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Ji S, Chae HK, Borst L, Hong YJ. Ultrasonographic features of a gastric submucosal lipoma in a cat: A case study. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2024; 65:906-909. [PMID: 39219613 PMCID: PMC11339904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
A 7-year-old Korean shorthair cat was admitted to our hospital with chronic constipation. Abdominal ultrasonography incidentally revealed a focal asymmetric gastric mass. The mass was submucosal and hypoechoic without loss of wall layering. Histopathological examination revealed a gastric submucosal lipoma (GSL). Although there have been reports of gastric submucosal fat infiltration in cats, there have been no reports regarding GSL. To our knowledge, this is the first report describing the ultrasonographic characteristics of GSL in a cat. Gastric submucosal lipoma should be considered as a differential diagnosis when a focal hypoechoic submucosal mass without loss of wall layering in the stomach is observed on ultrasound images. Key clinical message: This case report describes the ultrasonographic characteristics of GSL in a cat and aims to provide useful information for the diagnosis of lipoma occurring in the feline gastrointestinal tract. The ultrasonographic features and histological results we describe should be helpful in diagnosing submucosal lipoma in cats with similar conditions.
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Affiliation(s)
- Seoyeoun Ji
- Department of Veterinary Radiology (Ji) and Department of Veterinary Internal Medicine (Chae) and Department of Veterinary Surgery (Hong), Western Referral Animal Medical Center, Seoul 04101, Republic of Korea; College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea (Ji, Chae); Clinical Pathology, Antech Diagnostics, 17620 Mount Herrmann Street, Fountain Valley, California 92708, USA (Borst)
| | - Hyung-Kyu Chae
- Department of Veterinary Radiology (Ji) and Department of Veterinary Internal Medicine (Chae) and Department of Veterinary Surgery (Hong), Western Referral Animal Medical Center, Seoul 04101, Republic of Korea; College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea (Ji, Chae); Clinical Pathology, Antech Diagnostics, 17620 Mount Herrmann Street, Fountain Valley, California 92708, USA (Borst)
| | - Luke Borst
- Department of Veterinary Radiology (Ji) and Department of Veterinary Internal Medicine (Chae) and Department of Veterinary Surgery (Hong), Western Referral Animal Medical Center, Seoul 04101, Republic of Korea; College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea (Ji, Chae); Clinical Pathology, Antech Diagnostics, 17620 Mount Herrmann Street, Fountain Valley, California 92708, USA (Borst)
| | - Yeon-Jung Hong
- Department of Veterinary Radiology (Ji) and Department of Veterinary Internal Medicine (Chae) and Department of Veterinary Surgery (Hong), Western Referral Animal Medical Center, Seoul 04101, Republic of Korea; College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea (Ji, Chae); Clinical Pathology, Antech Diagnostics, 17620 Mount Herrmann Street, Fountain Valley, California 92708, USA (Borst)
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Zhang LX, Wang YF, Hu XJ, Qi J, Liang W. Chronic abdominal distention caused by diffuse nodular ileal and mesenteric lipomatosis: A case report. Medicine (Baltimore) 2024; 103:e39171. [PMID: 39093791 PMCID: PMC11296449 DOI: 10.1097/md.0000000000039171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024] Open
Abstract
RATIONALE Diffuse intestinal and mesenteric lipomatosis is a rare condition characterized by the overgrowth of adipose tissue in the intestines and mesentery. This case report aims to highlight the rare occurrence of chronic abdominal distention caused by this disease and its unique invasion into the muscle layer, which has not been previously reported. PATIENT CONCERNS A 36-year-old woman with a 7-year history of abdominal distension was admitted to our hospital's Department of Gastrointestinal Surgery. DIAGNOSE Abdominal and pelvic computed tomography revealed diffuse small intestinal lipomatosis. INTERVENTIONS The patient underwent surgery. We performed an open-field ilectomy involving removal of all lipomatous intestines (250 cm). OUTCOMES During the surgery, diffuse nodular ileal and mesenteric lipomatosis was confirmed, characterized by the presence of multiple nodular lipomas within the submucosal and muscular layers. The surgical intervention involved the resection of 250 cm of the affected ileum, followed by jejunoileal anastomosis. Postoperative pathology confirmed the diagnosis, with lesions observed in both the submucosa and muscle layers. The patient showed significant improvement in symptoms, with normal intestinal function and weight gain observed over a 10-month follow-up period, and no signs of recurrence. LESSONS Diffuse intestinal and mesenteric lipomatosis can lead to long-term abdominal distension. Additionally, it may be involved in the muscle layer of the intestinal wall. Surgery is the primary treatment option for symptomatic intestinal lipomatosis.
