large submucosal lipoma with 12 reactive lymph nodes.Colonic lipoma often present as incidental findings detected on either imaging or endoscopically whilst investigating other symptoms. Their appearances can mimic colonic malignancy and surgical resection may be required.

Intestinal Submucosal Lipomas

“…Endoscopic ultrasonography can help delineate the size, border and layer of origin of these colonic submucosal lesions and may improve diagnostic accuracy, but the endoscopic appearances may be changed in cases with ulceration and the diagnose may be compromised [3,6,17,18]. Endoscopy was quite useful in our series.…”

“…[2,6,11] More of the patients with symptomatic lipomas has bleeding with or without pain, and about 50 per cent has pain with or without bleeding [5,12].…”

“…They are relatively rare, slow-growing lesions with a silent clinical course and usually they are found incidentally [5][6][7][8][9][10][11].…”

Lipoma submucoso polipoide de la válvula ileocecal. Informe de un caso

“…Por lo general, se producen entre la quinta y sexta décadas de la vida y son a menudo hallazgos incidentales durante la colonoscopía o la cirugía.⁹ Los tumores no epiteliales intestinales son raros tumores benignos que pueden imitar las lesiones malignas. 10 Menos del 30% de los lipomas se observan en la literatura que son sintomáticos. 11 Los Lipomas mayor a 2 cm de diámetro es probable que sea sintomático.…”

Submucosal lipoma of colon - A common lesion at an uncommon location

“…[1][4] [5] Although they are the most common benign nonepithelial intestinal tumours, they are rare benign tumours [6] They are rare tumours that can mimic malignant lesions. [7] Less than 30% of the lipomas reported in literature are symptomatic. [5] Lipoma >2cm in diameter is likely to be symptomatic.…”