Endoscopy 2008; 40: E256-E257
DOI: 10.1055/s-2007-966583
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Lobulated colonic lipoma mimicking carcinoma with intermittent intussusception

I.- T.  Lin1 , W.- H.  Chang1 , T.- C.  Hsu2 , S.- C.  Shih1 , T. -E.  Wang1 , C.- H.  Chu1 , T.- C.  Liou1
  • 1Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan
  • 2Division of Colon and Rectal Surgery, Department of Surgery, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan
Further Information

T.- C. LiouMD 

Division of Gastroenterology

Department of Internal Medicine

Mackay Memorial Hospital

No. 92, Section 2,

Chungshan North Road

Taipei

Taiwan

Fax: +886-2-25433642

Email: ltc@ms2.mmh.org.tw

Publication History

Publication Date:
17 December 2008 (online)

Table of Contents

Lipomas are the most common nonepithelial tumors of the colon, and rank third in frequency among benign colonic tumors after hyperplastic and adenomatous polyps [1]. Symptomatic colonic lipomas are uncommon, accounting for 6 % in clinical series at the Mayo Clinic [2]. Intussuscepted colonic lipomas are rare and often confused with malignant tumors, so that most of them are diagnosed after intervention [3]. We report on a lobulated colonic lipoma with unusual presentations that mimicked carcinoma.

A 47-year-old woman presented with intermittent, colicky abdominal pain. Physical examination showed no specific finding except for pale conjunctiva. Laboratory investigation revealed iron-deficiency anemia. The fecal occult blood test was positive. Double contrast colon series showed an irregular lobulated mass, measuring 5 cm in diameter and located in the hepatic flexure ([Figure 1]). Colonoscopy revealed a 5 cm diameter polypoid mass with an irregular lobulated margin, tan-pink ulcerated surface, and easy contact bleeding in the ascending colon near the hepatic flexure ([Figure 2]). Abdominal computed tomography (CT) showed an intussuscepted lesion located in the hepatic flexure. An ill-defined fat-containing soft-tissue mass was measured at 5 cm in diameter and acted as a leading point of intussusception ([Figure 3]). Because of suspicion of malignant tumor, the patient underwent laparotomy with right hemicolectomy.

Zoom Image

Figure 1 Double contrast colon series showed an irregular lobulated mass measuring 5 cm in diameter, located in the hepatic flexure.

Zoom Image

Figure 2 Colonoscopy revealed a polypoid mass with an irregular lobulated margin, and tan-pink ulcerated necrotic surface that mimicked a malignant tumor.

Zoom Image
Zoom Image

Figure 3 Abdominal computed tomography showed an ill-defined fat-containing soft-tissue mass, which acted as a leading point of intussusception (a, arrow). The wall of the colon near the mass was thickened with rings of intussusception (b, arrow). There was no lymphadenopathy.

The gross appearance of the lesion was that of a polypoid hard mass measuring 5 × 4 × 4 cm, with an ulcerated necrotic surface and located at the distal ascending colon ([Figure 4]). The histologic findings revealed a lipoma composed of mature adipose tissue. The surface of the mass was superficially ulcerated with inflammation and fibrosis ([Figure 5]). The patient was discharged on the seventh day after the operation, following an uneventful recovery.

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Figure 4 Resected specimen of the colon showed a polypoid hard mass measuring 5 × 4 × 4 cm, with an ulcerated necrotic surface, located at the distal ascending colon.

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Figure 5 Pathologic findings revealed mucosal ulceration with inflammation and fibrosis. The submucosal mass was composed of mature adipose tissue. (Hematoxylin and eosin, original magnification × 100).

Large colonic lipomas (> 2 cm) can present as abdominal pain from obstruction or intussusception, and bleeding or chronic anemia could occur when mucosa overlying the lipoma is ulcerated [4]. Ulcerative and lobulated appearance may be due to fibrosis and healing of traumatic mucosa resulting from chronic and occasional intussusception [5]. In this case, abdominal CT is sensitive for colonic lipomas with intussusception.

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Endoscopy_UCTN_Code_CCL_1AD_2AC

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References

  • 1 Siegal A, Witz M. Gastrointestinal lipoma and malignancies.  J Surg Oncol. 1991;  47 170-174
  • 2 Taylor B, Wolff B. Report of two unusual cases and review of Mayo Clinic experiences, 1976 – 1985.  Dis Colon Rectum. 1987;  30 888-893
  • 3 Huh K C, Lee T H, Kim S M. et al . Intussuscepted sigmoid colonic lipoma mimicking carcinoma.  Dig Dis Sci. 2006;  51 791-779
  • 4 EI-Khalil T, Mourad F H, Uthman S. Sigmoid lipoma mimicking carcinoma: case report with review of diagnosis and management.  Gastrointest Endosc. 2000;  51 495-496
  • 5 Meghoo C AL, Cook P R, McDonough C A. et al . Large colonic lipoma with mucosal ulceration mimicking carcinoma.  Gastrointest Endosc. 2003;  58 468-470

T.- C. LiouMD 

Division of Gastroenterology

Department of Internal Medicine

Mackay Memorial Hospital

No. 92, Section 2,

Chungshan North Road

Taipei

Taiwan

Fax: +886-2-25433642

Email: ltc@ms2.mmh.org.tw

#

References

  • 1 Siegal A, Witz M. Gastrointestinal lipoma and malignancies.  J Surg Oncol. 1991;  47 170-174
  • 2 Taylor B, Wolff B. Report of two unusual cases and review of Mayo Clinic experiences, 1976 – 1985.  Dis Colon Rectum. 1987;  30 888-893
  • 3 Huh K C, Lee T H, Kim S M. et al . Intussuscepted sigmoid colonic lipoma mimicking carcinoma.  Dig Dis Sci. 2006;  51 791-779
  • 4 EI-Khalil T, Mourad F H, Uthman S. Sigmoid lipoma mimicking carcinoma: case report with review of diagnosis and management.  Gastrointest Endosc. 2000;  51 495-496
  • 5 Meghoo C AL, Cook P R, McDonough C A. et al . Large colonic lipoma with mucosal ulceration mimicking carcinoma.  Gastrointest Endosc. 2003;  58 468-470

T.- C. LiouMD 

Division of Gastroenterology

Department of Internal Medicine

Mackay Memorial Hospital

No. 92, Section 2,

Chungshan North Road

Taipei

Taiwan

Fax: +886-2-25433642

Email: ltc@ms2.mmh.org.tw

Zoom Image

Figure 1 Double contrast colon series showed an irregular lobulated mass measuring 5 cm in diameter, located in the hepatic flexure.

Zoom Image

Figure 2 Colonoscopy revealed a polypoid mass with an irregular lobulated margin, and tan-pink ulcerated necrotic surface that mimicked a malignant tumor.

Zoom Image
Zoom Image

Figure 3 Abdominal computed tomography showed an ill-defined fat-containing soft-tissue mass, which acted as a leading point of intussusception (a, arrow). The wall of the colon near the mass was thickened with rings of intussusception (b, arrow). There was no lymphadenopathy.

Zoom Image

Figure 4 Resected specimen of the colon showed a polypoid hard mass measuring 5 × 4 × 4 cm, with an ulcerated necrotic surface, located at the distal ascending colon.

Zoom Image

Figure 5 Pathologic findings revealed mucosal ulceration with inflammation and fibrosis. The submucosal mass was composed of mature adipose tissue. (Hematoxylin and eosin, original magnification × 100).