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Affiliation(s)
- Li-xiao Zhang
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yong-fei Wang
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xiao-jie Hu
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jie Qi
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wei Liang
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei, China
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3
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Chaouch MA, Taieb AH, Maaref M, Baccari L, Saad J, Noomen F. Laparoscopic resection of a gastric lipoma following massive upper gastrointestinal bleeding: A case report. Int J Surg Case Rep 2024; 120:109876. [PMID: 38878729 PMCID: PMC11226956 DOI: 10.1016/j.ijscr.2024.109876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
IMPORTANCE AND BACKGROUND Gastric lipomas are rare submucosal tumours that account for less than 1 % of all stomach tumours. Despite their benign nature, they can lead to significant clinical manifestations such as gastric outlet obstruction and massive gastrointestinal haemorrhage. CASE PRESENTATION We report the case of a 50-year-old woman with no prior comorbidities, presenting with severe upper gastrointestinal bleeding. Diagnostic imaging and endoscopy identified a submucosal mass in the prepyloric area, later confirmed to be a gastric lipoma. The surgical intervention involved laparoscopic resection of the mass. DISCUSSION This case underscores the importance of considering gastric lipomas in differential diagnoses of gastrointestinal bleeding. While often asymptomatic, their potential to cause acute complications necessitates awareness among clinicians. The management strategies range from observational approaches in asymptomatic cases to surgical excision in symptomatic cases. CONCLUSIONS Gastric lipomas, though rare and often benign, can present with life-threatening complications. Accurate diagnosis using a combination of endoscopy and imaging, particularly CT scans, is critical for effective management. Surgical removal remains the definitive treatment for symptomatic lipomas, highlighting the need for a tailored approach based on the tumour's characteristics and location.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia.
| | - Ahmed Hadj Taieb
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Maaref
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
| | - Louay Baccari
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
| | - Jamal Saad
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
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Qin H, Zhao YW, Wang XZ, Jiang L, Liu Q, Li ZW, Zhao GS. A case report of small intestinal volvulus caused by lipomatosis of the small intestine successfully treated with enterectomy. Front Oncol 2024; 14:1415211. [PMID: 39007103 PMCID: PMC11239392 DOI: 10.3389/fonc.2024.1415211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
Small intestinal lipomatosis is a rare condition that presents a diagnostic challenge due to the absence of identifiable clinical symptoms and limitations of small intestine examination methods. Consequently, preoperative diagnosis is difficult and only a limited number of cases have been documented in the scientific literature. Here, we report a rare case of volvulus caused by small intestinal lipomatosis. A 58-year-old female patient was tentatively diagnosed with acute ileus. The whirl sign was detected using abdominal three-dimensional enhanced computed tomography, along with marked local intestinal dilation and multiple irregular fat-like containing lesions. During surgery, abnormal dilation of the small intestine between 80 and 220 cm from the ileocecal valve was detected and the affected intestine displayed a folded and twisted configuration. Examination of the resected intestine showed that the inner wall of the diseased intestinal lumen was covered with more than 100 lipomas of different sizes, the largest of which measured ~8.0 cm in diameter. Based on clinical symptoms alone, it was difficult to identify the cause of intestinal volvulus before surgery. Complete resection of the affected small intestine and subsequent pathological analysis yielded a definitive diagnosis of small intestinal lipomatosis. While small intestinal lipomatosis is a rare condition, prognosis is favorable if diagnosed early and treated appropriately. The application of three-dimensional enhanced computed tomography imaging can aid in accurate diagnosis, while complete resection of the affected small intestine is crucial to improve patient prognosis.
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Affiliation(s)
- Hao Qin
- Department of Acute abdominal surgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yu Wei Zhao
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
| | - Xiao Zhou Wang
- Department of Emergency surgery, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
| | - Lei Jiang
- Department of Emergency surgery, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
| | - Qiang Liu
- Department of Emergency surgery, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
| | - Zhan Wu Li
- Department of Emergency surgery, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
| | - Guang Sheng Zhao
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian Universtity, Dalian, Liaoning, China
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Sahni M, Daga R, Jangir N, Singh S, Sharma R. Management of a Rare Challenging Case of Duodenal Ampullary Lipoma. Indian J Surg Oncol 2024; 15:322-324. [PMID: 38817998 PMCID: PMC11133299 DOI: 10.1007/s13193-023-01857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/29/2023] [Indexed: 06/01/2024] Open
Abstract
Duodenal lipoma is a very rare entity with limited case reports present in literature. But duodenal ampullary lipomas are even more rare in nature. Owing to the recent advances in endoscopy and modern imaging techniques, more cases are being diagnosed and treated. However, challenge lies in performing a less invasive and least morbid procedures to treat them surgically in such complex location of tumour. To study the diagnosis and treatment of duodenal ampullary lipoma in a young male patient and challenges faced during surgical management. A 15-year-old young boy presented to us with complaints of intermittent upper gastrointestinal bleed and jaundice since last 2 months. At admission, his serum haemoglobin was 3 g% for which he was transfused 3 units of packed blood cells for optimization. On further evaluation, CT scan abdomen revealed 71 × 49 mm large heterogeneous mass in D3 segment of duodenum causing duodeno-duodenal intussusception involving D1 and D2 segment along with ampullary region with mass being the lead point. There was compression of CBD with dilatation measuring 11 mm in diameter and mild IHBR dilatation. UGIE revealed narrowing at D1-D2 junction due to polypoidal lesion with overlying smooth mucosa with no active bleeding point identified. His blood parameters were normal except for low haemoglobin (before blood transfusion) and total serum bilirubin of 2.3 mg/dl.He was optimized for surgery and underwent exploratory laparotomy with duodenotomy at D2 with mass excision of 7 × 5 cm sessile polyp with base over ampulla followed by plastic repair of sphincter of Oddi (pancreas preserving procedure). He was started on oral liquids on POD 3 and was discharged on normal diet by POD 7 with an uneventful recovery. Result of histopathological report revealed, on gross cut section, the presence of mass of 7 × 5 × 3 cm size with smooth mucosa and fibrofatty tissue. On microscopic examination, diagnosis of submucosal lipomatous polyp was made. Our case report indicated duodenal ampullary lipoma is extremely rare entity. The symptoms are nonspecific and CT scan abdomen is the first investigation of choice for diagnosis. The treatment depends on the patient's condition as well as the size and position of the tumour. In our case report, the tumour base was exactly at the level of ampulla where we performed complex procedure of local excision of mass with sphincteroplasty avoiding major Whipple procedure for such benign condition. It provided rapid postoperative recovery to the patient.
