Synovial lipomatosis: A rare cause of knee pain in an adolescent female

Synovial lipomatosis is a benign proliferative disease of the subsynovial adipose which can lead to a variety of presentations. Cases of synovial lipomatosis in children or adolescents are rare. This case report describes an adolescent patient with a rare bilateral presentation of synovial lipomatosis. She had been treated for years prior to her presentation for juvenile idiopathic arthritis. She presented with chronic bilateral knee pain, swelling, and mechanical symptoms. Bilateral MR imaging demonstrated effusions, hypertrophy of the synovium, and polyp-like projections of tissue with the same signal intensity as fat which is pathognomonic for synovial lipomatosis. Arthroscopic synovectomy and extensive debridement of polyp like fat projections of the right knee was performed. Histopathology was consistent with the synovial lipomatosis diagnosis. Postoperatively, the patient was satisfied with her outcome with improved pain relief and function in her right knee.

Tongue Lipoma:Report of 2 Cases and Review of Literature

Background: Tongue is an exceptional site of lipoma, a yet very common tumor. Aim: To improve awareness in tongue lipoma diagnosis and treatment approaches through a report of 2 cases and a review of literature. Case Report: A 57-year female patient presented with a large and long-standing mass of 10 years of duration of the base of the tongue, difficulties in feeding and speaking. Another patient of 33 years old presented with an asymptomatic swelling of the left side of the mobile tongue. The two patients had no remarkable medical history and their clinical examination was otherwise unremarkable. In all the two masses, macroscopic examination of the surgical specimen showed an elastic consistency and a yellowish cut surface. Microscopically, matures adipocytes in an abundant fibrous connective tissue were noted in one of the specimen and fibrolipoma was diagnosed. In the other one, matures adipocytes were noted and its patient was diagnosed as having lipoma. Discussion: Tongue lipoma diagnosis, clinically challenging, is easily suspected at macroscopic examination of surgical specimen of a tongue mass. Treatment should favor as possible as a non-mutilating approach given the benign character and the classical low propensity for recurrence of the tumor.

Perirenal extra-adrenal myelolipoma

Myelolipomas are rare tumors consisting of both adipose and hematopoietic tissue and are typically found within the adrenal gland. Extra-adrenal involvement is rare, especially those tumors involving the perirenal space and collecting system. We report a case of a patient with an incidentally discovered perirenal mass that was initially concerning for a retroperitoneal liposarcoma. Following surgical resection and pathological analysis, the lesion was found to be an extra-adrenal myelolipoma. This case report and review of the literature demonstrates the importance of the proper workup and management of perirenal lipoma variants while addressing the issues of tissue biopsy, surgical intervention, and pre- and post-operative surveillance.

Ileo-colonic intussusception secondary to small-bowel lipomatosis:A case report

Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04% to 4.5%.Because the lipomas are diffusely distributed in the intestine,most patients are symptom-free,and invasive intervention is not advised by most doctors.Here,we describe a case with intussusception due to small-bowel lipomatosis.Partial small bowel resection and anastomosis were performed because the intestinal wall was on the verge of perforation.This case indicates that regular followup is necessary and endoscopic treatment should be considered to avoid surgical procedures if the lipoma is large enough to cause intestinal obstruction.

Colonic lipoma covered by hyperplastic epithelium: Case report

Colonic lipomas are submucosal nonepithelial tumors covered by intact or eroded mucosa. In rare cases, alterations in the mucosa covering a lipoma include hyperplasia, adenoma, atrophy, ulceration, and necrosis. Here, we report a case of a colonic lipoma covered by hyperplastic epithelium in a 68-year-old woman. Based on the colonoscopy findings, a snare polypectomy was performed for a presumptive diagnosis of an epithelial lesion; however, the histological examination revealed a colonic submucosal lipoma with overlying hyperplastic epithelium.

Tale of fat and fib-cardiac lipoma managed with radiofrequency ablation: A case report

BACKGROUND Cardiac lipoma and lipomatous hypertrophy of interatrial septum(LHIS)are very rare disorders with distinct pathological features.While cardiac lipoma is a well-circumscribed encapsulated tumor of mature adipocytes,LHIS is due to entrapment of fat cells in the interatrial septum during embryogenesis.Although a biopsy is the definitive diagnostic test,these disorders can be differentiated by a cardiac magnetic resonance imaging(MRI).Treatment of LHIS is not warranted in asymptomatic patients.In symptomatic patients,surgical resection is the only recommended treatment,which has shown to improve good long-term prognosis.CASE SUMMARY A 63-year-old Caucasian woman with past medical history significant for hypertension,hypothyroidism,right breast ductal cell carcinoma treated with mastectomy and breast implant,platelet granule disorder,asthma requiring chronic intermittent prednisone use,presented to the outpatient cardiology office with recent onset exertional dyspnea,palpitations,weight gain and weakness.Initial workup with electrocardiogram and holter monitor did not reveal significant findings.During the subsequent hospitalization for community acquired pneumonia,the patient developed symptomatic paroxysmal atrial fibrillation.Transthoracic echocardiogram showed a right ventricular mass.A biopsy was not pursued given the high risk of bleeding due to platelet granule disorder.Cardiac MRI showed characteristic features consistent with cardiac lipoma and LHIS.Prednisone was discontinued.Genetic testing for arrhythmogenic right ventricular dysplasia and 24-h urine cortisol test was negative.As multiple attempts at rhythm control failed with sotalol and flecainide,pulmonary vein isolation and right atrial isthmus radiofrequency ablation were done.She is in follow-up with symptomatic relief and no recurrence of atrial fibrillation for 10 mo.CONCLUSION Benign fatty lesions in heart include solitary lipoma,lipomatous infiltration and lipomatous hypertrophy of interatrial septum.Although transvenous biopsy provides a definitive diagnosis,Cardiac MRI is superior to computed tomography and aids in differentiating benign from malignant lesions.Surgical excision of cardiac lipoma along with capsule and pedicle removal generally prevents recurrence,but with our patient’s unusual tumor features and comorbidities proscribed a surgical approach.Symptom management with antiarrhythmics and ablation techniques were successfully utilized.

