Giant submucosal lipoma located in the descending colon: A case report and review of the literature

Abstract

Colonic lipoma is an uncommon tumor of the gastrointestinal tract. Most cases are asymptomatic, with a small tumor size, and do not need any special treatment. However, we encountered one patient with a giant submucosal lipoma, with a maximum diameter of 8.5 cm, which exhibited symptoms such as intermittent lower abdominal pain, changes in bowel habits with passage of fresh blood and mucus per rectum, abdominal distension, anorexia and weight loss. Unfortunately, the possibility of colonic malignancy could not be precluded and left hemicolectomy was planned. The exact diagnosis of this special case was accomplished by intraoperative pathology. In the end, local resection was performed instead of left hemicolectomy. To the best of our knowledge, colonic lipoma exceeding 8 cm in diameter has not been previously reported. We, therefore, present this case and discuss age and sex factors, clinical and histopathological findings, diagnostic methods and treatment by reviewing the available literature, to serve as a reminder that colonic lipoma can also exist in patients with significant symptoms. In addition, intraoperative pathology should be investigated in those doubtful cases, so as to guide the exact diagnosis and treatment plan.

Giant Intraperitoneal Lipoma of the Cecum

“…8 The etiology is not well-known, although increased incidences are reported in people who are obese, have hypercholesterolemia, diabetes mellitus, trauma history, or exposure to radiation or with familial tendency, however none of these were applicable to the present case. 1 The symptoms are not related to the involved segment of large bowel. Generally, a lipoma of less than 2 cm is usually asymptomatic, whereas 75% of lipomas exceeding 2 cm in diameter (size appears to correlate with symptoms) present with symptoms such as pain (55%), diarrhea, intermittent subacute obstruction of the colon, bleeding from the ulcerated tip of the lesion (40%) and may be the lead point for intussusceptions (5-7% in patients with large lipomas).…”

“…1 The intraperitoneal lipomas were published as sporadical cases arising from more commonly ileal mesentery. 4 Colonic lipomas are uncommon mesenchymal tumours that are covered by fibrous tissue and formed by well differentiated adipocytes.…”

“…Lipoma of the colon may be detected incidentally at colonoscopy, surgery or autopsy. 1 Although colonic lipomas smaller than 2cm are usually asymptomatic, lesions >2cm are usually symptomatic. 2 Large colonic lipomas can be mistaken as malignancy, which may result in extensive surgical operations.…”

Acute intussusception on a lipoma of the left colon: report of a case

“…[5] For that reason, they are, usually, incidentally identified during imaging studies, colonoscopy, surgery or autopsy. [4,6] Though symptoms are rare, they are more frequent with large pedunculated lipomas (larger than 3 cm). Symptoms include abdominal pain, irregular rectal bleeding, anemia and digestive disorders (constipation, diarrhea).…”

“…Jiang et al examined this issue in five aspects and recommended that endoscopic removal would not be appropriate in the following cases: 1) lipoma is larger than 4 cm, sessile or has a limited pedicle, 2) malignancy is suspected, 3) intussusception is present, 4) it involves the muscular layer or serosa, 5) it cannot be radically removed at colonoscopy. [6] Indeed, lipoma size and the size of its pedicle constitute the main limiting factors for the endoscopic resection, although there are publications in the literature reporting that lipomas with wide pedicles and large diameters may also be endoscopically removed. [10] So, in the case of lipoma with intussusception, surgery is the rule; there is no place for endoscopic excision or air-enema reduction.…”