Published online Jan 26, 2019. doi: 10.12998/wjcc.v7.i2.209
Peer-review started: September 2, 2018
First decision: October 4, 2018
Revised: December 23, 2018
Accepted: December 29, 2018
Article in press: December 30, 2018
Published online: January 26, 2019
Colonic lipomas are rare, slow-growing benign tumors. Colonic lipomas are generally asymptomatic and are found incidentally. Although cases of cecal lipoma have been sporadically reported in the literature, the disease has not been systematically reviewed.
We present a 44-year-old man who underwent a routine physical check-up during which colonoscopic examination revealed an asymptomatic 1.5-cm cecal mass at the appendiceal orifice. Laparoscopic exploration was performed that also demonstrated a congested and erythematous appendix. En bloc resection of both the cecum and vermiform appendix was performed because of the suspicion of malignancy. Histopathological examination revealed a cecal lipoma composed of mature adipose tissue, and the appendix showed subclinical inflammation. Our procedures and findings were discussed, along with relevant English literature that was retrieved from the PubMed database from 2000 to 2017. Twenty-six cases, including ours, were reported. Consistent with the findings of the literature, it is difficult to obtain a definitive diagnosis by colonoscopic biopsy.
Surgery remains the treatment of choice for this condition. Intraoperative frozen pathological sectioning helped the surgeon decide the extent of surgery, and radical surgery was avoided. Excision of benign lesions occupying the appendiceal orifice may be indicated for the prevention of later development of acute appendicitis. The prognosis is generally good, with only one of the 26 reported patients complicated with acute appendicitis, who subsequently succumbed due to severe comorbidities and sepsis.
Core tip: All patients with cecal lipoma reported in the literature were treated with radical right hemicolectomy because malignancy could not be completely ruled out before surgery. However, in our presented case, intraoperative frozen histopathological sectioning helped the surgeon decide the extent of surgery, and radical surgery was avoided. Furthermore, excision of benign lesions occupying the appendiceal orifice may be indicated for the prevention of later development of acute appendicitis.