Giant lipoma of the left mesocolon: Radiological and surgical aspects. (2019)

• Record Type: Journal Article
• Authors: Koama, Adjirata; Zongo, Nayi; Nde/Ouédraogo, Nina Astrid; Kambou/Tiemtoré, Benilde Marie Ange; Lompo, Olga Melanie; Sanou, Adama; Diallo, Ouséni; Lougué/Sorgho, Claudine; Cissé, Rabiou
• Is Part Of: International journal of surgery case reports. Volume 58(2019)
• Page Start: 190
• Page End: 192
• Publication Date: 2019
• Subjects: Lipoma -- Left mesocolon -- Scan -- MRI -- TEP scan -- Hemicolectomy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.04.029
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Epidemiology: Lipoma of the mesocolon is a rare tumour less described in the literature. Diagnosis: It generally involves large masses. Clinically, it is often asymptomatic. When they exist, these symptoms are less specific and generally due to the large size of the tumour (compression, invagination, hernia). Imaging, especially TDM and MRI are an important step of the preoperative diagnosis. In imaging as in anatomopathology, lipoma-like liposarcoma is the main differential diagnosis. A differential diagnosis with lipoma-like sarcoma must be done. Treatment: Treatment is surgical. However, there are variations in the surgical procedures. Some authors had carried out lumpectomy. In our case, we carried out a left colectomy removing the tumour and the mesocolon, as well as the satellite lymph nodes. Each approach has its arguments, i.e. a conserving treatment exposing to repetition if the histological and/or immunochemistry data come out less reassuring, and a more secure and less invasive treatment. There is no consensus on the procedure which depends on the teams. Abstract: Introduction: Abdominal masses are common in digestive surgery and gastro-enterology units. However, meso-intestinal lipomas remain rare and lipoma of the left colon uncommon. We report a case of giant lipoma of the left mesocolon whose diagnosis was highly guided by radiological examinations. Presentation of case: A female patient aged 56, consulted for left subcostal abdominal pains. The clinical examination showed an abdominal mass occupying the left hemiabdomen. The abdominal-pelvic CT scan highlighted a large abdominal-pelvic mass in the left abdomen. Abdominal-pelvic MRI revealed a large fatty mass spreading from the front subphrenic space up to the level of the left iliac fossa, non-suspected and compatible with lipoma. FDG-Pet Scan had not revealed pathological fixing. The mass appeared like a total gap space. Exploratory surgery revealed a lipoma mass in the left mesocolon. Hemicolectomy was performed taking away the mass. Histology confirmed the diagnosis of lipoma and the outcome was favourable. Discussion: Our case represents the fourth case of mesocolon lipoma described in the literature. Imaging, especially TDM and MRI are an important step of the preoperative diagnosis. The surgery consists of either a lumpectomy or a colectomy. Conclusion: Lipoma of the left mesocolon is exceptional. Radiological examinations provide most arguments to suggest lipoma. However the organ's diagnosis is provided by surgical exploration and the certainty diagnosis by pathological examination. Treatment is surgical.