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Affiliation(s)
- Manish Sahni
- Department of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Ram Daga
- Department of Surgical Gastroenterology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Nishant Jangir
- Department of Surgical Gastroenterology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Suresh Singh
- Department of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Rajgovind Sharma
- Department of Surgical Oncology, M.G. Medical College and Hospital, Jaipur, Rajasthan India
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Lu T, Kan J, He X, Zou J, Sheng D, Xue Y, Wang Y, Xu L. Gastric Submucosal Fat Accumulation Is Associated with Insulin Resistance in Patients with Obesity. Obes Surg 2024; 34:534-541. [PMID: 38191965 PMCID: PMC10811089 DOI: 10.1007/s11695-023-07014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Ectopic fat accumulation plays a significant role in obesity-related metabolic dysfunction, and few studies have reported an association between ectopic gastric fat and metabolic risk factors. We aim to fulfill this need by assessing the degree of gastric submucosal fat accumulation in pathologic sections of 190 sleeve gastrectomy specimens. METHODS Study patients were divided into two groups (D1 and D2) based on whether fat accumulation exceeded 1/3 of the submucosa of the stomach. Demographic and metabolic risk factors were compared between the two groups. Metabolic risk variables that might be associated with the degree of fat accumulation were screened in the original cohort. After balancing for possible confounders, the robustness of the correlations was assessed using binary and conditional logistic regression analyses. RESULTS All study patients had fat accumulation in the submucosa of the stomach. C-reactive protein (CRP), body mass index (BMI), visceral fat area (VFA), and insulin resistance (IR) were higher in the D2 group than in the D1 group in the original cohort (P < 0.05). Logistic regression analysis showed that BMI and IR may be associated with increased fat accumulation. After balancing variables other than obesity indicators and IR using propensity score matching, BMI and IR remained significantly different between the two groups (P < 0.05). Further analysis of the matched cohort using two logistic regression analyses showed that IR was an independent risk factor for increased fat accumulation. CONCLUSION This study indicated that gastric submucosal fat accumulation was prevalent in patients with obesity and was associated with IR.
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Affiliation(s)
- Tao Lu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan Road, Nanjing, 210011, Jiangsu Province, China
| | - Jianxun Kan
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan Road, Nanjing, 210011, Jiangsu Province, China
| | - Xue He
- Department of Pathology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan Road, Nanjing, 210011, Jiangsu Province, China
| | - Jialai Zou
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan Road, Nanjing, 210011, Jiangsu Province, China
| | - Dandan Sheng
- Department of Nuclear Medicine, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan Road, Nanjing, 210011, Jiangsu Province, China
| | - Yating Xue
- Department of Pathology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan Road, Nanjing, 210011, Jiangsu Province, China
| | - Yan Wang
- Department of Pathology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan Road, Nanjing, 210011, Jiangsu Province, China
| | - Lijian Xu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan Road, Nanjing, 210011, Jiangsu Province, China.
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7
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Malla S, Razik A, Sharma R, Goyal A. Diffuse small bowel lipomatosis with intussusception. BMJ Case Rep 2021; 14:14/6/e242336. [PMID: 34130977 DOI: 10.1136/bcr-2021-242336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sundeep Malla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Abdul Razik
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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8
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Solano J, Herrera G, Cadena M, Cabrera LF, Isaac E, Pedraza M. Non surgical management for massive gastric lipomatosis. Int J Surg Case Rep 2019; 66:149-152. [PMID: 31846867 PMCID: PMC6920312 DOI: 10.1016/j.ijscr.2019.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/15/2019] [Accepted: 11/24/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Gastric lipomatosis (GL) is defined as a lipomatous lesion with diffuse infiltration of the submucosal layer by adipose tissue with multiple lesions and must be differentiated from gastrointestinal lipomas, which are solitary submucosal masses composed of well-differentiated adipose tissue surrounded by a fibrous capsule. GL are uncommon, represents 5 % of gastrointestinal tract lipomas and less than 1∼3 % of all gastric tumors. CASE PRESENTATION A 65-year-old woman, who underwent non-operatively approach by Gastric lipomatosis. Non-specific gastrointestinal symptoms and endoscopic examination ruled out the possibility of mucosal ulceration or bleeding. Endoscopic ultrasonography and abdominal CT that confirmed gastric lipomatosis. DISCUSSION Gastric lipomas are usually small, solitary and asymptomatic, and are hence often detected incidentally, surgical management in asymptomatic patients still be a in debate. CONCLUSION Non operative management in massive gastic lipomatosis is appropiate when the patient is asymptomatic without mucosal ulceration, regardless of the amount of gastric lipomas. Avoiding patient the morbidity of a total gastrectomy.
