Laparoscopic management of small-bowel intussusception in a 64-year-old female with ileoal lipomas

A 64-year-old female patient presented with upper ab-dominal pain and vomiting. Ultrasonography showed a hyperechoic mass in the right lower abdomen and computed tomography showed a low-density mass with intestinal invagination. An emergency laparo-scopic right-hemicolectomy was performed, and the resected specimen was found to contain three tumors, which were identified histopathologically as intestinal lipomas. Adult intussusception is relatively rare and difficult to be diagnosed, since most symptoms of adult intussusception are nonspecific. We report our clinical experience of the diagnosis and emergent laparoscopic surgery for an adult patient with intussusception.

Lipomas of Colon:Report of 5 Cases

Five cases of colonic lilpomas,which are relatively rare in China,were diagnosed byfibrocolonoscopy with biopsy.All lipomas were resectecl through fibrocolonoscopy except that the tu-mor of one case measured 4.3 cm in diameter was rcsected surgically.Our results suggest that al-though in some ease the colonic lipomas may be neccssanily rcsccted by operation,most of themmighr be removed by librocolonoscope only.

Multiple Symmetric Lipomas: A Case Report

Multiple symmetric lipomas are a rare disease characterized by multiple symmetrical deposits of adipose tissue associated with alcohol abuse.A 68-year-old man was admitted to our hospital for being operated on for a mass growth on the neck and back.Based on the patient’s medical history and preoperative magnetic resonance imaging findings,we performed surgical resection.There was no recurrence at one year postoperatively.

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.

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.

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.

Balloon-assisted endoscopic submucosal dissection for treating small intestinal lipomas:Report of two cases

BACKGROUND Most small intestinal lipomas are treated surgically,and some require repeated surgeries for multiple lipomas.However,application of endoscopic submucosal dissection(ESD)technology in the deep small intestine is rarely reported owing to the special anatomical structure of the small intestine,medical equipment limitations,and the lack of relevant experience among endoscopists.CASE SUMMARY Two patients with small intestinal lipomas treated at the Air Force Medical Center from November 2015 to September 2019 were selected to undergo balloonassisted ESD to treat the lipomas and explore the technical feasibility and safety of ESD for treating small intestinal lipomas.The two patients successfully underwent balloon-assisted ESD to treat four small intestinal lipomas,with a complete resection rate of 100%(4/4),without intraoperative or postoperative bleeding,perforation,or other complications.After 3-6 mo of postoperative follow-up,the clinical symptoms caused by the lipomas were significantly relieved or disappeared after treatment.CONCLUSION Balloon-assisted ESD is a safe and reliable new method for treating deep intestinal lipomas and shows good clinical feasibility.

Clinical evaluation of submucosal colonic lipomas: Decision making

Even lipomas are the most common mesenchymal benign tumors of the gastrointestinal tract, symptomatic colonic presentation is rare. Herein, we evaluated four patients suffering from various size of colonic lipomas and approached by different therapeutic modalities.

Systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies

To systematically review the syndrome of giant gastric lipomas, report 2 new illustrative cases.Literature systematically reviewed using PubMed for publications since 1980 with following medical subject heading/keywords: (“giant lipoma”) AND (“gastric”) OR [(“lipoma”) and (“gastric”) and (“bleeding”)]. Two authors independently reviewed literature, and decided by consensus which articles to incorporate. Computerized review of pathology/endoscopy records at William Beaumont Hospitals, Royal Oak and Troy, Michigan, January 2005-December 2015, revealed 2 giant gastric lipomas among 117110 consecutive esophagogastroduodenoscopies (EGDs), which were thoroughly reviewed, including re-review of original endoscopic photographs, radiologic images, and pathologic slides.

Is endoscopic resection a correct treatment for atypical gastrointestinal lipomas?

