Rectal angiolipoma: A case report and review of literature

Table 1 Gastrointestinal angiolipomas defined in literature

Literature	Localization	Case(age/sex)	Polyp size	Polyp peduncle	Symptom	Preoperativediagnosticimagingmethods(exceptendoscopicprocedure)	Therapy	Follow-up(F/U)/recurrence
Jensen EH et al[9] 2006	Esophagus	85 yr/M	39 mm x 25 mm	Pedunculated large polyp	A 2-mo dysphagia to solids foods, complete esophageal obstruction; had prolapsed to the level of the GE junction	CT , EUS	Anterior esophagotomy, transsection of polyp using an endoscopic stapling device (open surgical excision)	No F/U
DeRidder Ph et al[10] (1989)	Stomach	59 yr/M	6 mm	Submucosal well demarcated mass	Chronic occult GI bleeding		Laparotomy- excision	12 mo/No recurrence
McGregor DH et al[11] (1993)	Stomach	69 yr/M	50 mm x 40 mm x 20 mm	Gastric submucosal mass on great curvature, without peduncle	Chronic hemorrhage and severe anemia		Exploratory laparotomy, mass resection	30 mo/No recurrence
Hunt J et al[12] (1996)	Stomach	27 yr/F	80 mm x 55 mm x 45 mm	Large polypoid mass with large peduncle	Suggestive of intussusception through the pylorus, acute GI hemorrhage		Exploratory laparotomy, distal partial gastrectomy, Billroth I gastric reconstruction, resection of polyp	not given/ No recurrence
Mohl W et al[14] (2004)2	Duodenum, Colon	The first was 66 yr/M, the second was 75 yr/F (2 pts with 1 duodenal and colonic A-L other duodenal A-Ls)	1st-10 mm located near papilla of Vater, and colon 2nd-23 mm at the upper duodenal knee	Both with peduncle	1st acute, 2nd chronic GI bleeding Upper GI bleeding due to duodenal A-L		Endoscopic snare polypectomy for 2 duodenal and for 1 colonic A-Ls	not given/ No recurrence
Jung IS et al[15] (2004)	Duodenum	60 yr/F	35 mm x 4 mm	With peduncle	Dyspepsia for 6 mo	EUS	Endoscopic polypectomy	No F/U
Kaneko T et al[16] (1996)1	Meckel’s diverticulum accompanied A-L				Intussusception
Ferrozzi F et al[3] (1998)	Ileal				With tuberous sclerosis	CT
Manner M et al[17] (2001)	Proximal ileum	71 yr/F	38 mm	With peduncle	Occult bleeding, ileoileal intussusception	US, CT	Small bowel resection
Kwak HS et al[18] (2003)	Small bowel/ proximal ileum	75 yr/M	30 mm	Intraluminal lobulated polypoid mass with peduncle	Epigastric discomfort, loss of appetite, weight loss	Enteroclysis, MRI	Surgery	No F/U
Aouad K et al[19] (2000)	(Bauhin valve) ileocecal valve				Gastrointestinal hemorrhage
Kato K et al[20] (1999)1	Ileocecal valve	69 yr/M	52 mm x 50 mm x 40 mm	Without peduncle, a submucosal smooth surface mass A-L	3-d right lower quadrant abdominal pain	Contrast enhanced abdominal CT	Laparoscopy-assisted ileocecostomy, and a side-to- side anastomosis extracorporeally (a minimally invasive laparoscopic technique)	5 yr/No recurrence
Saroglia G et al[21] (1996)	Ileocecal valve	55 yr/M	55 mm	Submucousal mass	Invagination	Barium contrast graphy	Surgery	No F/U
Vandamme J et al[22] (1964)	Descending colon	43 yr/M	150 mm x 40 mm	With peduncle	GI bleeding and non painful sub- obstruction by invagination	Barium contrast graphy	Surgery, colon resection	not given/ No recurrence
Okuyama T et al[23] (2002)	Sigmoid colon	49 yr/M	65 mm x 23 mm	Pedunculated polyp with smooth surface	Asymptomatic, during routine exam positive fecal blood	Double contrast enema, enhanced CT	Hemostatic clip and endoscopic electro- surgical polypectomy	No F/U
Chen YY et al[24] (2005)	Transvers colon	70 yr/M	50 mm	With peduncle	Colonic obstruction	US, Abdominal CT, Colonic barium enema, colonoscopic examination	Surgical segmental resection	2 yr/No recurrence
Kacar S et al	Rectum	70 yr/F	10 mm	With peduncle	Asymptomatic	-	Polypectomy performed by endoscopic polypectomy snare	6 mo/No recurrence Under F/U

¹Abstract of reference (full text not available);

²Three lesions of angiolipoma in two patients, were defined. GE: Gastroesophageal; A-L: Angiolipoma.

Table 2 Histopathological findings of cases in literature

Literature	Histopathological findings under light microscope
Jensen EH et al[9]	A submucosal polypoid mass, consisting of benign lipomatous tissue mixed with vascular channels, consistent with benign angiolipoma
DeRidder et al[10]	Submucosa contained a well demarcated nodule composed of flat, extending from the under surface of the muscularis mucosa to the deep margin of biopsy. There were separate, well developed small arteries and veins
McGregor D et al[11]	A circumbscribed, lobular, pinkish-tan soft ovoid mass showing proliferation of mature adipose tissue and vascular tissue surrounded by a thin to focally thick fibrous capsule in the submucosa, no definite fibrin trombi
Hunt J et al[12]	A solitary Peutz-Jeghers-type polyp showing typical glandular epithelium, overriding a 5 cm gastric angiolipoma
Mohl W et al[14]	2 submucosal duodenal angiolipomas, one with large central vessel and one colonic angiolipoma
Yung IS et al[15]	A submucosal lesion composed of mature adipose tissue and small vessels with fibrin thrombi within the vascular channels
Manner M et al[17]	An angiolipoma with 20% vascular component and mucosal ulceration
Kwak HS et al[18]	Mature, higly vascular adipose tissue consistent with angiolipoma
Kato K et al[20]	A circumbscribed proliferation of mature adipose and vascular tissue surrounded by a thin to focally thick fibrous capsule in the submucosa, with fibrin thrombi in small capillaries
Saroglia G et al[21]	Mature adipose and vascular tissue
Vandamme J et al[22]	Angiolipoma with multiple small vessels and adipose tissue
Okuyama T et al[23]	Encapsulated by a thin layer of connective tissue, arising in the submucosa and composed of mature adipose tissue and proliferating capillaries, many fibrin thrombi in capillary lumen
Chen YY et al[24]	Encapsulated by a thin layer of connective tissue arising from the submucosa, histologically was comprised of mature adipose tissue and proliferative blood vessels
Kacar S et al	Proliferated submucosal blood vessels and mature adipose tissue. There was no fibrin thrombus