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Affiliation(s)
- Jaime Solano
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota Dc, Colombia; Department of Gastroenterology and Endoscopy, Fundación Santa Fe de Bogotá, Bogota Dc, Colombia
| | - Gabriel Herrera
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota Dc, Colombia; Deparmten of Ocologic Surgery, Fundación Santa Fe de Bogotá, Bogota Dc, Colombia
| | - Manuel Cadena
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota Dc, Colombia
| | - Luis Felipe Cabrera
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota Dc, Colombia; Departmen of General Surgery, Universidad El Bosque, Bogota, Colombia
| | - Efrain Isaac
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota Dc, Colombia; Departmen of General Surgery, Universidad El Bosque, Bogota, Colombia
| | - Mauricio Pedraza
- Departmen of General Surgery, Universidad El Bosque, Bogota, Colombia.
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Tabone RA, DeGreve T, Webb P, Yuide P. Jejuno-jejunal intussusception secondary to diffuse intestinal lipomatosis. J Surg Case Rep 2019; 2019:rjz354. [PMID: 31824643 PMCID: PMC6892380 DOI: 10.1093/jscr/rjz354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/03/2019] [Indexed: 11/12/2022] Open
Abstract
A 25-year-old man presented to the emergency department with severe abdominal pain and vomiting. He had previously presented 10 days prior with similar symptoms. Computed tomography imaging showed a large jejuno-jejunal intussusception. Multiple intestinal masses were identified intraoperatively with the rare diagnosis of intestinal lipomatosis later confirmed via histopathology. Diagnosis and management of rare surgical pathologies is always challenging. Intussusception should always be considered as a differential diagnosis for abdominal pain in adults, as adult intussusception is typically due to a structural abnormality with majority of cases requiring surgical intervention. Exploratory laparotomy with segmental resection and primary anastomosis proved to be a successful approach in our case, with the patient having an uneventful recovery. Follow-up has consisted of gastrointestinal endoscopy and colonoscopy, which have not demonstrated any further lipomas.
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Affiliation(s)
- Renee Angela Tabone
- General Surgery, Queensland Health, Logan Hospital, Brisbane, QLD 4131, Australia; Griffith University, School of Medicine, Gold Coast, QLD 4215, Australia
| | - Tom DeGreve
- General Surgery, Queensland Health, Logan Hospital, Brisbane, QLD 4131, Australia; Griffith University, School of Medicine, Gold Coast, QLD 4215, Australia
| | - Peita Webb
- General Surgery, Queensland Health, Logan Hospital, Brisbane, QLD 4131, Australia; Griffith University, School of Medicine, Gold Coast, QLD 4215, Australia
| | - Peter Yuide
- General Surgery, Queensland Health, Logan Hospital, Brisbane, QLD 4131, Australia; Griffith University, School of Medicine, Gold Coast, QLD 4215, Australia
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Sullivan IW, Hota P, Dass C. Gastric lipomas: a case series and review of a rare tumor. BJR Case Rep 2019; 5:20180109. [PMID: 31501708 PMCID: PMC6726183 DOI: 10.1259/bjrcr.20180109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022] Open
Abstract
The purpose of the study was to investigate and review the multimodality imaging findings of gastric lipomas. Seven patients with gastric lipomas identified by CT imaging at a single institution between 2003 and 2017 were retrospectively evaluated. Patient demographics, clinical presentation, non-invasive imaging, endoscopic, and pathological findings were recorded.The most common location for gastric lipoma was the gastric antrum (3/7). The mean lipoma size was 2.7 cm ± 0.8 cm. Six out of seven lipomas demonstrated homogenous fat attenuation with mean Hounsfield units (HU) between -80 and -120. A single lipoma measuring -50 HU demonstrated soft tissue septations. In addition to routine CT and MRI, gastric lipomas were diagnosed on the low-dose CT protocols such as coronary calcium scoring, renal stone, and positron emission tomography-CT (PET-CT). Our CT findings corroborate those reported previously. Soft tissue septations visualized in one lesion likely represented post-biopsy changes, adding this etiology to a differential which previously included only ulceration. Cases characterized by MRI are rare in the literature, and our study provides one such example. To our knowledge this study represents the first documentation of gastric lipomas on PET-CT and other low-dose CT imaging protocols.