We would like offering our experience about a very rare and underestimated type of gastrointestinal lipoma,which is the lipoma with precancerous or frankly malignant features of the mucosal epithelium,the socalled atypical lipoma.So far,only few cases have been described in the world literature.Recently,we grappled with what we think the first case of atypical colonic lipoma presenting with adenocarcinomatous transformation of the overlying epithelium,as discussed in more detail below.We propose a new definition and classification for this kind of lesions and discuss about their diagnosis,treatment and prognosis.

Conduction disorder and primary cardiac tumor: a fatal case of multiple lipomas of the right atrium

Cardiac primary tumors are uncommon with an estimated prevalence between 0.17%and 0.19%.[1,2]Cardiac lipoma are extremely rare representing only 10%?19%of primary cardiac tumors and only few are symptomatic,depending on their location within the heart.[3,4]They originate from the subendocardium(50%),subepicardium(25%)or myocardium(25%)and with different sizes and locations.[5]Few cases of sudden death due to primary cardiac tumors are reported in literature(0.0025%);in these cases,conductive and haemodinamic abnormalities have been indicated as the cause of death.

Pituitary Lesions, Obesity, and Mesenteric Lipomas in Insulin-Resistant Horses

The aim of the current study was to identify associations between pituitary lesions, body condition scores, and mesenteric lipomas in horses with insulin resistance. Necropsy examinations were performed following euthanasia in 30 adult horses designated as insulin resistant (n = 11) or insulin sensitive (n = 19). Insulin sensitivity was determined using the insulin-modified frequently sampled intravenous glucose tolerance test and resting insulin concentrations. At necropsy, mesenteric lipomas were measured. The pituitary and adrenal glands, pancreas, and liver were evaluated histologically;pituitary glands were scored based on published criteria. Insulin-resistant horses had significantly higher pituitary scores (p = 0.0035) and body condition scores (p = 0.0001), even when adjusting for age, and a greater frequency of mesenteric lipomas (p = 0.014) and greater lipoma area (p = 0.0332) than insulin-sensitive horses. Regardless of insulin status, horses with pituitary scores ≥3 (diffuse hyperplasia;n = 25) had higher body condition scores (p = 0.0313) and a greater frequency of mesenteric lipomas (p < 0.0002) than those with lower pituitary scores. High body condition score was not correlated to an increased frequency of mesenteric lipomas. Detection of higher pituitary scores in insulin-resistant horses suggested an association between insulin resistance and pituitary morphology. Horses in the insulin-resistant group and those with high pituitary scores had higher body condition scores and a greater frequency of mesenteric lipomas. These horses might be at increased risk for lipoma-associated colic.

Lipomas of the Colon: A Surgical Challenge

Lipomas of the colon are rare benign tumors second only to adenomas in their incidence. They are devoid of malignant potential. They usually become manifest by way of complications ranging from bleeding to acute intestinal obstruction. Radiological investigations may help to confirm the diagnosis in a significant number of non-emergent situations. However, confirmation of diagnosis is invariably done at the time of therapeutic intervention. A proper choice of therapeutic option between endoscopic or open surgical intervention needs to be made for a good outcome.

Oral spindle cell lipomas

Spindle cell lipoma is an histological type of lipoma which are rarely found in the oral cavity. We describe two cases of intraoral spindle cell lipomas. The pa- tients were men and presented painless slow growing masses in the left cheek and hard palate, measuring 50 × 30 mm and 23 × 20 mm respectively. Microsco- pically, both lesions presented a solid proliferation of mature fat cells intermixed with bundles of connec- tive tissue. Cells were immunopositive for S100 pro- tein and CD34 (one case), with low mitotic activity (Ki-67). The final diagnosis was spindle cell lipomas. The lesions were excised and no recurrence was no- ticed after six months. Oral spindle cell lipomas are unexpected to occur in the oral mucosa, and the main differential diagnosis is well-differentiated liposar- coma/atypical lipoma. Lesions are treated with sur-gical excision and recurrences are rare.

