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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 5  |  Issue : 6  |  Page : 548-550

Colonic lipoma: A rare yet important cause of intestinal obstruction


Department of Pathology, UPRIMS and R, Saifai, Etawah, Uttar Pradesh, India

Date of Web Publication14-Feb-2017

Correspondence Address:
Savita Agarwal
203, New Campus, Type 3G Block, UPRIMS and R, Saifai, Etawah - 206 130, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0513.200113

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  Abstract 

Gastrointestinal tract (GIT) lipomas are rare, benign mesenchymal neoplasm affecting all segments of the GIT and colon is affected most frequently. Reported incidence of colonic lipomas varies from 0.2% to 4.4%. These tumors are believed to arise from the connective tissue of the wall of the intestine. We here describe a case of 60-year-old male who presented with features of intestinal obstruction. The patient underwent left hemicolectomy for a mass involving proximal descending colon. Diagnosis of colonic lipoma was made on histopathological examination.

Keywords: Colon, gastrointestinal tract, lipoma, mesenchymal neoplasm


How to cite this article:
Agarwal S, Pandey P, Singh S, Ralli M. Colonic lipoma: A rare yet important cause of intestinal obstruction. Clin Cancer Investig J 2016;5:548-50

How to cite this URL:
Agarwal S, Pandey P, Singh S, Ralli M. Colonic lipoma: A rare yet important cause of intestinal obstruction. Clin Cancer Investig J [serial online] 2016 [cited 2017 May 24];5:548-50. Available from: http://www.ccij-online.org/text.asp?2016/5/6/548/200113


  Introduction Top


Gastrointestinal tract (GIT) lipomas are rare, benign mesenchymal neoplasm affecting all segments of the GIT and colon is affected most frequently.[1] Reported incidence of colonic lipomas varies from 0.2% to 4.4%.[2] These tumors are believed to arise from the connective tissue of the wall of the intestine.[3] They may be of a submucosal, subserosal, and intramural type. Among these, submucosal type is the most common. These tumors usually occur at older age in the sixth decade and more often remain asymptomatic.[1] Intestinal obstruction is a rare presenting feature of colonic lipoma.[3] We here describe a case of 60-year-old male who presented with features of intestinal obstruction. The patient underwent left hemicolectomy for a mass involving proximal descending colon, and diagnosis of colonic lipoma was made on histopathological examination.


  Case Report Top


A 60-year-old male presented to the Emergency Department with subacute intestinal obstruction, abdominal pain, distention, and failure to pass feces. On examination, the abdomen was soft and distended. Colonoscopic examination revealed a polypoidal mass in the proximal descending colon. Mass had a smooth surface and was covered by normal-looking mucosa. Left hemicolectomy was performed, and the specimen was sent for histopathological examination. Gross examination showed a segment of large bowel measuring 34 cm in length. A well-delineated, sessile mass measuring 3.5 cm × 3 cm × 3 cm was seen in proximal descending colon [Figure 1], approximately 2.5 cm from the proximal resected margin. Cut surface of the mass was soft, yellowish, and greasy. Remaining bowel did not show any mass lesion. Sections from the tumor revealed sharply circumscribed proliferation of the lobules of adipose tissue in the muscularis propria layer [Figure 2]. Overlying mucosa appeared attenuated. No evidence of dysplasia or malignancy was seen. Histopathological diagnosis of colonic lipoma was made. Postoperative recovery of the patient was uneventful.
Figure 1: Gross specimen of the large bowel showing well-delineated, sharply circumscribed mass lesion protruding into the bowel lumen. Cut surface of the mass is yellowish and greasy

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Figure 2: Microscopic section showing proliferation of lobules of adipocytes within the muscularis propria (H and E, ×100)

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  Discussion Top


Lipoma of the GIT is uncommon, and among cases reported, colon is the most common site. Although rare, they are the most common benign mesenchymal neoplasm of the GIT and next in frequency after adenoma. Bauer was the first one to describe this entity in GIT.[3] It usually occurs in the sixth decade with slight female preponderance.[1] Our patient belonged to old age group.