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Affiliation(s)
- Ian W Sullivan
- Department of Radiology, Temple University
Hospital, Philadelphia, PA, USA
| | | | - Chandra Dass
- Department of Radiology, Temple University
Hospital, Philadelphia, PA, USA
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11
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Armas I, Brandão M, Guerreiro I, Guerreiro I, Lobo J, Freitas C, Pinto-de-Sousa J, de Sousa JA. Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction. AUTOPSY AND CASE REPORTS 2019; 9:e2018071. [PMID: 30863737 PMCID: PMC6394361 DOI: 10.4322/acr.2018.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/24/2018] [Indexed: 11/23/2022] Open
Abstract
Intestinal lipomatosis is rare and often asymptomatic but can present with intestinal obstruction. Occasionally, metastatic breast cancer is identified in the ovary before a breast primary is discovered. We report the case of a 50-year-old woman diagnosed with synchronous intestinal obstruction due to lipomatosis, and incidental ovarian metastases from breast cancer. The patient presented with a 12-day history of nausea, diffuse abdominal pain, and constipation. An abdominal x-ray showed air-fluid levels, and computed tomography documented small bowel distention. An explorative laparotomy was performed, which revealed small bowel distention, an obstructive lesion of the ileocecal valve, three terminal ileum lesions, ascites, and heterogeneous ovaries. Right ileocolic resection and left oophorectomy were performed. The pathological diagnosis revealed lipomatous submucosal lesion of the ileocecal valve and ileum, and 17 lymph nodes, which were all negative for malignant cells. The oophorectomy revealed ovarian metastasis from breast carcinoma. Ascitic fluid was positive for malignant cells. Mammography and breast/axillary ultrasonography showed a solid nodule of the left breast, ductal carcinoma, and multiple enlarged left axillary lymph nodes, which were positive for neoplastic cells. Immunohistochemical evaluation showed hormonal receptor positivity and C-erb2 negativity. Breast magnetic resonance imaging showed a 14 mm left nodule and a positron emission tomography scan revealed 18F-FDG uptake in the left breast, left axillary lymph nodes, right ovary, and peritoneum. The tumor was staged as stage IV ductal breast carcinoma, cT1N1M1, Grade 2, Luminal B-like. The multidisciplinary oncological meeting proposed chemotherapy, and a re-staging breast MRI after chemotherapy, which showed a complete response. The patient started treatment with letrozole and remains disease-free 22 months after finishing chemotherapy.
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Affiliation(s)
- Isabel Armas
- Unidade Local de Saúde do Nordeste, General Surgery. Bragança, Portugal
| | - Mariana Brandão
- Instituto Português de Oncologia do Porto, Medical Oncology. Porto, Portugal
| | - Inês Guerreiro
- Instituto Português de Oncologia do Porto, Medical Oncology. Porto, Portugal
| | - Inês Guerreiro
- Instituto Português de Oncologia do Porto, Medical Oncology. Porto, Portugal
| | - João Lobo
- Instituto Português de Oncologia do Porto, Patology Department. Porto, Portugal
| | - Carla Freitas
- Centro Hospitalar Tâmega e Sousa, General Surgery. Penafiel, Porto, Portugal
| | - João Pinto-de-Sousa
- Centro Hospitalar Tâmega e Sousa, General Surgery. Penafiel, Porto, Portugal
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Chumbalkar V, Fu Z, Boguniewicz A, Singh TP, Lee H. Gastric Lipohyperplasia Presenting as Gastric Polyposis: the First Case Report and Morphometric Study of Additional 127 Bariatric Specimens with a Proposal for Diagnostic Criteria. Obes Surg 2019; 29:1805-1809. [PMID: 30737763 DOI: 10.1007/s11695-019-03740-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Excessive fat accumulation in the gastrointestinal tract is pathologic. Gastric mucosal polyposis due to excessive submucosal fat infiltration in a bariatric partial gastrectomy specimen was encountered, which has not been described in the literature. This observation prompted us to assess the extent of fat in gastric submucosa and study the incidence of mucosal polyposis due to submucosal fat accumulation in morbidly obese patients. MATERIALS AND METHODS Archived pathology slides of 128 bariatric partial gastrectomy specimens including the index case and 89 control cases obtained from Whipple's procedure were examined. The amount of submucosal fat was categorized as 0 (no fat), 1 (up to 70% fat), and 2 (> 70% fat). The maximum submucosal fat thickness was measured with the interval cutoff of 5 mm and 10 mm. RESULTS Of the 128 cases, 90 (70.3%) were category 1 and 31 (24.2%) were category 2. Maximum submucosal fat thickness was > 10 mm in 3 (2.3%) cases including the index case. The extent of submucosal fat accumulation correlated with the body mass index. The frequencies of category 2 and > 10 mm of fat thickness were higher in the bariatric patient group compared with the control group. CONCLUSION We propose a submucosal fat thickness of > 10 mm and diffuse (> 70%) fat accumulation as diagnostic criteria for gastric lipohyperplasia. Using these criteria, the prevalence of gastric lipohyperplasia in the morbidly obese population is 2.3%. A subset of these may present as gastric mucosal polyps.