Ileal collision tumor associated with gastrointestinal bleeding: A case report and review of literature

BACKGROUND Collision tumors involving the small intestine,specifically the combination of a hamartomatous tumor and a lipoma,are extremely rare.To our knowledge,no previous case report has described a collision tumor composed of two benign tumors of different origins in the small intestine.CASE SUMMARY Here,we present the case of an 82-year-old woman who presented with hemorrhagic shock and was found to have a mass measuring approximately 50 mm×32 mm×30 mm in the terminal ileum.Based on computed tomography scan findings,the mass was initially suspected to be a lipoma.A subsequent colonoscopy revealed a pedunculated submucosal elevation consisting of two distinct parts with a visible demarcation line.A biopsy of the upper portion suggested a juvenile polyp(JP).Owing to the patient’s advanced age,multiple comorbidities,and poor surgical tolerance,a modified endoscopic submucosal dissection was performed.Histopathological examination of the excised mucosal mass revealed a lipoma at the base and a JP at the top,demonstrating evidence of rupture and associated bleeding.The patient’s overall health remained satisfactory,with no recurrence of hematochezia during the six-month follow-up period.CONCLUSION This case report provides new evidence for the understanding of gastrointestinal collision tumors,emphasizing their diverse clinical presentations and histopathological characteristics.It also offers diagnostic and therapeutic insights as well as an approach for managing benign collision tumors.

Recurrent intramuscular lipoma at extensor pollicis brevis:A case report

BACKGROUND This report describes and discusses recurrent intramuscular lipoma(IML)of the extensor pollicis brevis(EPB).An IML usually occurs in a large muscle of the limb or torso.Recurrence of IML is rare.Recurrent IMLs,especially those with unclear boundaries,necessitate complete excision.Several cases of IML in the hand have been reported.However,recurrent IML appearing along the muscle and tendon of EPB on wrist and forearm has not been reported yet.CASE SUMMARY In this report,the authors describe clinical and histopathological features of recurrent IML at EPB.A 42-year-old Asian woman presented with a slowgrowing lump in her right forearm and wrist area six months ago.The patient had a history of surgery for a lipoma of the right forearm one year ago with a scar of 6cm on the right forearm.magnetic resonance imaging confirmed that the lipomatous mass,which had attenuation similar to subcutaneous fat,had invaded the muscle layer of EPB.Excision and biopsy were performed under general anesthesia.On histological examination,it was identified as an IML showing mature adipocytes and skeletal muscle fibers.Therefore,surgery was terminated without further resection.No recurrence occurred during a follow-up of five years after surgery.CONCLUSION Recurrent IML in the wrist must be examined to differentiate it from sarcoma.Damage to surrounding tissues should be minimized during excision.

Large colonic lipoma with a laterally spreading tumor treated by endoscopic submucosal dissection:A case report

BACKGROUND Since fat does not transmit electrical energy well,delayed perforation and postpolypectomy syndrome due to electrical thermal injury are concerns in the endoscopic removal of colonic lipoma.The endoscopic submucosal dissection(ESD)technique concentrates electrical energy conducts to the submucosa,not the adipose tissue.This helps to minimize electrical thermal injury,especially in the case of large colonic lipomas.In rare cases,such as colonic lipomas accompanied by mucosal lesions,it is difficult for endoscopists to decide how to safely remove them.CASE SUMMARY A 78-year-old man underwent colonoscopy for colorectal cancer screening.During colonoscopy,a yellowish submucosal tumor with positive cushion sign was observed in the ascending colon measuring about 4.5 cm.A nodular mucosal lesion of about 2.5 cm was observed on the mucosal surface of the lipoma.The lipoma was so large that it occupied much of the inside of the colon,making it difficult to see the entire laterally spreading tumor(LST)at once.The LST was confined to the surface of the lipoma,which had a semipedunculated shape with a wide neck.The margin of the LST was not observed at the neck of the lipoma.ESD was performed and the colonic lipoma with the LST was successfully removed without complications.After 3 d of hospitalization,the patient was discharged without any symptoms.The final pathology report showed that the lesion consisted of submucosal lipoma and tubulovillous adenoma with lowgrade dysplasia.CONCLUSION ESD is effective and safe for treating a large colonic lipoma with an LST by minimizing electrical thermal injury.