In the colon, the most preferred site is ascending colon (61%), followed by descending colon (20.1%), transverse colon (15.4%), and rectum (3.4%).[3] Submucosal lipoma of descending colon is rare as seen in the present case. Clinically symptomatic colonic lipomas account for 6% only, and symptoms are determined by the size and location of the mass.[1] As majority of the cases of colonic lipoma remain asymptomatic, diagnosis is usually incidental during colonoscopy or on imaging or following surgery performed for some other reason. Clinical presentation with intestinal obstruction, as seen in the present case, is an extremely uncommon manifestation of colonic lipoma. Several cases have been reported, where it led to intussusception, massive hemorrhage, prolapse, or perforation.[4] Grossly, these tumors are usually solitary and may appear rounded, sessile, or pedunculated, multilobulated, soft, and yellowish.[3],[5] Larger lipomas may undergo surface ulceration with bleeding.[6]

For diagnosis of intestinal lipomas, various diagnostic modalities such as barium enema, endoscopic ultrasonography (USG), computed tomography scan, colonoscopy, and histopathological examination are in use. On barium enema, lipoma shows squeeze sign due to tumor deformity by peristalsis; although USG has limited utility due to the presence of gas in the abdomen, endoscopic USG demonstrates hyperechoic colonic lesion.[5] It also provides information regarding the involvement of muscularis and serosa and helps in assessing the depth of the lesion which is required for selecting the type of procedure, endoscopy versus surgical resection, to be undertaken for their removal. On colonoscopy tent sign, cushion sign and naked fat sign are described.[3],[5],[7]

Several theories have been proposed regarding the development of GIT lipomas; however, none has been validated till date. According to these postulated theories, defect in the development of lymphovascular circulation leads to localized overgrowth of adipose tissue forming tumor-like masses; another belief is that chronic inflammation and irritation lies there development.[3]

Regarding the treatment of this lesion, it is believed that as long as the tumor is small and asymptomatic, no treatment except for observation is required, and the moment it becomes symptomatic, some intervention is mandatory in the form of either endoscopic resection or segmental resection depending on the size of the mass. Endoscopic resection can be performed when the tumor is smaller than 2.5 cm. Lipomas larger than 2.5 cm should be managed by segmental resection as endoscopic removal of larger lipomas is associated with greater risk of complication and also because larger lesions carry greater risk of being premalignant or malignant.[5],[8],[9] Autoamputation of the tumor with spontaneous expulsion is also reported.[10]


  Conclusion Top


Intestinal lipomas are rare yet one of the clinically significant masses, and definite diagnosis of the lesion is mandatory for appropriate management. Colonic lipomas need to be differentiated from other premalignant and malignant intestinal lesions which have similar presenting features, i.e., older age and presentation with obstruction, intussusception, and bleeding; hence, it is important to correctly diagnose them with the help of colonoscopy, imaging techniques, and histopathological examination.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nallmothu G, Adler DG. Large colonic lipomas. World J Clin Cases 2015;3:457-61.  Back to cited text no. 1
    
2.
Vecchio R, Ferrara M, Mosca F, Ignoto A, Latteri F. Lipomas of the large bowel. Eur J Surg 1996;162:915-9.  Back to cited text no. 2
    
3.
Andrei LS, Andrei AC, Usurelu DL, Puscasu LI, Dima C, Preda E, et al. Rare cause of intestinal obstruction - Submucous lipoma of the sigmoid colon. Chirurgia (Bucur) 2014;109:142-7.  Back to cited text no. 3
    
4.
Katsinelos P, Chatzimavroudis G, Zavos C, Paroutoglou G, Papaziogas B, Kountouras J. A novel technique for the treatment of a symptomatic giant colonic lipoma. J Laparoendosc Adv Surg Tech A 2007;17:467-9.  Back to cited text no. 4
    
5.
Agrawal A, Singh KJ. Symptomatic intestinal lipomas: Our experience. Med J Armed Forces India 2011;67:374-6.  Back to cited text no. 5
    
6.
Gould DJ, Anne Morrison C, Liscum KR, Silberfein EJ. A lipoma of the transverse colon causing intermittent obstruction: A rare cause for surgical intervention. Gastroenterol Hepatol (N Y) 2011;7:487-90.  Back to cited text no. 6
    
7.
Ghanem OM, Slater J, Singh P, Heitmiller RF, DiRocco JD. Pedunculated colonic lipoma prolapsing through the anus. World J Clin Cases 2015;3:457-61.  Back to cited text no. 7
    
8.
Bentama K, Chourak M, Chemlal I, Benabbou M, Raiss M, Hrora A, et al. Intestinal subocclusion due to colonic lipoma: A case report. Pan Afr Med J 2011;10:22.  Back to cited text no. 8
    
9.
Geraci G, Pisello F, Arnone E, Sciuto A, Modica G, Sciumè C. Endoscopic resection of a large colonic lipoma: Case report and review of literature. Case Rep Gastroenterol 2010;4:6-11.  Back to cited text no. 9
    
10.
Gupta AK, Mujoo V. Spontaneous autoamputation and expulsion of intestinal lipoma. J Assoc Physicians India 2003;51:833.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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