Childhood giant omental and mesenteric lipoma

Giant omental lipoma, a rare etiology of right-iliac fossa pain in adult: A surgical case report

BACKGROUND

Omental lipoma is an uncommon abdominal tumor of mature fat cells. Those benign tumors are usually asymptomatic but occasionally can cause signs and symptoms based on their location, size, and presence of complications. Radiological investigations such as Abdominal ultrasonography (USG) and computed tomography (CT) are crucial to evaluate and diagnose intra-abdominal tumors, especially omental lipomas.

PRESENTATION

A 61-year-old male patient presented to our hospital with right iliac fossa pain. Physical examination and laboratory test results were normal. The performed abdominal CT scan revealed a large right-sided intraperitoneal mass measuring about 2.4 × 10 × 20 cm. Then, an ultrasound-guided biopsy was done and the picture was most consistent with lipoma. So, surgical intervention was decided and omental lipoma was completely exteriorized via a laparoscopic approach. The weight of the excised omental mass was 2.45 kg, measuring 23 × 18 × 7 cm. The resected specimens, including omental lipoma and omental lymph nodes, were sent for histopathological studies. The postoperative period was uneventful.

DISCUSSION

Omental lipoma is an unusual entity that occurs often in children and rarely in adults. The clinical features of omental lipomas include abdominal discomfort, abdominal lump, abdominal pain, nausea, and/or weight loss. Diagnosis of the omental lipoma relies on imaging and physical examination, which was normal in the presented case. Abdominal CT provides definitive fat content characterization and its localization within the omentum.

CONCLUSION

Due to the rare etiologic origin of omental lipomas, we report the case of a 61-year-old male with right iliac fossa pain, found to be caused by detected giant omental lipoma.

Primary Omental Lipoma in a Child: A Case Report and Literature Review

BACKGROUND

Lipoma is a common benign tumor derived from adipose tissue, with an incidence of nearly 10%. It is the most common mesenchymal tumor throughout the body. However, the pathogenesis of lipoma is not clear yet, and the increased incidence is attributable to obesity, elevated serum cholesterol, diabetes, trauma, radiation, familial predisposition, and chromosome. Primary omental tumor is a rare lipoma occurring in the greater omentum, most of which is reported in the form of clinical case reports. Nevertheless, primary omental tumor is even rarer in children. To date, there have been few reports of clinical cases.

CASE PRESENTATION

We report a rare case of primary omental lipoma in a 6-year-old boy. After an accidental fall, a CT scan found that he had a tumor in the left upper abdomen. He had no history of abdominal pain, abdominal mass, vomiting, etc. The boy was admitted to the hospital within 3 days, and was diagnosed with an intra-abdominal tumor. After admission, abdominal ultrasound and enhanced CT showed a 71 ×40 ×60 mm mass in the left middle abdomen, which was considered a lipoma. There was no abnormality in tumor markers. Through laparoscopic surgery, intraoperative exploration revealed that the tumor was located in the left mid-upper abdomen, and was yellow, solid, soft, and isolated. The intraoperative diagnosis was an omental lipoma. We used an ultrasonic knife to resect the omentum close to the base of the tumor. The tumor was completely resected, put in a retrieval bag and sealed. Finally, the left and right sides of the umbilical incision were extended to take out the tumor tissue. The child received liquid food 6 h after the operation and was discharged 3 days later. The postoperative pathological diagnosis was an omental lipoma. He was seen at follow-up 3 months after discharge and had no complaints, an abnominal ultrasound showed no tumor recurrence.

CONCLUSION

Primary omental lipoma in children is a rare benign tumor of the omentum. Its etiology and pathology are not clear. US, CT, and MRI can facilitate clinical diagnosis and preoperative evaluation. Laparoscopic surgery is an effective treatment, and the prognosis of children is favorable. This case is beneficial to improve the clinical knowledge of pediatric surgeons about this rare disease.

Imaging spectrum of mesenteric masses

Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential diagnosis with neoplastic, infectious, or inflammatory etiologies and can either be solid or cystic. Imaging features are critical for the diagnosis. We review the epidemiology, imaging spectrum, and differentiating features and treatment of mesenteric masses.

Benign mesenteric lipomatous tumor in a child: a case report and literature review

BACKGROUND

Lipomatous tumors are the most common type of soft-tissue tumors. Benign lipomatous tumors are lipomas and lipoblastoma. We herein report a case of benign mesenteric lipomatous tumor and the largest collection of known benign mesenteric lipomatous tumors in children in the literature.

CASE PRESENTATION

A 3-year-old girl presented with repeated dull abdominal pain and left abdominal mass swelling. On a physical examination, the child had a soft, moderately distended left abdomen that was not tender when palpated. Computed tomography and magnetic resonance imaging demonstrated a large fatty mass within the mesentery, measuring approximately 8 × 6 cm. The mass extended from the right upper quadrant to the lower pole of the kidneys. Laparotomy with resection of the mesenteric tumor was performed under general anesthesia. A well-capsuled tumor was a soft, yellow mass and found loosely attached to the mesenterium of the ileum. A histopathological examination demonstrated the lobular proliferation of mature adipocytes. Atypical lipoblasts were not seen. These features are compatible with benign lipomatous tumor, such as lipoma or lipoblastoma with maturation.

CONCLUSION

In conclusion, benign mesenteric lipomatous tumors tend to be large in size over 10 cm in longitudinal length. However, resection is well tolerated in the vast majority of cases with benign post-operative courses.

A Giant Childhood Mesenteric Lipoblastoma With Extensive Maturation

Abdominal lipoblastomas are uncommon soft tissue tumors in children and rarely arise from the mesentery. Due to intraabdominal location and slow growth, these masses can go unnoticed for long periods of time and often found on surgical exploration. We present a case of a 12-year-old male with years of abdominal distension accompanied by new onset early satiety that was found to have an intra-abdominal mass. He underwent an exploratory laparotomy revealing a large 33 x 27 x 15 cm rubbery mesenteric mass displacing the entire intra-abdominal contents, connected by a single vascular pedicle and encasing a loop of small intestine. The mass was resected and the patient did well without signs of recurrence. Histology confirmed the presence of mature adipocytes but on further cytogenetic analysis, a translocation between chromosomes 2 and 8 at the 12q arm was detected, which is often associated with lipoblastomas. This case represents the one of the largest mesenteric lipoblastomas that matured extensively to lipoma-like histology at the time of surgical resection.