Upper gastrointestinal bleeding as an unusual manifestation of localized Ménétrier’s disease with an underlying lipoma:A case report

BACKGROUND Ménétrier’s disease is a rare condition characterized by enlarged gastric folds,usually located in the whole body and fundus of the stomach.This report presents an unusual case of localized Ménétrier’s disease elevated by a submucosal lipoma and thus looking like a polypoid mass and causing an episode of upper gastrointestinal bleeding.The mass was successfully removed with endoscopic submucosal dissection.CASE SUMMARY Esophagogastroduodenoscopy was performed on a 76-year-old male patient after an episode of upper gastrointestinal bleeding,manifesting as fatigue and melena.A large polypoid mass(4 cm×1 cm)with enlarged mucosal folds was found in the body of the stomach,between the lesser curvature and posterior wall.A small ulcer at the distal end of the mass was identified as the source of the bleeding.Biopsy was negative for neoplasia.Computed tomography showed a submucosal lesion beneath the affected mucosa,most likely a lipoma.The mass was removed en bloc with tunneling endoscopic submucosal dissection.Final pathology determined that the mass included Ménétrier’s disease and a submucosal lipoma.The patient was scheduled for follow-up esophagogastroduodenoscopy.CONCLUSION Localized Ménétrier’s disease can coexist with a submucosal lipoma creating a polypoid mass with risk of bleeding.

Surgical Removal of a Huge Epiglottic Lipoma: Case Report

Background: Lipoma is a very rare benign tumour of upper aero-digestive tract with less than 115 cases described in the English-literature. They account for approximately 1% of benign tumours of the larynx and oro/hypopharynx. The symptoms are variable including progressive horseness, dysphagia and even severe dyspnea which can sometimes be life-threatening. The clinical presentation of lipoma is important particularly during the induction of general anesthesia, for they can cause unpredictable airway obstruction. Surgery is the treatment of choice which includes endoscopic techniques, microscopic laryngeal surgery and external surgical approach (cervicotomy). However, a standard surgical management for large lipomas of the epiglottis has not been present yet. In this article, we present a case report of a huge lipoma of the epiglottis successfully treated with tracheotomy and external surgical approach—cervicotomy with hyoidthyroidpexy without sacrificing any laryngeal structure. Case Presentation: We present a case of a 54-year-old female with a huge lipoma on the lingual surface of the epiglottis that extends upwards to the level of the left aryepiglottic fold narrowing the pyriform sinus, making impossible for our anesthesiologist the glottic visualization and the orotracheal intubation. Following a tracheotomy, the endoscopic and microscopic surgery approach was inadequate to manipulate the epiglottic lipoma. Instead, we performed macroscopic external surgery (cervicotomy with hyoidthyroidpexy) in which the epiglottic lipoma was pulled into the endolaryngeal window with forceps and then dissected from the surrounding tissues “in toto”. Conclusion: Despite epiglottic lipomas are rare and benign, they are important because of being potential cause of laryngeal obstruction. Surgery is the treatment of choice and different procedures are able to manage it. The external surgery approach—cervicotomy with hyoidthyroidpexy after tracheotomy enabled the huge lipoma to be extirpated without leaving any remnants or causing excessive laryngeal damage.

CO_2激光显微手术治疗巨大会厌脂肪瘤1例

会厌良性病变以囊肿最多见,恶性以鳞状细胞癌最多[1],治疗方法主要依据肿物的性质和大小决定。近年来,CO2激光被广泛应用于临床,已有多篇CO2激光显微手术治疗会厌囊肿及早期会厌癌的文献报道[2]。与传统术式相比,其术野更清晰,切除更彻底,创伤小,术后恢复快且复发率低,且保留了喉的发音及吞咽功能,提高了患者术后生活质量。但对于会厌部的实质性肿瘤如会厌脂肪瘤,因属临床罕见病,尚无统一标准术式,也极少有新的术式尝试。