Most colonic lipomas occur in the cecum and ascending colon, are
asymptomatic, and need no treatment. However, lesions exceeding 2 cm in
diameter may produce symptoms [1]
[2]. We report successful endoscopic ultrasound
(EUS)-assisted resection of a large ulcerated rectal lipoma presenting
hematochezia.
A 53-year-old woman presented with a 3-month history of intermittent
hematochezia. Colonoscopic examination revealed a soft, approximately 2-cm
diameter, yellowish polypoid mass with normal surface mucosa except for a
0.9-cm central ulceration 8 cm from the anal verge ([Fig. 1]). With no other significant findings on
colonoscopy except the ulcerated lipoma, we concluded that the lipoma was the
likely cause of the hematochezia.
Fig. 1 Endoscopic images of the
polypoid mass showing: a normal surface mucosa except for a 0.9-cm central ulceration; b
cushion sign.
Endoscopic ultrasonography was performed and revealed a
2.0 × 1.6-cm homogeneous, hyperechoic, round mass lesion at
the submucosal layer ([Fig. 2]). Based on these
findings, we diagnosed this tumor as a ‘giant’ lipoma and concluded
that this submucosal tumor could be resected endoscopically. Saline solution
was injected into the base of the lesion, which was then removed via monopolar
electrosurgical snare resection ([Fig. 3]).
Histological examination revealed a characteristic colonic lipoma with
ulceration.
Fig. 2 Endoscopic ultrasound
(EUS) image of lipoma, demonstrating the hyperechoic submucosal feature.
Fig. 3 a Injection of saline
solution into the base of the lesion, and snare polypectomy. b Result of polypectomy. c The
removed lesion, demonstrating the ‘naked fat sign’.
Many reports have suggested that endoscopic treatment of large
symptomatic lipomas is a valid alternative to surgery. However, the decision to
remove lipomas and the best technique for doing so, either endoscopically or
surgically, remains controversial because high risks of hemorrhage and
perforation associated with the removal of large lipomas have been documented
[3]. Colonic lipomas arise in the submucosa but
occasionally extend into the muscularis propria or subserosa. EUS can be used
to determine whether a lipoma extends into the muscularis propria, which is a
risk factor for perforation that should preclude endoscopic removal. With
improvements in EUS and injection-assisted polypectomy techniques, endoscopic
treatment can successfully achieve complete resection of giant lipomas with
fewer complications [4].
Endoscopy_UCTN_Code_CCL_1AD_2AC
