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Abdomen » Gastrointestinal
Infarcted pelvic lipoma
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Presentation This 11 year-old male presented with emesis and intermittent crampy abdominal pain, worse since 3 days with pain radiating to both lower quadrants. Also, low grade fever was present.
 
 
 
Caption: Grayscale midline transverse image of lower abdomen and pelvis.
Description: This transverse image of the lower abdomen and pelvis demonstrates a diffusely hyperechogenic mass in the midline, posterior and superior to the bladder, displacing bowel loops laterally.
 
 
 
Caption: Grayscale midline sagittal image of lower abdomen and pelvis.
Description: This midline sagittal image of the lower abdomen and pelvis demonstrates a large, well-circumscribed, hyperechoic mass in the midline pelvis adjacent to the urinary bladder.
 
 
 
Caption: Midline transverse color Doppler image of pelvis.
Description: Midline transverse color Doppler image of pelvis shows absence of intrinsic vascularity in the mass.
 
 
Caption: Video 1
Description: Transverse sweep, lower abdomen through pelvis
 
 
Caption: Video 2
Description: Sagittal sweep, lower abdomen and pelvis
 
 
 
Caption: Frontal abdomen radiograph
Description: Frontal abdomen radiograph shows paucity of gas in the lower abdomen and pelvis with suggestion of soft tissue density structure in the midline pelvis concerning for mass.
 
 
 
Caption: Sagittal contrast enhanced CT scan of abdomen and pelvis
Description: Sagittal contrast enhanced CT scan of abdomen and pelvis demonstrates large, well-circumscribed mass of predominately fatty attenuation abutting the sigmoid colon, with central speculated soft tissue and scattered calcification, exerting mass effect on bladder and bowel loops.
 
 
 
Caption: Axial contrast enhanced CT of the pelvis
Description: Axial contrast enhanced CT scan of the pelvis demonstrates large, well-circumscribed mass of predominately fatty attenuation abutting the sigmoid colon, with central speculated soft tissue and scattered calcification, exerting mass effect on bladder and bowel loops.
 
Differential Diagnosis Germ cell tumor, pelvic sarcoma, lipoblastoma
 
Final Diagnosis
Infarcted pelvic lipoma
 
Discussion
Lipomas are benign tumors composed of mature adipocytes. They are the most common soft tissue tumor seen in approximately 2% of the population. 

Pediatric lipomas of the intestine are rare. They are frequently found in the submucosa of the large intestine, and more likely to be on the right side of the colon. Most lipomas are asymptomatic - those that do cause symptoms are likely to exceed 2 cm in diameter. Our case demonstrates an 11.5 cm size lesion with mass effect on surrounding tissues.

Pathology Comment: The lesion consisted of mature fat with large areas of hyalinized fibrous tissue. Occasional vacuolated adipocytes were noted but definitive lipoblasts were not seen. Patchy ischemic change noted, raising the possibility of torsion of the mass. Patchy acute inflammation also noted. This mature lipomatous lesion with evidence of areas of infarction was a pedunculated mass attached to the sigmoid colon (via a thin, fatty, twisted stalk) . Lipomas of the serosal surface of the colon are very rare, but submucosal and subserosal lipomas that can prolapse onto the serosal surface do occur.
 
Case References
  1. https://radiopaedia.org/articles/lipoma
  2. Infarction of a Caecal Lipoma Simulating Appendicitis (The Ulster Medical Journal, Volume 54, No. 2, pp. 211 – 213) D G Mudd, A Rajavi, Joan M Alderdice https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2448118/pdf/ulstermedj00091-0131.pdf

 
Follow Up Exploratory laparotomy with resection of pelvic mass. Patient performed well after surgery, follow-up uneventful.
 
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