Spindle cell lipoma of the mandibular mucogingival junction: a case report of unusual oral neoplasm

Spindle cell lipoma（SCL） is a benign lipomatous neoplasm typically located in the posterior neck and back of older males. It presents as a well-circumscribed mass in the buccal mucosa, tongue, floor of the mouth or hard palate. There are only two case reports of SCL in the gingiva and alveolar ridge. Here, we report a case of SCL in the mandibular mucogingival junction of a 68-year-old male. Clinical,histopathological and immunohistochemical findings are presented. Although oral SCL is rare, it should be considered in the differential diagnosis of spindle cell neoplasms occurring in the oral cavity.

A rare case of intraoral lipoma in a six year-old child:a case report

One type of soft tissue lesions of the oral cavity is lipoma, which is a kind of benign tumor composed of mature lipid cells. Although the lipoma presents as one of the most common mesenchymal neoplasms, most tend to develop on the trunk and proximal portions of the extremities. However, lipomas in the oral and maxillofacial region are much less frequent. Here we present a case of an intraoral lipoma in a six year-old child.

A Pedunculated Fibrolipomatous Polyp of Tonsil: A Rare Case Report

Lipoma being the most common mesenchymal tumour of the body is rare in head and neck region. Fibrolipoma is a rare benign tumour of palatine tonsil which may present a pedunculated lesion in oropharynx and can cause dysphagia, foreign body sensation in throat, sleep disturbance and voice change. Our patient presented with foreign body sensation in throat. Examination showed pedunculated polypoidal mass arising from right palatine tonsil, treated with tonsillectomy under general anaesthesia. Histopathological examination confirmed as fibrolipoma of tonsil. Malignant transformation in fibrolipoma is very rare but some cases have been reported. Hence patient was followed up for two years and no recurrence noted.

Small intestinal lipomas:Diagnostic value of multi-slice CT enterography

AIM:To analyze the clinical and imaging features of the small intestinal lipomas and to evaluate the diagnostic value of multi-slice computed tomography(CT) enterography.METHODS:Fourteen cases(one had two intestinal lesions) of surgically confirmed lipomas of the small intestine were retrospectively analyzed.The location,size,clinical and radiological aspects were discussed.RESULTS:Twelve patients presented with abdominal pain,of whom three complained of paroxysmal colic.Melena or bloody stools was mentioned in five cases.One lesion was detected incidentally during routine physical examination.One lesion was found unexpectedly during the preoperational evaluation for cholecystitis.Examination of the abdomen revealed palpable masses in four cases.Precontrast CT scan showed round or oval well-defined hypo-intense intraluminal masses with the attenuation ranging from-130 HU to-60 HU.On contrast enhancement CT scan,no striking enhancement was seen.CONCLUSION:The small intestinal lipomas are rare and difficult to diagnose merely based on clinical manifestations,while the characteristic features at small intestinal CT enterography can help establish reliable prospective diagnoses.

Lipoma within inverted Meckel’s diverticulum as a cause of recurrent partial intestinal obstruction and hemorrhage: A case report and review of literature

Lipoma within an inverted Meckel's diverticulum presen- ting with hemorrhage and partial intestinal obstruction is an exceptional clinical entity. We report a case of 47-year-old male with a history of recurrent episodes of partial intestinal obstruction and melena due to a subserosal lipoma located in the base of an inverted Meckel's diverticulum. According to our knowledge, this is the first case of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario without the existence of heterotrophic gastric or pancreatic tissues.

Partial intestinal obstruction secondary to multiple lipomas within jejunal duplication cyst: A case report

Lipoma within jejunal duplication presenting as abdominal bloating and partial intestinal obstruction is an exceptional clinical entity.We report a case of 68-year-old man complaining of abdominal bloating for 10 d due to multiple lipomas arising from jejunal duplication cysts.Only a few cases of a single lipoma within a Meckel’s diverticulum giving rise to this clinical scenario have been reported in the English language literature.However,no case of multiple lipomas within jejunal duplication cysts has been reported.We present a case in which doubleballoon endoscopy revealed a small intestinal structure changed into Meckel’s diverticulum-like cavities containing several lipomas.This case highlights intestinal lipoma as an uncommon cause of adult intussusceptions,which should be included in the differential diagnosis of small intestinal obstruction and appropriate examinations should be chosen.

