João Mafalda, Cunha Inês, Gravito-Soares Elisa, Gravito-Soares Marta, Amaro Pedro, Figueiredo Pedro
Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal.
Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
GE Port J Gastroenterol. 2021 Feb 5;29(1):45-50. doi: 10.1159/000513967. eCollection 2022 Jan.
Colonic lipomas are common mesenchymal tumours. They are usually asymptomatic and incidentally diagnosed during endoscopic or radiological examinations. Taking into account their typical endoscopic and radiological features and benign nature, tissue sampling, resection or follow-up are generally not required.
A 61-year-old woman with poor surgical fitness presented with colonic subocclusion and lower gastrointestinal bleeding. A colonoscopy performed 1 month earlier showed a large polypoid lesion with necrotic and ulcerated areas occupying the lumen of the proximal ascending colon with inconclusive histology. An abdominopelvic computed tomography scan with intravenous contrast was done revealing a cecal-colonic intussusception of a heterogeneous mass. The patient was successfully managed conservatively. A delayed revision colonoscopy showed a significantly smaller atypical subepithelial lesion with no necrosis or ulceration. A single, large and deep incision with a pre-cut needle-knife® allowed the direct collection of lesion tissue using standard biopsy forceps through the so-called single-incision needle-knife® (SINK) biopsy technique. Histological examination was compatible with submucosal lipoma. After 18 months of follow-up, the patient remains asymptomatic.
DISCUSSION/CONCLUSION: Colonic lipoma complications are rare and can lead to misdiagnosis; in general, they are surgically managed. A conservative approach and a minimally invasive endoscopic procedure allowed a definite diagnosis avoiding the morbidity and mortality of a major surgical intervention in a high-risk patient.
结肠脂肪瘤是常见的间充质肿瘤。它们通常无症状，在内镜检查或影像学检查时偶然被诊断出来。鉴于其典型的内镜和影像学特征以及良性性质，一般不需要进行组织采样、切除或随访。
一名手术耐受性差的61岁女性出现结肠不全梗阻和下消化道出血。1个月前进行的结肠镜检查显示一个大的息肉样病变，伴有坏死和溃疡区域，占据了升结肠近端的管腔，组织学检查结果不明确。进行了腹部盆腔增强计算机断层扫描，显示盲肠-结肠套叠，有一个不均匀的肿块。该患者通过保守治疗成功治愈。延迟的复查结肠镜检查显示一个明显较小的非典型上皮下病变，无坏死或溃疡。使用预切开针刀®进行单次大而深的切口，通过所谓的单切口针刀®（SINK）活检技术，使用标准活检钳直接采集病变组织。组织学检查结果与黏膜下脂肪瘤相符。经过18个月的随访，患者仍无症状。
讨论/结论：结肠脂肪瘤并发症罕见，可导致误诊；一般采用手术治疗。保守方法和微创内镜手术能够明确诊断，避免了对高危患者进行重大手术干预所带来的发病率和死亡率。
