In our case, the patient despite the expulsed tumor underwent laparotomy and right hemicolectomy because of the presence of multiple ulcers and lipomas observed in the ascending colon at colonoscopy which followed the mass expulsion. Diagnosis Diagnosis of intestinal lipoma, if not accidental, is usually established during surgery for possible intestinal

cancer or for treatment of lipoma complications [25, 26]. In barium enema, an ovoid, well delineated, smooth and radiolucent mass is usually observed. The size and the shape of the mass may be changed with bowel movements with the elongation of the mass Savolitinib being the foremost appearance (“”squeeze sign”") [8]. In most cases, typical signs of intramular, extramucosal tumors are usually observed with a markely greater radiolucency because of the adipose tissue presence [13]. Diagnosis is achieved in less than 20% of cases [7]. Computed tomography will also show a spherical, ovoid, pear shaped mass with sharp margins with density of -40 to -120 Housfield units in uncomplicated cases [7, 25]. In cases however with intusucception atypical imaging appearance may be encountered [31]. In colonoscopy,

a normal lipoma may be visualized and therefore establish the diagnosis [26]. In more atypical cases, different observations may cause suspicion of the diagnosis [31]; the elevation of the mucosa over the mass with forceps (“”tent PD98059 datasheet sign”"), the indentation of the lipoma with forceps (“”cushion sign”")

or fat extrusion after biopsy (“”naked fat sign”"). Colonoscopy apart from diagnosis can provide a treatment modality especially in small lipomas less than 2 cm in diameter [6, 7, 25, 26]. However, different approaches concerning the removal of the lipoma involve IMP dehydrogenase either the use of diathermia by which the stalk vessels can be thrombosed [26] or use of clips or loops [25, 26]. The fact that fat is an inefficient electric current conductor and consequently hemorrhage may evolve should always be considered [7]. Additionally, the possibility of perforation seems to rise during colonoscopy and again should be considered [26]. Nevertheless, some authors believe that diagnosis is not eventually established because since lipomas are submucosal the biopsy performed will not involve tissue originating from deeper tissues [7]. MRI may provide additionally information but is not yet considered as a potential diagnosis AZD6738 molecular weight indicator [7, 25, 26]. Despite all imaging modalities preoperative diagnosis is established in 62% of patients [32]. Histopathology In histopathology, mature and adult fat cells with lipoblasts surrounded by a fibrous capsule are usually observed [7]. “”Pseudo-malignant”" features may also be observed without however sarcomatous changes which are due to intermittent torsion and ischemia of the lesion [26].