An unusual intraoral lipoma: case report and review of the literature.

Lipoma is a common tumor of soft tissue with rare occurrence in oral cavity accounting for only 1-4% of benign oral tumours. It may be noticed only during routine dental examinations. Most of them rarely cause pain, resulting in delay to seek treatment. Lipoma of the oral cavity may occur in any region. The buccal mucosa, tongue, and floor of the mouth are among the common locations. A case of large intraoral lipoma occurring in mental region in a 60-year-old female patient is reported. It was treated surgically under local anesthesia, and 6 month follow up showed excellent healing without any recurrence.

[Diagnosis and therapy of benign intraarticular tumors]. / Diagnostik und Therapie benigner intraartikulärer Tumoren.

Intraarticular benign tumors are rare lesions in many cases seen as incidental findings. One of the typical lesions is the diffuse or nodular form of pigmented villonodular synovitis, which needs a complete surgical removal. Magnetic Resonance Imaging (MRI) is diagnostic in most of the cases because of the intracellular iron content which shows an at least in some parts dark T2-sequence. Adjuvant therapies as radiosynoviorthesis should be considered in diffuse or recurrent lesions. Synovial Chondromatosis represents a metaplastic disorder of the synovial membrane resulting in the production of loose cartilage bodies. Also in this dissease synovectomy or, in late cases, removal of the loose bodies only, is recommended. Synovial hemangiomas are hamartomas which may lead to pain or restriction of movement. In these cases total or partial resection is justified. Alternative treatment options such as laserablation may be possible. Lipoma arborescens represents a proliferative lipoid lesion of the subsynovial region leading to villonodular synovial proliferation. If clinically symptomatic, resection by arthroscopic or open synovectomy is recommented.

Prolapsed giant sigmoid lipoma: a rare cause of adult ischaemic intussusception.

Intussusception is a rare cause of obstruction in adults and has a variable, non-specific presentation. Adult intussusception is usually associated with an underlying organic pathology, such as a benign or malignant tumour which acts as the lead point. Prolapse of the lead-point mass through the anal canal is an extremely rare presentation with very few reported cases in the literature. We describe a case of a 67-year-old man who presented with rectal prolapse of a large soft tissue mass. CT of the abdomen and barium enema revealed partial intussusception of an upper sigmoid lipomatous polyp. Examination under anaesthesia was performed and the prolapse reduced. A laparoscopic sigmoid colectomy was planned. The patient subsequently re-presented clinically unwell with a recurrent necrotic prolapsing mass. Laparotomy and sigmoid colectomy was performed and the patient recovered fully. The resected mass was a 7×4.5×4.0 cm necrotic sigmoid lipoma.

Single port laparoscopic right hemicolectomy for ileocolic intussusception.

A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.

[Development of lipoma following a single cupping massage - a case report]. / Auftreten eines Lipoms nach einmaliger Schröpfkopfmassage - ein Fallbericht.

BACKGROUND: The cupping massage is a form of bloodless cupping. This type of cupping is particularly used to treat muscular tension and musculoskeletal pain, such as chronic neck pain; however the data records on mechanisms and potential side effects are not satisfactory. CASE REPORT: In a study on the effectiveness of cupping massage in patients with chronic neck pain, one patient showed a formation of a lipoma in the cupping area after the first treatment session. CONCLUSION: Because of the short time interval between therapy and development of the lipoma, a primary cause is not realistic. This adverse event has not been described in the literature before, and the present report describes the case in summary.

Colonic intussusception caused by colonic lipoma: a case report.

Intussusception is a pediatric condition that rarely presents in adults. Colonic lipomas 4 cm and more in diameter can cause colonic intussusception leading to emergency operation. Surgical resection of the involved segment must be the procedure of choice. We report a case of colonic intussusception caused by colonic lipoma in an adult. The patient underwent operation, and histopathological examination of the specimen confirmed the diagnosis of colonic submucosal lipoma.

Giant lipoma of the transverse colon: a case report and review of the literature.

BACKGROUND: Colonic lipomas are benign adipose tumors which are usually submucosal. Small lesions are asymptomatic and may be detected incidentally. Large lipomas can cause symptoms. AIM: We report a case of symptomatic giant colonic lipoma OBSERVATION: A 67-year old woman was admitted to hospital with persistent abdominal pain, for which a barium enema showed a large polypoid mass occluding the lumen of the transverse colon. Colonoscopy revealed a tumor narrowing the bowel lumen of about 5 cm in diameter with a sessile appearance and ulcerated overlying mucosa. The possibility of colonic malignancy could not be precluded and an operative resection was performed. Pathological examination revealed a colonic lipoma. Twelve months after the surgery, the patient was free of symptoms. CONCLUSION: Awareness of the possibility of colonic lipomas is important for clinicians in terms of evaluation of therapeutic regimen.