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

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 leffc 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.

Submucous colon lipoma: A case report and review of the literature

Colon lipoma is remarkably rare in clinical practice. We reported a case of ascending colon lipoma in an 83-year-old woman. She was asymptomatic with a lipoma of 35 mm×30 mm×24 mm in size which was found by routine colonoscopy. Right hemicolectomy was performed uneventfully. The diagnosis was made by histological examination. Reviewing the literature and combining with our experience, we discussed the clinical features, diagnosis and treatment of this uncommon disease.

Peeling a giant ileal lipoma with endoscopic unroofing and submucosal dissection

Lipoma is relatively common in the colon but is less often in the small intestine. Most lipomas are incidentally detected at endoscopy and are usually small and asymptomatic. However, some of them can present with obstruction and/or intussusceptions. Surgical resection is commonly recommended to remove such significant lipomas with a limited pedicle and larger than 2 cm in size, as endoscopic resection may result in unfavorable complications such as intestinal perforations. We report a case of 62-year-old man presenting with hematochezia. Colonoscopy showed a submucosal tumor, about 50 mm in size, in the terminal ileum. A clinical diagnosis of lipoma was established based on the findings of colonoscopy and abdominal computed tomography (CT). As the patient complained of hematochezia and mild iron deficiency anemia associated with repeated tumor prolapse, we decided to remove his lipoma. Consequently, the lesion was completely removed en bloc . Although abdominal CT immediately after removal of the lesion showed a small amount of free air, conservative treatment was successfully carried out for the perforation. Histologically, the removed lesion was a lipoma.

Ileal lipoma-a rare cause of ileocolic intussusception in adults:Case report and literature review

The occurrence of intussusception in adults is rare,accounting for less than 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction.The condition is found in less than 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction.The child to adult ratio is more than 20:1.We report a rare case of ileocolic intussusception in an adult secondary to an ileal lipoma.

Ileocolic intussusception caused by a lipoma in an adult

Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.

Sonographic features of duodenal lipomas in eight clinicopathologically diagnosed patients

AIM:To investigate the sonographic features and diagnostic value of endoscopic ultrasonography (EUS) for duodenal lipomas (DLs).METHODS:A total of eight consecutive patients with DL diagnosed pathologically were included in the study.One EUS expert reviewed the ultrasonic images for all lesions,including the original layer of the duodenal wall,the echo intensity and the echo homogeneity.The size of the lesions and the perifocal structures were also investigated.The diagnosis by EUS was compared with the histological results.RESULTS:Using routine endoscopy,only one case was correctly diagnosed as DL.Four cases were classified as submucosal tumors,and three cases were mistaken for stromal tumors.All tumors appeared as round or oval intensive hyperechoic lesions with distinct anterior borders that originated from the submucosal layer on EUS.Tumors ranged from 8 to 36 mm in size,with an average size of 16 mm.Homogeneous echogenicity was seen in all cases except one that had a tubular structure inside the tumor.Echo attenuation was observed only in the area behind the tumors in five cases,and it was observed both inside and behind the tumors in three cases in which the posterior border was obscure or invisible.Seven (87.5%) cases were correctly diagnosed as DL,and one (12.5%) was mistaken as Brunner's gland adenoma by EUS.Pathologically,all tumors originated from the submucosal layer and consisted of mature fat cells without heteromorphism.Among the fat cells,there was a small amount of thick-wall vessels infiltrating the lymphocytes,and abundant fibrous connective tissues.CONCLUSION:On EUS,DL is featured as an intensive homogeneous hyperechoic submucosal lesion with marked echo attenuation and without involvement of the mucosa.

Lipoma induced jejunojejunal intussusception

Intussusception in adults is rare. The clinical picture of intussusception in adults is subtle and the diagnosis is,therefore,elusive. The presence of a structural abnor- mality in the great majority of the adult cases mandates high clinical suspicion. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointes- tinal lipoma constitutes an infrequent clinical entity. The present report describes a case of jejunojejunal intus- susception in an adult with a history of severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was suspected preoperatively but computed tomography scan could not rule out malignancy. Explor- atory laparotomy revealed jejunojejunal intussusception secondary to a lipoma which was successfully treated with segmental intestinal resection.

Cecal lipoma with pseudomalignant features: A case report and review of the literature

Colonic lipoma is a well-documented benign neoplasia, endoscopicaUy appearing as a smooth round yellowish polyp with a thick stalk or broad-based attachment. We describe a 63-year old woman with persistent abdominal pain, in whom colonoscopy revealed a cecal mass with malignant features. Based on the colonoscopy findings, right hemicolectomy was laparoscopicaUy performed for a presumptive diagnosis of a cecal adenocarcinoma, but histological examination revealed a colonic lipoma with overlying mucosal ulceration.