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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 25-26

Giant submucosal lipoma of colon causing intussusception in an adult


Department of Pathology, University College of Medical Sciences, Delhi, India

Date of Submission28-Oct-2019
Date of Decision28-Dec-2019
Date of Acceptance05-Jan-2020
Date of Web Publication11-Apr-2020

Correspondence Address:
Nadeem Tanveer
Department of Pathology, University College of Medical Sciences, Dilshad Garden, Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ccij.ccij_101_19

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How to cite this article:
Yadav P, Tanveer N. Giant submucosal lipoma of colon causing intussusception in an adult. Clin Cancer Investig J 2020;9:25-6

How to cite this URL:
Yadav P, Tanveer N. Giant submucosal lipoma of colon causing intussusception in an adult. Clin Cancer Investig J [serial online] 2020 [cited 2020 Jun 3];9:25-6. Available from: http://www.ccij-online.org/text.asp?2020/9/1/25/282293



Dear Editor,

Lipoma of the large intestine is rare with an incidence of 0.2%–4.4%.[1] Intussusception is rare in adults with an incidence of 2–3 per million per year.[2] Colonic intussusception caused by lipoma is even rarer. Only 37 definite cases have been reported in the English language literature over the past 45 years.[3] Abdominal computed tomography (CT) is the investigation of choice for abdominal lipoma, with 71.4%–87.5% sensitivity and around 100% specificity.[1],[3] The definitive diagnosis for lipoma is made after histopathological evaluation (HPE). Capsule endoscopy and digital balloon endoscopy are newer modalities for diagnosing gastrointestinal lipoma, particularly in the small bowel.[4] Colonoscopic features include smooth surface, “cushion sign” or “pillow sign” (depression or pillowing of mass on exerting pressure with biopsy forceps), “naked fat sign” (extrusion of fat from biopsy site), and “tenting sign” (easy to elevate mucosa with biopsy forceps over lipomatous mass).[5],[6]

A 35-year-old male presented to the surgery department with complaints of pain abdomen for 4 days and vomiting and obstipation for 2 days. Abdominal ultrasound showed dilated bowel loops and multiple air-fluid levels. Abdominal CT scan was suggestive of colocolic intussusception with lipoma of the transverse colon. The patient underwent surgical exploration. Intraoperatively, a 5-cm segment of proximal transverse colon was found telescoping into distal segment. A large polypoidal mass (4 cm × 4 cm) was found at the lead point. No ascites and no liver, peritoneal, or mesenteric deposits were seen. Excised formalin-fixed specimen was sent for HPE for confirmation of diagnosis. Grossly, a large bowel segment measuring 10.5 cm was seen with unremarkable outer surface. On cut-section, an intraluminal pedunculated polypoidal soft tissue mass was identified, measuring 4.5 cm × 4 cm × 4 cm [Figure 1]a. Mucosa appeared edematous. On cut-section of the mass, it was well-circumscribed yellow, not infiltrating through the peduncle [Figure 1]b, suggesting lipomatous polyp. Hematoxylin and eosin-stained sections from growth showed mature adipocytes having eccentric nucleus and clear cytoplasm, limited to submucosa [Figure 2]a and c]. It was not extending to muscularis propria. No lipoblasts were seen. The overlying epithelium showed focal surface ulceration with submucosal edema, congestion, and vascular proliferation [Figure 2]b. A final diagnosis of giant submucosal lipomatous polyp with colocolic intussusception was made.
Figure 1: (a) Large bowel segment measuring 10.5 cm with unremarkable outer surface and an intraluminal pedunculated polypoidal soft tissue mass, measuring 4.5 cm × 4 cm × 4 cm. Mucosa appeared edematous. (b) On cut-section of the mass, it was well-circumscribed yellow, not infiltrating through the peduncle, suggesting lipomatous polyp

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Figure 2: (a) H and E-stained sections from growth showed mature adipocytes, limited to submucosa. It was not extending to muscularis propria. No lipoblasts were seen. (b) Overlying epithelium showed focal surface ulceration with submucosal edema and congestion. (c) Mature adipocytes having eccentric nucleus and clear cytoplasm

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Lipoma is the second most common benign tumor of large intestine after adenomas.[2] It is most common in the ascending colon (61%), followed by descending colon (20.1%), transverse colon (15.5%), and rectum (3.4%).[1] Most of them (90%) are submucosal which can occasionally extend into muscularis propria, and 10% are subserosal.[3] They are mostly asymptomatic; however, giant lipoma can present with acute abdomen. Giant lipoma of the transverse colon causing intussusception in the adult is rare as seen in the present case. Adult intussusception necessitates surgical intervention (open or laparoscopic) due to high incidence of malignancy (60%–65%) and also to relieve symptoms.[7] Lipomectomy and limited resection of the involved segment are considered adequate treatment for preoperatively diagnosed colonic lipoma.[3] A preoperative CT scan can suggest the rare possibility of colonic lipoma and help avoid an extensive resection.

Consent

Informed consent was taken from the patient for publication of case details and photographs.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bagherzadeh Saba R, Sadeghi A, Rad N, Safari MT, Barzegar F. Colonic intussusception in descending colon: An unusual presentation of colon lipoma. Gastroenterol Hepatol Bed Bench 2016;9:S93-6.  Back to cited text no. 1
    
2.
Siamionava Y, Varabei A, Makhmudov A. Recurrent colonic intussusception due to a lipoma of the transverse colon at the background of congenital dolichocolon and chronic constipation. BMJ Case Rep. 2019;12(8). pii: e230732. doi:10.1136/bcr-2019-230732.  Back to cited text no. 2
    
3.
Koama A, Zongo N, Nde Ouédraogo NA, Kambou-Tiemtoré MA, Lompo OM, Sanou A, et al. Giant lipoma of the left mesocolon: Radiological and surgical aspects. Int J Surg Case Rep 2019;58:190-2.  Back to cited text no. 3
    
4.
Cordeiro J, Cordeiro L, Pôssa P, Candido P, Oliveira A. Intestinal intussusception related to colonic pedunculated lipoma: A case report and review of the literature. Int J Surg Case Rep 2019;55:206-9.  Back to cited text no. 4
    
5.
Casiraghi T, Masetto A, Beltramo M, Girlando M, Di Bella C. Intestinal obstruction caused by ileocolic and colocolic intussusception in an adult patient with cecal lipoma. Case Rep Surg 2016;2016:3519606. doi: 10.1155/2016/3519606.  Back to cited text no. 5
    
6.
Yatagai N, Ueyama H, Shibuya T, Haga K, Takahashi M, Nomura O, et al. Obscure gastrointestinal bleeding caused by small intestinal lipoma: A case report. J Med Case Rep 2016;10:226.  Back to cited text no. 6
    
7.
Shi L, Zhao Y, Li W. Endoscopic resection of a giant colonic lipoma with endoloop-assisted unroofing technique: A case report. Med (Baltimore) 2018;97:e10995.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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