Fibrolipoma em mucosa jugal: relato de um caso / Fibrolipoma in the cheek: a case report

O lipoma é uma neoplasia benigna de tecido adiposo, pouco frequente na mucosa bucal, de desenvolvimento lento e assintomático. O fibrolipoma é a variante mais comum desta neoplasia, caracterizado pela presença de tecido adiposo e fibroconjuntivo. O presente artigo tem como objetivo relatar um caso clínico de fibrolipoma, ressaltando seus aspectos clínico e histopatológico

[Soft-tissue tumors: primary excision or wait and see?]. / Lipom, Atherom, Fibrom. Wann muss ein Weichteiltumor raus?

Soft tissue tumors are relatively commonly seen lesions in the doctor's office. An initial differentiation between malignant and benign tumors is usually possible on the basis of the case history and a careful physical examination. In adults, primary excision under local anesthesia is the treatment of choice in many cases, while in children and in the case of large tumors suspected of being malignant, a histological diagnosis must always be obtained. A number of procedures are available for biopsy taking. If the definitive histological work-up confirms malignancy, or if the findings are uncertain, the diagnostic investigation should be extended to include such imaging procedures as CT scanning or MRI.

Giant submucosal lipoma of the cecum: report of a case and review of literature.

Lipoma of the colon is a relatively rare benign tumor. A case with intermittent subacute colon obstruction due to a giant lipoma of the cecum is reported. A 51-year-old woman presented with intermittent, abdominal crampy pain in the right upper and lower quadrants, accompanied by alternative episodes of diarrhea and constipation. She had had similar symptoms over the last three months. A double-contrast barium enema showed a large (approx. 7 cm in diameter) polypoid mass occluding the lumen of the cecum and the ascending colon. Colonoscopy revealed a submucosal mass suspected of benign tumor but too large for endoscopic resection. Surgery revealed a hard elongated mass in the right colon, which telescoped into the transverse colon and caused colo-colonic intussusception. Right hemicolectomy was performed and pathology documented a mature, submucosal lipoma of the cecum. Six years after the surgery, the patient has not showed any of the previous symptoms. Along with a review of the literature, the incidence, diagnosis complications and treatment of colonic lipomas are discussed.

Giant retroperitoneal lipoma: a case report

RACIONAL: O lipoma é a neoplasia mesenquimal mais freqüente, raramente localizada no retroperitônio. Na maioria das vezes, o diagnóstico diferencial pré-operatório com os lipossarcomas de baixo grau de malignidade é difícil de ser estabelecido. OBJETIVO: Apresentar um caso de lipoma gigante retroperitoneal em mulher de 32 anos que há 2 anos apresentava história de dor e tumor abdominal palpável. A ultra-sonografia abdominal e o enema opaco mostraram grande massa localizada no retroperitônio, que deslocava o ceco e o cólon ascendente. A laparotomia mostrou tumor encapsulado com 20 x 13 x 10 cm e 3.400 g de peso. O estudo histopatológico mostrou presença de lipoma retroperitonial. A paciente encontra-se bem, sem recidiva da doença, 17 anos após a cirurgia.

A case of sigmoid lipoma presenting with intussusception.

Colonic lipomas are rare, benign tumours that rarely produce symptoms. Presented here is a case where a sigmoid lipoma acted as lead point to produce intussusception.

Lipomas de colon: nuevas aportaciones a su diagnóstico / Colonic lipomas: new contributions to the diagnosis

