de Ruijter S H W, van Marle A G J, Doornewaard H, Melse J C
Universitair Medisch Centrum Utrecht, afd. Heelkunde, Postbus 85.500, 3508 GA Utrecht.
Ned Tijdschr Geneeskd. 2006 Sep 9;150(36):1990-3.
An 81-year-old woman had abdominal cramps, rectal bleeding since 2 weeks and weight loss. Colonoscopy showed an ulcerating tumour of about 4 cm in the transverse colon. Pathological examination of biopsies taken during colonoscopy indicated moderately active chronic colitis. Based on the colonoscopy findings, the tumour appeared to be malignant and laparotomy was performed and the transverse colon was resected. Pathological examination of the resected lesion revealed a submucosal lipoma. The patient recovered fully. Lipomas account for 4% of benign gastrointestinal tumours and 90% of lipomas are submucosal. Their presentation is often similar to malignant tumours. The naked fat sign after biopsy and the elasticity of the lesion are typical features encountered during colonoscopy. Given the high fat content of these lesions, they are easily discernible with CT and MRI. Lipomas with a diameter < 2 cm can be safely removed endoscopically. Larger lesions should be removed by segment resection.
一名81岁女性出现腹部绞痛、持续2周的直肠出血及体重减轻。结肠镜检查显示横结肠有一个约4厘米的溃疡性肿瘤。结肠镜检查时所取活检的病理检查显示为中度活动性慢性结肠炎。基于结肠镜检查结果，该肿瘤似乎为恶性，遂行剖腹手术并切除横结肠。切除病变的病理检查显示为黏膜下脂肪瘤。患者完全康复。脂肪瘤占胃肠道良性肿瘤的4%，其中90%为黏膜下脂肪瘤。其表现常与恶性肿瘤相似。活检后的裸脂征及病变的弹性是结肠镜检查时遇到的典型特征。鉴于这些病变脂肪含量高，CT和MRI很容易辨别。直径<2厘米的脂肪瘤可通过内镜安全切除。较大的病变应行节段性切除。