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Affiliation(s)
- Vaibhav Chumbalkar
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, 12208, USA
| | - Zhiyan Fu
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, 12208, USA
| | - Ann Boguniewicz
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, 12208, USA
| | - Tejinder P Singh
- Department of Surgery, Minimally Invasive and Bariatric Surgery, Albany Medical Center, Albany, NY, 12208, USA
| | - Hwajeong Lee
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, 12208, USA.
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13
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Cieszczyk K, Pasnik I, Wronecki L, Ostrowska A, Bojar P, Marzec-Kotarska B, Szumilo J. Gastric lipomatosis. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2018. [DOI: 10.1515/cipms-2018-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Gastric lipomatosis is a condition characterized by the presence of multiple lipomas or diffuse mature adipose tissue infiltration within the gastric wall. The diffuse form is thought to be an extremely rare, with only few described cases. The lesion may be asymptomatic or associated with symptoms and signs depending on location and size. Treatment depends on clinical presentation, range and complications. In a symptomatic disease, it should be surgical, but conservative treatment is preferred for asymptomatic and solitary lesions. Among diagnostic methods, computed tomography and magnetic resonance imaging are thought to be the most valuable.
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Affiliation(s)
- Katarzyna Cieszczyk
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Iwona Pasnik
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Lech Wronecki
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Anna Ostrowska
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Pawel Bojar
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Barbara Marzec-Kotarska
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Justyna Szumilo
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
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14
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Kokosinska A, Rissi DR. Diffuse Infiltrative Colonic Lipomatosis in a Vietnamese Pot-bellied Pig. J Comp Pathol 2018; 162:47-49. [PMID: 30060842 DOI: 10.1016/j.jcpa.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
Diffuse infiltrative gastrointestinal lipomatosis (DIGIL) is characterized by widespread proliferation of adipose tissue within the submucosal and subserosal layers of the gastrointestinal tract. Here we describe a case of diffuse infiltrative colonic lipomatosis in a 3-year-old male Vietnamese pot-bellied pig. Gross anatomical changes included obesity with sparse small intestinal contents and no colonic contents. The colonic lumen was narrowed and the colonic wall was diffusely thickened (∼5 mm), white, homogeneous and soft. Other findings were vesical uroliths and mild fibrinous pneumonia. Histologically, the colonic submucosa and muscle layers were expanded and almost completely replaced by sheets of adipose tissue admixed with scant fibrovascular tissue. Other minor changes included mild fibrinous pneumonia, splenic lymphoid depletion and testicular atrophy. The colonic changes in the current case are consistent with those described for DIGIL. This is a rare condition in human beings and animals and has never been described in pigs.
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Affiliation(s)
- A Kokosinska
- Department of Pathology, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - D R Rissi
- Department of Pathology, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA; Athens Veterinary Diagnostic Laboratory, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA.
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15
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Aoyama S, Ami K, Fukuda A, Imai K, Chong JM, Ando M. Gastric lipomatosis treated by total gastrectomy: a case report. Surg Case Rep 2017; 3:126. [PMID: 29247384 PMCID: PMC5732123 DOI: 10.1186/s40792-017-0404-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/03/2017] [Indexed: 11/18/2022] Open
Abstract
Background Gastric lipomatosis is characterized by multiple gastric lipomas or a diffuse gastric infiltration of the submucosal or subserosal layer by the adipose tissue; diffuse-type gastric lipomatosis is an extremely rare condition. Here, we present the case of a patient with gastric lipomatosis treated by total gastrectomy. Case presentation A 54-year-old man diagnosed with gastric submucosal tumor in 2008 was referred to our hospital for further examination and treatment in September 2016. Upper gastrointestinal endoscopy revealed a submucosal tumor with an associated ulcer on the anterior wall of the lower body of the stomach. A compressing mass was observed on the anterior wall of the greater curvature and the posterior wall of the stomach. Following a biopsy of the submucosal tumor and ulcer, lipoma without malignancy was diagnosed by microscopy. A giant gastric lipoma was suspected because endoscopic ultrasound revealed a high-echoic lesion on the antral wall that extended to the stomach. Therefore, total gastrectomy was performed, and gastric lipomatosis was confirmed by a histological examination of the resected specimen. Conclusions Surgical treatment is a highly effective treatment for symptomatic gastric lipomatosis with extensive involvement or multiple lipomas and can be used for patient diagnosis.