Introducción. Los lipomas de colon ocupan el segundo lugar dentro de los tumores benignos de colon, son tumores formados por tejido adiposo bien diferenciado, con una estroma fibrosa de sostén. La mayoría de estos tumores son asintomáticos, aunque en ocasiones pueden producir complicaciones urgentes. Casos clínico. Se presentan 7 casos de lipomas de colon, diagnosticados en el Servicio de Cirugía General del Hospital Miguel Servet de Zaragoza, desde enero de 1993 hasta enero de 1997. Se trataba de 3 varones y 4 mujeres, todos ellos por encima de la sexta década de la vida El síntoma clínico que motivó su diagnóstico fue, en 4 pacientes, un cuadro de rectorragias causadas por el propio lipoma y en los otros 3 casos se presentó como un hallazgo causal, en uno de ellos en el marco de una angiodisplasia de colon y en los otros dos tras intervención urgente motivada por oclusión intestinal. En cuanto a su localización, tres de los lipomas se hallaban en el sigma, uno en el colon transverso y los tres restantes en el colon ascendente. Discusión. El lipoma de colon es una tumoración de localización submucosa y con máxima incidencia en ciego y colon ascendente, con escasa tendencia a la malignización. El síntoma clínico más frecuente es el dolor abdominal, seguido de alteraciones en el hábito intestinal y rectorragias. En la mayoría de los pacientes la colonoscopia y el enema opaco son pruebas diagnósticas concluyentes, pero en ocasiones es necesaria la utilización de técnicas más modernas como la ultrasonografía endoscópica y la TACT (tomografía computarizada combinada con aire). Se admite de forma general que el tratamiento quirúrgico de estos tumores debe realizarse cuando sean sintomáticos o si se han complicado de manera urgente. Conclusiones. Los lipomas de colon, aunque son tumoraciones benignas y de baja incidencia, pueden plantear problemas para su diferenciación de procesos neoplásicos malignos y del resto de tumoraciones submucosas, necesitando a veces técnicas diagnósticas definitivas. Su tratamiento debe ser individualizado, conociendo que su tendencia natural es la del crecimiento paulatino hasta alcanzar un tamaño en el que desencadenaría una urgencia quirúrgica, por lo que se puede defender su extirpación en los pacientes en la edad media de la vida y sin factores de riesgo quirúrgico (AU)

Lipoma de colon transverso como causa de intususcepción colónica / Lipoma of the transverse colon as cause of colonic intussuception

Se presentan 2 casos de intususcepción colónica secundaria a un lipoma de colon transverso, intervenidos en un período de 8 años, de similares características anatomoclínicas y sometidos a una colectomía segmentaria. Los lipomas son los tumores benignos extramucosos más frecuentes del colon, la mayoría de ellos asintomáticos. La forma clínica de presentación más relevante es la obstrucción intestinal crónica intermitente secundaria a una intususcepción colo-colónica. En el estudio preoperatorio son exámenes complementarios importantes la colonoscopia, el enema baritado y la TAC abdominal, que en conjunto permiten plantear un diagnóstico presuntivo correcto. Un cambio de posición dentro del colon de una lesión protruida en el enema baritado y/o en la colonoscopia sugiere la existencia de una invaginación colo-colónica. La incapacidad de descartar un cáncer de colon apoya la elección de un tratamiento quirúrgico radical en la mayoría de los casos

Intermittent intussusception caused by colonic lipoma.

Colonic lipomas are rare, usually small, and occur most often in the right colon, particularly in the cecum. They are most common in elderly women. Intermittent episodes of intussusception are not uncommon in patients with colonic lipoma, but they are usually caused by larger pedunculated lipomas. We report a 43-year-old woman with a large colonic submucosal lipoma that induced intermittent colocolic intussusception. The patient presented with symptoms of peptic ulcer, including intractable upper abdominal pain, which did not resolve with treatment. Abdominal sonography showed typical findings of intussusception caused by a lipoma, but the manifestations on barium enema and computed tomography mimicked a malignant colonic tumor. The patient's abdominal pain disappeared after right hemicolectomy and the tumor was demonstrated to be a lipoma. The postoperative course was uneventful; there was no evidence of recurrence at follow-up 6 months later. Physicians should be aware that surrounding organs should also be evaluated in cases of chronic peptic ulcer with intractable upper abdominal pain.

Lipomas colorretais: correlaçäo anatomoclínica de 29 casos / Colorectal lipomas: anatomoclinical study of 29 cases

