Indian Journal of Surgery Medknow Publications on behalf of Association of Surgeons of India ISSN: 0972-2068 Vol. 65, Num. 6, 2003, pp. 513-514

Indian Journal of Surgery, Vol. 65, No. 6, November-December, 2003, pp. 513-514

Gastrointestinal lipomas presenting as obstruction

Harsh Mohan, Amanjit Bal

Department of Pathology, Govt. Medical College & Hospital, Sector - 32-A, Chandigarh, India.
Address for correspondence: Dr. Harsh Mohan, Department of Pathology, Govt. Medical College, Sarai Building, Sector-32-A, Chandigarh - 160047, India. E-mail: harshmohan@glide.net.in

Paper Received: June 2002. Paper Accepted: December 2002. Source of Support: Nil.

How to site this article: Mohan H, Bal A. Gastrointestinal lipomas presenting as obstruction. Indian J Surg 2003;65:513-4.

Code Number: is03112

ABSTRACT

Lipomas are benign tumours common at other sites but rare in the gastrointestinal tract. The colon is the commonest location for lipomas in the gastrointestinal tract, but gastric and duodenal lipomas are rare. Most of the lipomas are clinically silent but rarely they can present with bleeding or obstruction. Large lipomas causing obstruction can mimic malignant tumours clinically as well as on endoscopy. To rule out malignant lesion and avoid extensive surgical procedures biopsy or intraoperative frozen section is a must.

Key words: Lipoma, Gastrointestinal, Obstruction.

INTRODUCTION

Gastrointestinal (GI) lipomas are benign, slow-growing tumours constituting only 5-6% of GI tumours. In the GI tract their most common location is the colon, accounting for 60-75% of all GI lipomas,¹ followed by the small intestine (20-25%).² Duodenal and gastric lipomas are rare. The stomach accounts for 5% of all GI lipomas.³ To date, only about 200 gastric lipomas have been described in world literature.⁴ GI lipomas are usually asymptomatic but rarely can present with obstruction or GI bleeding. We report three cases of GI lipomas presenting as obstruction.

CASE REPORTS

Case 1
A 45-year-old woman presented with complaints of pain in the epigastrium, dyspepsia, intermittent vomiting and weight loss. Clinical examination and laboratory studies did not reveal any abnormality. An upper GI endoscopy revealed a polypoidal mass located in the pre-pyloric region measuring approximately 4 X 4 cm and protruding into the gastric lumen thus stenosing it. The overlying gastric mucosa was unremarkable. Clinically, the mass was suspected to be a leiomyoma. The patient underwent a laparotomy for resection of the gastric mass. Per-operatively there was a soft rounded intramural mass located in the gastric antrum which was excised with clear margins. A frozen section was obtained which indicated the mass to be a lipoma with inflammatory changes. Histopathological examination confirmed the mass to be a lipoma (Figure 1).

Case 2
A 34-year-old male presented with complaints of vomiting and abdominal pain. Upper GI endoscopy revealed a polyp in the second part of the duodenum measuring 3 X 2 cm and protruding into the intestinal lumen. The overlying mucosa was unremarkable. Snare polypectomy was undertaken and the microscopic examination of the excised polyp revealed a submucosal lipoma.

Case 3
A 65-year-old male presented with complaints of recurrent pain abdomen and constipation. Colonoscopic examination revealed a large soft growth in the sigmoid colon measuring 6 X 4 cm. The overlying mucosa was ulcerated and congested. A portion of the colon along with the mass was removed and sent for histopathological examination. Cut section showed a large grey yellow lobulated mass measuring 6.5 X 5.5 cm projecting into the lumen. Microscopic examination revealed a submucosal lipoma with the adjoining area showing inflammation and fibroblastic proliferation.

DISCUSSION

Lipomas are benign tumours that are common in other sites but rare in the GI tract. In the GI tract they are mainly located in the colon. Gastric lipomas constitute 3% of all gastric tumours with 75% of them located in the antrum.⁵ Most of the GI lipomas are submucosal in origin, only 5% are subserosal in origin.⁶ GI lipomas are generally asymptomatic and the tumour size and location usually dictates the occurrence of symptoms. Lipomas less than 1 cm in size are usually asymptomatic but lesions greater than 4 cm become symptomatic and present with GI bleeding from ulceration of the overlying mucosa or rarely with symptoms of obstruction and intussusception.⁷

The GI lipomas can be diagnosed by GI endoscopy which is the preferred modality for small lesions. The endoscopic findings which are positive predictors of benign lesions are: a sharply defined submucosal mass, often yellow in colour as opposed to the surrounding pink mucosa. Sometimes, clinically it is difficult to make a distinction between GI lipomas and other intramural tumours like leiomyoma, leiomyosarcoma, adenomyoma and fibroma, especially when the size of the tumour is large. In such cases endoscopic ultrasonography⁸ and CT scan can be of help but confirmatory diagnosis is made on histological examination only. Incisional biopsy can be performed in large lesions to rule out malignancy. The treatment of choice for symptomatic GI lipoma is local enucleation or cicumferential excision with a clear margin of normal tissue. GI lipomas are benign tumours and do not have potential for malignant transformation, so intraoperative frozen section and histological diagnosis is essential to rule out malignant lesions and avoid extensive surgical procedures such as extended gastrectomy and colectomy.

REFERENCES

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3. Maderal F, Hunter F, Fuselier G. Gastric lipomas- an update of clinical presentation, diagnosis and treatment. Am J Gastroenterol 1984:79;964-7.

4. Antes G, Neher M. Lipoma of the stomach- diagnosis and therapy. Rontegenpraxis 1995:48;252-3.

5. Ciraldo A, Thomas D, Schmidt S. Gastric lipoma presenting as gastrointestinal bleeding-a case report. Internet J Oncol 2000:1.

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7. Patankar T, Prasad S, Patankar Z, Chaudary S. Ileo-colic intussusception secondary to ileal lipoma. JAPI J Assoc Physicians India 1999;47:923-5.

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