Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2023; 11(26): 6194-6199
Published online Sep 16, 2023. doi: 10.12998/wjcc.v11.i26.6194
Large colonic lipoma with a laterally spreading tumor treated by endoscopic submucosal dissection: A case report
Jun Yong Bae, Hun Kyu Kim, Yee Jin Kim, Se Woong Kim, Youngeun Lee, Chang Beom Ryu, Moon Sung Lee
Jun Yong Bae, Hun Kyu Kim, Yee Jin Kim, Se Woong Kim, Internal Medicine and Digestive Disease Center, Seoul Medical Center, Seoul 02053, South Korea
Youngeun Lee, Department of Pathology, Seoul Medical Center, Seoul 02053, South Korea
Chang Beom Ryu, Moon Sung Lee, Internal Medicine and Digestive Disease Center and Research Institute, Soon Chun Hyang University of School of Medicine, Bucheon 14584, South Korea
Author contributions: Bae JY, Ryu CB, and Lee MS contributed to conceptualization and supervision, and procedure; Bae JY, Kim KK, and Lee YE contributed to manuscript writing and editing; Bae JY, Kim KK, Kim YJ, Kim SW, and Ryu CB contributed to manuscript editing.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no potential conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang Beom Ryu, MD, PhD, Professor, Internal Medicine and Digestive Disease Center and Research Institute, Soon Chun Hyang University of School of Medicine, 170 Jomaru-ro, Bucheon-si, Gyeonggi-do, Bucheon 14584, South Korea. ryuchb@gmail.com
Received: May 27, 2023
Peer-review started: May 27, 2023
First decision: July 23, 2023
Revised: August 2, 2023
Accepted: August 17, 2023
Article in press: August 17, 2023
Published online: September 16, 2023
Processing time: 104 Days and 3.4 Hours
Abstract
BACKGROUND

Since fat does not transmit electrical energy well, delayed perforation and post-polypectomy syndrome due to electrical thermal injury are concerns in the endoscopic removal of colonic lipoma. The endoscopic submucosal dissection (ESD) technique concentrates electrical energy conducts to the submucosa, not the adipose tissue. This helps to minimize electrical thermal injury, especially in the case of large colonic lipomas. In rare cases, such as colonic lipomas accompanied by mucosal lesions, it is difficult for endoscopists to decide how to safely remove them.

CASE SUMMARY

A 78-year-old man underwent colonoscopy for colorectal cancer screening. During colonoscopy, a yellowish submucosal tumor with positive cushion sign was observed in the ascending colon measuring about 4.5 cm. A nodular mucosal lesion of about 2.5 cm was observed on the mucosal surface of the lipoma. The lipoma was so large that it occupied much of the inside of the colon, making it difficult to see the entire laterally spreading tumor (LST) at once. The LST was confined to the surface of the lipoma, which had a semipedunculated shape with a wide neck. The margin of the LST was not observed at the neck of the lipoma. ESD was performed and the colonic lipoma with the LST was successfully removed without complications. After 3 d of hospitalization, the patient was discharged without any symptoms. The final pathology report showed that the lesion consisted of submucosal lipoma and tubulovillous adenoma with low-grade dysplasia.

CONCLUSION

ESD is effective and safe for treating a large colonic lipoma with an LST by minimizing electrical thermal injury.

Keywords: Colonic lipoma; Endoscopic submucosal dissection; Laterally spreading tumor; Tubulovillous adenoma; Electrical injury; Case report

Core Tip: Most colonic lipomas are asymptomatic and do not require removal. Mucosal lesions of colorectal lipomas are rarely observed, but removal is necessary if there is a precancerous mucosal lesion such as tubular adenoma or tubulovillous adenoma. Due to the poor electrical conductivity of fat, excessive electrical energy during the endoscopic removal can cause complications. Endoscopic submucosal dissection is a preferred technique to minimize electrical thermal injury, especially for large colonic lipomas with a mucosal lesion.