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Affiliation(s)
- Shota Aoyama
- Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation, Toshima Hospital, 33-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Katsunori Ami
- Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation, Toshima Hospital, 33-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Akira Fukuda
- Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation, Toshima Hospital, 33-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Kenichiro Imai
- Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation, Toshima Hospital, 33-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Ja-Mun Chong
- Department of Pathology, Tokyo Metropolitan Health and Medical Treatment Corporation, Toshima Hospital, Tokyo, Japan
| | - Masayuki Ando
- Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation, Toshima Hospital, 33-1, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
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16
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Pei MW, Hu MR, Chen WB, Qin C. Diagnosis and Treatment of Duodenal Lipoma: A Systematic Review and a Case Report. J Clin Diagn Res 2017; 11:PE01-PE05. [PMID: 28892976 PMCID: PMC5583857 DOI: 10.7860/jcdr/2017/27748.10322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/05/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Duodenal lipoma is very rare with limited case reports present in literature. Owing to recent advances in endoscopy and modern imaging techniques, more cases are being diagnosed and treated. However, no systematic study of duodenal lipomas has been reported. AIM To study the diagnosis and treatment of duodenal lipoma in a female patient and review the relative literatures to enhance the knowledge of it. MATERIALS AND METHODS A literature search for 'duodenal lipoma' was performed on PubMed. Papers published from 1948 to 2016 in the English language were identified. Each article was then read in detail and analysed for clinical data, imaging features, diagnosis and therapy. Also, we hereby present a case of upper gastrointestinal obstruction secondary to multiple duodenal lipomas in a 67-year-old woman. The patient underwent a limited bowel resection with an uneventful recovery. RESULTS Literature review demonstrated 59 cases of duodenal lipoma, which indicate that duodenal lipomas are rare to occur but commonly found in the second part. The peak of incidence seems to be around the fifth and seventh decade of life. Duodenal lipomas may present as gastrointestinal bleeding, abdominal pain, obstruction or upper abdominal fullness. CT, MRI, Endoscopic Ultrasound (EUS), endoscopy are highly accurate diagnostic tools. The disease could be managed by endoscopy or surgery. CONCLUSION Our review of literature indicated duodenal lipoma is extremely rare. The symptoms are nonspecific and CT is the first choice for diagnosis. The treatment depends on the patient's condition as well as the size and position of the tumour.
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Affiliation(s)
- Mao Wei Pei
- Assistant Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
| | - Ming Rong Hu
- Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
| | - Wen Bin Chen
- Assistant Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
| | - Chao Qin
- Assistant Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
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17
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Duran Álvarez MA, Gómez López JR, Guerra Garijo T. Gastric Adenomyoma: The Unexpected Mimicker. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 24:198-202. [PMID: 29255751 DOI: 10.1159/000453302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/07/2016] [Indexed: 12/15/2022]
Abstract
Gastric adenomyoma is a rare benign tumor composed of epithelial structures and smooth muscle stroma. Here, we report an unusual case of gastric adenomyoma mostly composed of smooth muscle that was incidentally found during a laparoscopic intervention. On radiology, it mimicked an acquired hypertrophic pyloric stenosis in an adult patient, and pathologically it resembled a pure smooth muscle hamartoma. Complete submission of the lesion for histology was necessary to find the epithelial component and make the right diagnosis. As a mimicker of benign and malignant entities, gastric adenomyoma is usually an unexpected finding after surgery. The aim of this report is to analyze this adenomyoma variant in the setting of an unexplained thickening of the gastric wall, with explanations concerning histogenesis and biological potential.
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18
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Jayasundara J, Sellahewa CS, Hall AD, Patel RT. A case of gastroduodenal lipomatosis. Ann R Coll Surg Engl 2016; 98:e203-e205. [PMID: 27551904 DOI: 10.1308/rcsann.2016.0243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although sporadic lipomas are not uncommon in the upper gastrointestinal tract, diffuse gastroduodenal lipomatosis is a rare clinical entity. Medical literature reveals a limited number of such cases presenting with upper gastrointestinal obstruction or bleeding. We present the management experience of a 43-year-old woman who presented with intussusception causing high small-bowel obstruction secondary to jejunal lipomatosis. Computed tomography showed diffuse fatty thickening of the gastric wall in addition to multiple lipomas in stomach, duodenum and in the jejunum with jejunal intussusception. As complete resection of the affected segment was not possible, a side-to-side jejunal bypass was made. The patient remains well on review after 18 months.
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Affiliation(s)
- Jasb Jayasundara
- Russell's Hall Hospital, Dudley Group NHS Foundation Trust , Dudley
| | - C S Sellahewa
- Russell's Hall Hospital, Dudley Group NHS Foundation Trust , Dudley
| | - A D Hall
- Russell's Hall Hospital, Dudley Group NHS Foundation Trust , Dudley
| | - R T Patel
- Russell's Hall Hospital, Dudley Group NHS Foundation Trust , Dudley
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19
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Beninson JA, Keller JM, Hoenerhoff MJ. Diffuse Infiltrative Gastrointestinal Lipomatosis in a Guinea Pig (Cavia porcellus). Comp Med 2015; 65:420-423. [PMID: 26473346 PMCID: PMC4617333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/29/2015] [Accepted: 05/06/2015] [Indexed: 06/05/2023]
Abstract
An intact adult male guinea pig (Cavia porcellus) went into cardiopulmonary arrest during a surgical procedure, and efforts at resuscitation were unsuccessful. Gross examination revealed a gastric rupture along the greater curvature of the stomach, which was associated with free blood and ingesta in the abdominal cavity, and a 2-cm nodular, partially circumferential, soft-to-firm mass within the pyloric region. Histologically, the pyloric mass was composed of sheets of infiltrative adipocytes expanding the muscular wall. Similar infiltrative sheets of adipocytes were present adjacent to the rupture site and within the small intestine, cecum, and colon. These findings are consistent with diffuse infiltrative lipomatosis, an exceedingly rare condition in human and veterinary species. This report is the first description of this rare disease in guinea pigs, and the concurrent involvement of both the stomach and intestines has not been reported in any veterinary species.
