0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Image of the Month—Diagnosis FREE

[+] Author Affiliations

Section Editor: Grace S. Rozycki, MD

More Author Information
Arch Surg. 2007;142(12):1222. doi:10.1001/archsurg.142.12.1222.
Text Size: A A A
Published online

ANSWER: INTUSSUSCEPTED TRANSVERSE COLONIC LIPOMA

Lipomas of the intestine are relatively uncommon tumors of mesenchymal origin (Figure 2). They are most commonly found in the colon and cecum and only rarely reported in the stomach and esophagus.1Colonic lipomas were first described in 1757 by Bauer.2The incidence as reported in both clinical and large autopsy studies remains 2% to 4.4%.3In the colon, lipomas are mostly found on the right side (45%), with decreasing frequency heading toward the sigmoid colon. Thus, the distribution of lipomas is the exact opposite of colonic carcinoma. Most colon lipomas present as single pedunculated or sessile-appearing submucous lipomas. Less than 10% of reported lipomas are subserosal.4Most of these tumors are asymptomatic and occur largely as incidental findings during abdominal CT, colonoscopy, or laparotomy. Less than 25% of all patients with colonic lipomas develop symptoms. Symptomatic lipomas are usually found when the tumor grows to greater than 2 cm in diameter, leading to abdominal pain, hematochezia, change in bowel habits, or melena. Occasionally, patients may even experience defecation of lumps of hemorrhagic tissues due to self-amputation of the lipoma.5Colonic intussusception due to lipomas is unusual and often attributed to a malignant mass or a more common benign tumor. Buetow et al6report that lipomas must be at least 5 cm to cause colonic intussusception. However, masses as small as 3½ cm have also been reported to cause intussusception.7

Place holder to copy figure label and caption
Figure 2.

A 4-cm ulcerated submucosal lipoma in the resected ascending colon.

Graphic Jump Location

Given the age of the patient and symptoms on presentation, accurate preoperative diagnosis is difficult to attain. Barium enema studies typically reveal a radiolucent spherical filling defect with well-defined margins. The well-described squeeze sign, whereby changes in the shape of the lipoma can be detected through palpation, peristalsis, or patient position, may also be detected. Colonoscopy often detects the surface of a lipoma as normal and smooth. The typical colonoscopic features include the cushion sign or pillow sign, where pressing of the forceps against the lesion results in a depression or pillowing of the mass. A naked fat sign may also be detected with fat protruding at the biopsy site. Biopsies are usually not recommended for patients with lipomas because the lesion is beneath the normal surface mucosa and cannot promote diagnosis and a biopsy can increase the risk of bleeding and perforation. Abdominal CT scans are considered to be the most definitive diagnostic measure of recognizing colonic lipomas. The CT scans often detect lipomas as ovoid or pear shaped, with sharp margins and absorption densities typical of fatty compositions.

Treatment of colonic lipomas largely depends on size and symptoms. Patients with small asymptomatic colon lipomas simply require close, regular follow-up without any other intervention. Symptomatic lipomas require resection, especially those greater than 2 cm. The current indications for endoscopic resection are still controversial, and definitive guidelines are not available. Many have reported that risk of perforation or hemorrhage is increased with endoscopic resection, especially in sessile or broad-based lesions.8Surgical resection remains the preferred mode of treatment, especially when malignancy cannot be ruled out. Segmental colon resection is recommended for the removal of the lipoma. Good preoperative diagnosis, however, may help to limit the extent of surgical resection.

Correspondence:Michael E. Zenilman, MD, Department of Surgery, SUNY Downstate Medical Center, Box 40, 450 Clarkson Ave, Brooklyn, NY 11203 (mzenilman@downstate.edu).

Accepted for Publication: December 21, 2007.

Author Contributions:Study concept and design: Du. Acquisition of data: Du and Shah. Analysis and interpretation of data: Du, Shah, and Zenilman. Drafting of the manuscript: Du and Shah. Critical revision of the manuscript for important intellectual content: Du and Zenilman. Administrative, technical, and material support: Du, Shah, and Zenilman. Study supervision: Zenilman.

Financial Disclosure:None reported.

Siegal  AWitz  M Gastrointestinal lipoma and malignancies. J Surg Oncol 1991;47 (3) 170- 174
PubMed Link to Article
Haller  JDRoberts  TW Lipomas of the colon: a clinico-pathologic study of 20 cases. Surgery 1964;55773- 781
PubMed
Howerton  RABonello  JC A lipoma simulating colon cancer. Contemp Surg 1989;3520- 23
Zhang  HCong  JChen  C Submucous colon lipoma: a case report and review of the literature. World J Gastroenterol 2005;11 (20) 3167- 3169
PubMed
Radhi  JM Lipoma of the colon: self amputation. Am J Gastroenterol 1993;88 (11) 1981- 1982
PubMed
Buetow  PCBuck  JLCarr  MJ  et al.  Intussuscepted colon lipomas: loss of fat attenuation on CT with pathologic correlation in 10 cases. Abdom Imaging 1996;21 (2) 153- 156
PubMed Link to Article
Huh  KCLee  THKim  SM  et al.  Intussuscepted sigmoid colonic lipoma mimicking carcinoma. Dig Dis Sci 2006;51 (4) 791- 795
PubMed Link to Article
Chase  MPYarze  JC “Giant” colon lipoma—to attempt endoscopic resection or not? Am J Gastroenterol 2000;95 (8) 2143- 2144
PubMed

Figures

Place holder to copy figure label and caption
Figure 2.

A 4-cm ulcerated submucosal lipoma in the resected ascending colon.

Graphic Jump Location

Tables

References

Siegal  AWitz  M Gastrointestinal lipoma and malignancies. J Surg Oncol 1991;47 (3) 170- 174
PubMed Link to Article
Haller  JDRoberts  TW Lipomas of the colon: a clinico-pathologic study of 20 cases. Surgery 1964;55773- 781
PubMed
Howerton  RABonello  JC A lipoma simulating colon cancer. Contemp Surg 1989;3520- 23
Zhang  HCong  JChen  C Submucous colon lipoma: a case report and review of the literature. World J Gastroenterol 2005;11 (20) 3167- 3169
PubMed
Radhi  JM Lipoma of the colon: self amputation. Am J Gastroenterol 1993;88 (11) 1981- 1982
PubMed
Buetow  PCBuck  JLCarr  MJ  et al.  Intussuscepted colon lipomas: loss of fat attenuation on CT with pathologic correlation in 10 cases. Abdom Imaging 1996;21 (2) 153- 156
PubMed Link to Article
Huh  KCLee  THKim  SM  et al.  Intussuscepted sigmoid colonic lipoma mimicking carcinoma. Dig Dis Sci 2006;51 (4) 791- 795
PubMed Link to Article
Chase  MPYarze  JC “Giant” colon lipoma—to attempt endoscopic resection or not? Am J Gastroenterol 2000;95 (8) 2143- 2144
PubMed

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles