Author(s)

Sapundzieski M, Goerge R, Arshad Z, Kurrimboccus S.

Patient

male, 66 year(s)

Clinical Summary

This is a case of a large intraluminal benign lipoma within the colon transversum, seen on optical colonoscopy and confirmed on CTC, including virtual dissection and virtual colonoscopy. We would like to stress out the role of CT in the final diagnosis with fat density appearance of the lesion itself.

Clinical History and Imaging Procedures

A 66 year old patient, positive FOB, was sent for screening colonography as a part of the national bowel cancer screening program. It showed a >3cm pedunculated looking lesion in the transverse colon (Fig 1), which did not look like a typical polyp and has a features of either lipoma or protruding small bowel through diverticular defect. CT colonography was arranged for further differentiation. CTC was done after i.v. contrast admission in portal phase (Fig 2) with virtual flying through (Fig 3), virtual dissection (Fig 4) and barium enema like 3D VR of the colon (Fig 5) (GE software for CT colonography). We used manual room rectal air insufflations in supine and prone position. Butylscopolamin (Buscopan) was used for hypotonia. Final report was send to referring clinician and to colorectal surgeon.

Discussion

Colon is the most common gastrointestinal site for lipomas: about 60-70% of all lipomas of the gastrointestinal tract originate in the colon. Other than adenomas, lipomas represent the commonest benign neoplasm of the colon. Ninety percent of the colonic lipomas arise in the submucosa and 10% in the subserosa (appendices epiplicae).
They are usually round and ovoid but if they become larger they may display a lobulated polypoid appearance. The size of the colonic lipomas ranges between the size of colonic lipomas ranges between 1-10 cm in diameter, but most are smaller than 3cm. They are usually solitary but can be multiple.
The right side of the colon is involved more frequently than the left. The majority of noncomplicated colonic lipomas will not cause clinical complaints. However, recurrent intussusception of the tumour may cause intermittent abdominal pain whereas ulceration of the mucosa overlying the tumour may lead to intestinal blood loss.
On barium study, the filling defect produced by lipoma is circular, ovoid or pear-shaped, abruptly marginated and with intact mucosal surface. The lesion mostly has a broad base but sometimes a pedunculated mass is depicted. A specific radiographic feature of colonic lipoma is that, due to its deformable and pliable nature, the lesion changes in shape on varying degrees of distension of the colon during filling, as well as with palpation and with change of position of the patient.
On CT, a uniform attenuation of fat (-60 to -120 HU) is revealed. In case of intussusception, CT will reveal not only the endoluminal mass, but in addition, the typical multilayered aspect of colo-colic intussusception. CT plays also a very important role in the visualization of the rarer subserosal forms, which because of their exocolic location are usually not visualized on barium study.
Recurrence or neoplastic changes in these lesions has not been documented.

Final Diagnosis

Large benign lipoma of the colon transversum

MeSH

1. Colonic Neoplasms [C06.405.249.411.307.180]
   Tumors or cancer of the COLON.

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