Objetivo. Avaliar a ocorrência de lipomas colorretais, métodos diagnósticos e conduta terapêutica, com o intuito de estabelecer normas no atendimento dos portadores desta afecçäo. Casuística e Métodos. Revisadas autópsias feitas em período de 6 anos e estudados os prontuários de portadores de lipomas colorretais tratados entre 1965 e 1993, com ênfase ao quadro clínico, conduta diagnóstica e terapêutica. Os 29 portadores de lipomas intestinais submucosos foram distribuídos em três grupos. O grupo I, cujos lipomas foram detetados em necrópsias; o grupo II, com doentes sintomáticos, e um terceiro grupo de enfermos assintomáticos, com lipomas encontrados acidentalmente em peças cirúrgicas ressecadas por neoplasias ou durante procedimentos diagnósticos. Resultados. 0,6 por cento dos autopsiados apresentaram lipomas colorretais, situados, preferencialmente, no cólon direito, predominando em mulheres (70,0 por cento). No grupo II, a enterorragia foi o sintoma mais freqüente (54,5 por cento), seguida pela dor abdominal em cólica e por alteraçöes do hábito intestinal. A intussuscepçäo ocorreu em três doentes (27,3 por cento). Ao contrário da literatura, os lipomas sintomáticos localizaram-se, preferencialmente, no cólon esquerdo, sendo seu tamanho médio de 6,1cm. Os diagnósticos foram realizados por meio do enema opaco e, mais recentemente, pela colofibroscopia e tomografia computadorizada. Neste grupo, foram realizadas ressecçöes em dez doentes, sendo cinco amplas, três locais e duas endoscópicas. Um paciente eliminou, espontaneamente, seu lipoma. Lipomas múltiplos foram detetados em 30 por cento dos autopsiados e em 25 por cento do grupo assintomático. Nestes dois grupos, nenhum dos tumores era maior que 2,0cm de diâmetro. Conclusöes. Lipomas colorretais säo raros, quer na clínica diária, quer em autópsias. Antes do advento da colofibroscopia e da tomografia, a maioria dos doentes era submetida a ressecçäo extensa, na suposiçäo de doença maligna. Posteriormente, a polipectomia endoscópica e a ressecçäo local passaram a ser nossa conduta preferencial.

[Colorectal lipomas: anatomoclinical study of 29 cases]. / Lipomas colorretais: correlação anatomoclínica de 29 casos.

OBJECT: To evaluate the incidence of colorectal lipomas, its diagnostic methodology and therapeutic management. CASUISTIC AND METHODS: The reviewed necropsies performed in a six years period and the patients' records from colorectal lipomas cases treated up to 1965 until 1993 were studied enhancing the clinical presentation, their diagnosis and therapy. The 29 cases of submucosal intestinal lipomas were disposed in three groups. The first group with ten patients lipomas were detected at necropsies. The second group with 11 symptomatic patients and group three with 8 asymptomatic patients which lipomas were discovered accidentally in surgical specimens resected due to neoplasm or in the course of diagnostical procedure. RESULTS: 0.56% of patients who were submitted to necropsy disclosed colorectal lipomas situated preferentially in right colon and in female. Enterourhage was the most often symptom (54.5%) in the group two, followed by cramp abdominal pain. Intussusception appeared in three patients (27.3%). Contrary to the medical literature, the symptomatic lipomas were preferentially situated in left colon and its mean size was 6.1 cm. The diagnosis were performed through opaque enema and more recently by colofibroscopy and CT scan. Resections were performed in all patients: five were enlarged, three were local and other three were endoscopic resections. Multiple lipomas were detected in 30% of patients who were submitted to necropsy and in 25% of asymptomatic group. In both groups no tumor was larger than 2.0 cm of diameter. CONCLUSIONS: Colorectal lipomas are rare in both clinical presentation and necropsy. Before the advent of CT scan and colofibroscopy the majority of the patients were submitted to wide resections, in the assumption of malignancy. Afterwards the endoscopic polipectomy and local resection became our preferential management.

Magnetic resonance detection of myelodysplasia in children with Currarino triad.

PURPOSE: To evaluate the role of MRI in the detection of myelodysplasia in children with Currarino triad. MATERIALS AND METHODS: Six patients (two girls, four boys, aged 7 months-14 years, mean age 6 years) were studied with MRI, voiding cystourethrogram and barium enema or fistulography. CT and ultrasonography were also performed in two patients. RESULTS: All patients presented with partial agenesis of the sacrum. Three patients suffered from an intermediate form of anorectal malformation (ARM) and three had a high form of ARM. The presacral masses consistent with Currarino triad included anterior meningocoele in three patients, lipoma in two patients and anterior lipomeningocoele in one patient. MRI diagnosed tethering of the spinal cord in four of six patients. The tethering of the spinal cord was due to a lipomeningocoele in one patient, an intradural lipoma in one patient and a lipoma of the filum in two patients. CONCLUSION: The association of Currarino triad with tethered spinal cord seems more common than generally reported in the literature. Preoperative MRI of the lumbosacral spine is essential to detect significant myelodysplasia in all patients with Currarino triad.