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Affiliation(s)
- Jennifer A Beninson
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | - Jill M Keller
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark J Hoenerhoff
- Unit for Laboratory Animal Medicine, In Vivo Animal Core, University of Michigan, Ann Arbor, Michigan, USA
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20
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Familial Abdominal and Intestinal Lipomatosis Presenting with Upper GI Bleeding. Case Rep Gastrointest Med 2015; 2015:123723. [PMID: 26146574 PMCID: PMC4471306 DOI: 10.1155/2015/123723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/27/2015] [Indexed: 11/25/2022] Open
Abstract
Although lipomas are encapsulated benign tumors, systemic lipomatosis defines infiltrative nonencapsulated tumors resembling normal adipose tissue. Abdominal lipomatosis and intestinal lipomatosis are different clinicopathological entities with similar clinical symptoms. We describe here a case presenting with upper gastrointestinal bleeding from eroded submucosal lipoma at duodenum secondary to intestinal lipomatosis and abdominal lipomatosis.
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21
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Chum HH, Long CT, McKeon GP, Chang AG, Luong RH, Albertelli MA. Abdominal lipomatosis with secondary self-strangulation of masses in an adult rhesus macaque (Macaca mulatta). Comp Med 2014; 64:404-8. [PMID: 25402181 PMCID: PMC4236789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/02/2014] [Accepted: 06/06/2014] [Indexed: 06/04/2023]
Abstract
An 10-y-old, intact male rhesus macaque (Macaca mulatta) presented for bilateral scrotal swelling and a distended abdomen. A soft mass in the left upper quadrant of the abdomen was palpated. A barium study did not reveal any gastrointestinal abnormalities. Exploratory laparotomy revealed a large (1.25 kg, 15.0 × 13.0 × 9.5 cm), red and tan, soft, circumscribed, spherical mass within the greater omentum and 10 to 20 smaller (diameter, 1 to 4 cm), soft to firm masses in the mesentery and greater omentum. The resected mass was a self-strangulating abdominal lipoma, a pedunculated neoplasm composed of white adipocytes arising from peritoneal adipose tissue undergoing secondary coagulation necrosis after strangulation of the blood supply due to twisting of the mass around the peduncle. The smaller masses were histologically consistent with simple or self-strangulating pedunculated abdominal lipomas. The macaque presented again 9 mo later with a firm, 5.0-cm mass in the midabdomen, with intestinal displacement visible on radiographs. Given this animal's medical history and questionable prognosis, euthanasia was elected. Necropsy revealed numerous, multifocal to coalescing, 1.0- to 15.0-cm, pale tan to yellow, circumscribed, soft to firm, spherical to ellipsoid, pedunculated masses that were scattered throughout the mesentery, greater omentum, lesser omentum, and serosal surfaces of the gastrointestinal tract. All of the masses were pedunculated abdominal lipomas, and most demonstrated coagulation necrosis due to self-strangulation of the blood supply. To our knowledge, this report is the first to describe abdominal lipomatosis with secondary self-strangulation of masses in a rhesus macaque.
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Affiliation(s)
- Helen H Chum
- Office of Laboratory Animal Care, University of California Berkeley, Berkeley, California, USA.
| | - C Tyler Long
- Department of Laboratory Animal Resources, North Carolina State University, Raleigh, North Carolina, USA
| | - Gabriel P McKeon
- Department of Laboratory Animal Resources, North Carolina State University, Raleigh, North Carolina, USA
| | - Angela G Chang
- Department of Comparative Medicine, Stanford University, Stanford, California, USA
| | - Richard H Luong
- Department of Comparative Medicine, Stanford University, Stanford, California, USA
| | - Megan A Albertelli
- Department of Comparative Medicine, Stanford University, Stanford, California, USA
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Thakur B, Kishore S, Bhardwaj A, Kudesia S. Diffuse intestinal submucosal lipomatosis with incidental epidermal inclusion cyst of caecum clinically masquerading as carcinoma caecum. Rare Tumors 2014; 6:5380. [PMID: 25276322 PMCID: PMC4178275 DOI: 10.4081/rt.2014.5380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 12/03/2022] Open
Abstract
Symptomatic diffuse submucosal intestinal lipomatosis is a rare entity. Also few cases of epidermal inclusion cyst of caecum have been reported in literature. Here, we are presenting a rare case of intestinal submucosal lipomatosis with coincidence of epidermal inclusion cyst of caecum and presumptively diagnosed as carcinoma of ileocaecal region during surgery in a 55 years old male. Both are rare entity considering the location even they should be kept as a differential diagnosis in unusual cases of intestinal perforations with inconclusive radiological findings or clinical uncertainity.
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Affiliation(s)
- Brijesh Thakur
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences , Dehradun, India
| | - Sanjeev Kishore
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences , Dehradun, India
| | - Aparna Bhardwaj
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences , Dehradun, India
| | - Sandip Kudesia
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences , Dehradun, India
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